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Ductal prostate cancer: Radiation + hormone therapy or surgery?
I’m looking for advice from anyone who has or has or has had DUCTAL prostate cancer because it is a rare and aggressive type. I’m an active 71 year-old who was just diagnosed with ductal prostate cancer, a rare and aggressive cancer that spreads easily. PSMA scan showed no spread outside of the prostate. The surgeon recommends surgery because he says that leaves the option of radiation after surgery if needed, but that it is difficult/impossible to do surgery after radiation. He said there’s about a 50% chance of the cancer returning after surgery.
The radiation oncologist recommended radiation/hormone therapy for 18 months. He also said there’s 50% chance of reoccurrence/spreading, but that surgery has a 70 to 80% chance of reoccurrence. He also said the surgery wouldn’t be needed after radiation because they rarely see cancer return in the prostate because it usually spreads elsewhere in the body. But if it were in the prostate, he could do more radiation or cryotherapy. Anyone who has had ductal cancer would you please give your input? I need to make a decision soon.
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@chipe Hi. Thank you for your comment. My husband had a similar experience. At 51 had a Gleason of 10. Had his prostate removed and during surgery the surgeon said he could tell it had spread to the seminal vesicles. During surgery the surgeon removed 18 lymph nodes and after testing the cancer was found in one. He also had radiation therapy for 33 days and then was on ADT for two years. His doctor wanted to hit his cancer with every single defense.
How are you doing now? Are you done with your ADT therapy? How long has it been since you were first diagnosed?
My husband has been off of ADT for one year and five months.
Thank you.
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5 ReactionsFor what it's worth, I had an RARP with pathology confirming Gleason 9, intraductal carcinoma with extraprostatic extension and cribriform present. My surgeon said micrometastases was nearly guaranteed and sure enough, my 1st followup PSA confirms reoccurance. You can't know for sure what is going to happen but all you can do is follow the numbers. Numerous studies clearly indicate that high Gleason score, intraductal carcinoma, and cribriform cell patterns all significantly increase the probability of reoccurance, future matastisis, and castration resistance.
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3 ReactionsHi!
I was diagnosed just this past July, had my RARP in September and start ADT/Radiation in January. I don't want to give it a chance to gain a foothold again. Thank you for sharing your hubby's story! It is encouraging.
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2 ReactionsBiochemical recurrence
Did your PSA immediately go up after your RARP? Did you have a PSMA PET scan that shows where the cancer is?
Biochemical Relapse - the cancer’s back
Gleason eight is aggressive. Along with the ductal cancer issue You really need to do something soon to prevent it getting out of the prostate. Have you spoken to more than one urologist about having surgery? I’m not so sure about the radiation oncologist telling you that the chance of recurrence is so much higher with surgery. Surgery will completely remove the issue and you can then have salvage radiation if needed.
You might want to consult with an oncologist about this?
Are you at a center of excellence? You are a prime case for needing a top notch group of doctors to give you advice. Is there a mayo clinic near you?
Another thing I could recommend is going to an Ancan.org meeting and getting advice from the people there. they’ve been helping people with prostate cancer for 15 years and there’s always at least three doctors at the meetings. the next one is next Tuesday. You could go to the website and sign up and come to the meeting, being new they would talk to you first, and they would give you advice based on many years of experience with treatments for people with prostate cancer. You should find a center of excellence to advise on treatment as well.
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5 ReactionsI have only had the opportunity to have 1 psa test after surgery, and it came back undetectable. I did have a PSMA PET scan before surgery.