How to choose treatment for prostate cancer?

Posted by irishpat70 @irishpat70, Apr 15 8:54pm

It is too difficult for my husband to decide on treatment for Prostate Cancer. We have sought 2 different opinions from 2 good healthcare systems. We have met with a radiologist and surgeon from each and they all say he falls right in the middle to choose either treatment type. I would like to present his stats and find out if anyone can help. He is 71 years old and had quad bypass surgery 10 years ago. He has a knee and hip replaced but otherwise does quite well. His Gleason score is 3+4=7. Removal was his initial reaction but was presented with more possible side effects than radiation. The radiation choices are very different, One is hormone shots, radiation 5 days a week for 6 weeks. The other is so different with 5 total rad treatments and uses some different prep procedures. There would be more prep to avoid rectum damage and gold markers placed to help exact rad placement. How in the world do we know what is best? We are not doctors and know doctors are not gods but should know far more than we do! At least to point toward one option or the other based on past patient outcomes. I just wish I could help him more. Thanking you in advance for your input!

@colleenyoung

@irishpat70, just checking in. How are you and your husband doing?

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Thank you everyone for your input. Information is what we value right now. We saw another surgeon and radiologist from another health concern here. We are fortunate to be located where there is a lot avaliable to us. My husband decided on removal by the second surgeon we saw and that is now what is being planned. We have decided weighing all we've learned that this is best for him. Having it removed will give him far more peace of mind. It sure is a tough decision and as with all things the amount of information overwhelming. We know whatever choice is made is to do your due diligence and then make peace with your decision. I can now only support his choice and move forward with being as helpful as possible. Again, thank you for all! I will let you know how thing go. His surgery is scheduled for May 18. God Bless!

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@irishpat70

Thank you everyone for your input. Information is what we value right now. We saw another surgeon and radiologist from another health concern here. We are fortunate to be located where there is a lot avaliable to us. My husband decided on removal by the second surgeon we saw and that is now what is being planned. We have decided weighing all we've learned that this is best for him. Having it removed will give him far more peace of mind. It sure is a tough decision and as with all things the amount of information overwhelming. We know whatever choice is made is to do your due diligence and then make peace with your decision. I can now only support his choice and move forward with being as helpful as possible. Again, thank you for all! I will let you know how thing go. His surgery is scheduled for May 18. God Bless!

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@irishpat70, one step at a time. And we're here to walk the path with you. When will he have surgery?

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@irishpat70

Thank you everyone for your input. Information is what we value right now. We saw another surgeon and radiologist from another health concern here. We are fortunate to be located where there is a lot avaliable to us. My husband decided on removal by the second surgeon we saw and that is now what is being planned. We have decided weighing all we've learned that this is best for him. Having it removed will give him far more peace of mind. It sure is a tough decision and as with all things the amount of information overwhelming. We know whatever choice is made is to do your due diligence and then make peace with your decision. I can now only support his choice and move forward with being as helpful as possible. Again, thank you for all! I will let you know how thing go. His surgery is scheduled for May 18. God Bless!

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Wishing you guys the very best, a speedy recovery and much sunshine on your journey together.

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@sanway

Wishing you guys the very best, a speedy recovery and much sunshine on your journey together.

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I was 72 when I was diagnosed. I chose removal as I had an enlarged prostate causing urination problems. It did not get it all and had jumped to my lymph nodes. I then did 44 radiation treatments and two years of Lupron injections. This has held cancer at bay. I do not have any muscle or energy. I am in a constant state of fatigue, I have no libido. My private parts have all shrunk. My red blood cells are low and I am anemic, I am stage IV aggressive malignant neoplasm of prostate Gleason 4+3 = 7. Good luck with your decision.

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I was recently diagnosed and have a few biopsy samples at Gleason score 3+4 some less and at least 1 at 4+3. After talking to 2 different Oncologists at the same institute I am a bit torn about what treatment path to take.

After seeing the side effect list for Hormone therapy I say definitely not for me. The only decision is do I go for the LDR treatment of 5 weeks followed up by a 1 time HDR or go with a longer LDR only? One of my Oncologists basically said there's not enough data to say for sure that doing the combo deal is all that more effective at this point. Given the procedure details with the catheters and being put under and some possible bad side effects. I am on the fence. The other doctor was definitely pushing towards the combo. I would RATHER just do the LDR but I don't want to screw myself over either.

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@johalla

I was recently diagnosed and have a few biopsy samples at Gleason score 3+4 some less and at least 1 at 4+3. After talking to 2 different Oncologists at the same institute I am a bit torn about what treatment path to take.

After seeing the side effect list for Hormone therapy I say definitely not for me. The only decision is do I go for the LDR treatment of 5 weeks followed up by a 1 time HDR or go with a longer LDR only? One of my Oncologists basically said there's not enough data to say for sure that doing the combo deal is all that more effective at this point. Given the procedure details with the catheters and being put under and some possible bad side effects. I am on the fence. The other doctor was definitely pushing towards the combo. I would RATHER just do the LDR but I don't want to screw myself over either.

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Hi @johalla, welcome to the Prostate Cancer group. Deciding on treatment is a cross-road all men face when dealing with prostate cancer. It is the subject of many discussions in this group. For that reason, I moved your question to this existing discussion called "How to choose treatment for prostate cancer?" started by @irishpat70.

You may also be interested in these related discussions:
– Prostate cancer: What treatments did you choose? Results? https://connect.mayoclinic.org/discussion/prostate-cancer-4/
– Anyone had the 5 treatment proton therapy for prostate cancer? https://connect.mayoclinic.org/discussion/anyone-had-the-5-treatment-proton-therapy-for-prostate-cancer/

I'm confident that members like @ken82 @assad4zamani @dandl48 @cmartin65 @waynen and others can share their radiation choices and experiences with you.

Johalla, what criteria are making you tend towards Low-dose-rate (LDR) brachytherapy?

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@colleenyoung

Hi @johalla, welcome to the Prostate Cancer group. Deciding on treatment is a cross-road all men face when dealing with prostate cancer. It is the subject of many discussions in this group. For that reason, I moved your question to this existing discussion called "How to choose treatment for prostate cancer?" started by @irishpat70.

You may also be interested in these related discussions:
– Prostate cancer: What treatments did you choose? Results? https://connect.mayoclinic.org/discussion/prostate-cancer-4/
– Anyone had the 5 treatment proton therapy for prostate cancer? https://connect.mayoclinic.org/discussion/anyone-had-the-5-treatment-proton-therapy-for-prostate-cancer/

I'm confident that members like @ken82 @assad4zamani @dandl48 @cmartin65 @waynen and others can share their radiation choices and experiences with you.

Johalla, what criteria are making you tend towards Low-dose-rate (LDR) brachytherapy?

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Well the LDR is a given. The question really is do I want to shorten that a little and do an HDR after or just do more LDR and no HDR at all.

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@johalla

I was recently diagnosed and have a few biopsy samples at Gleason score 3+4 some less and at least 1 at 4+3. After talking to 2 different Oncologists at the same institute I am a bit torn about what treatment path to take.

After seeing the side effect list for Hormone therapy I say definitely not for me. The only decision is do I go for the LDR treatment of 5 weeks followed up by a 1 time HDR or go with a longer LDR only? One of my Oncologists basically said there's not enough data to say for sure that doing the combo deal is all that more effective at this point. Given the procedure details with the catheters and being put under and some possible bad side effects. I am on the fence. The other doctor was definitely pushing towards the combo. I would RATHER just do the LDR but I don't want to screw myself over either.

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I can't advise you on your question, since it wasn't my form of treatment. I had 20 doses of proton beam therapy. I didn't have any reaction to the therapy until after my 5th treatment when I had some pain during urination. I don't think one treatment would have an effect. What I don't understand is that you said a one time HDR. There's a fair amount of prep for the HDR, if they are talking about either Photon or Proton radiation. You have to know the size and location of the prostrate and be able to aim the radiation precisely at the target. Also, they take turns radiating one side and then the other. Not sure how they would ensure that the whole prostrate would be covered. The LDR and HDR are very different types of treatment. It seems like they would do one or the other. By the way, the proton beam therapy is painless and takes less then a minute for each treatment. The only issue may be some urination pain that can be treated. I think the latest photon treatment is similar.
You mentioned that hormone therapy is out of the question. My Gleason score for my worst cancerous cells was 4+4. Yours would be considered medium risk and mine is high risk. Since mine was high risk my doctor at Mayo prescribed 3 shots of Lupron with my radiation treatment. My survival chances increased by 20% with the Lupron. Although you can get by without it, I think the research says it also improves the survival rate for your situation. The hormone therapy does have some side effects but they do go away and at least in my case were tolerable.

Best of luck with your decision. Ask a lot of questions and go with what you feel most comfortable with.

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@johalla

I was recently diagnosed and have a few biopsy samples at Gleason score 3+4 some less and at least 1 at 4+3. After talking to 2 different Oncologists at the same institute I am a bit torn about what treatment path to take.

After seeing the side effect list for Hormone therapy I say definitely not for me. The only decision is do I go for the LDR treatment of 5 weeks followed up by a 1 time HDR or go with a longer LDR only? One of my Oncologists basically said there's not enough data to say for sure that doing the combo deal is all that more effective at this point. Given the procedure details with the catheters and being put under and some possible bad side effects. I am on the fence. The other doctor was definitely pushing towards the combo. I would RATHER just do the LDR but I don't want to screw myself over either.

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I went through the same thing in 2014 as I did not like the optioned the urologist and oncologist gave me so I researched while researching about 3 months I did 12 hyperbaric treatments and about 48 high dose vitamin C via IV after this I decided on Focal Laser Ablation at the Sperling Prostate Clinic in Florida. You can talk with them and send them your medical info and will let you know if you are a good candidate. I am taking Lupron now and will be off it in one month and I maintain myself also by using marajuana oil (Phoenix tears) you can look up the protocol on the net search Rick Simpson Oil. I take it in the evening and sleep solid through the night with no wake ups. It’s up to you but worth I vestigating.

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I know what you mean as I went through the same thing in 2014. I almost decided on brac therapy (radiated seeds placed in you) but when I told him I wanted to delay since my grandson was coming to visit. He then told me that I could not have children near me because of the radiation. So then I asked him well what will the radiation do to my other organs and his response was “there is a 95% chance we cure your cancer” my response was I don’t care about my cancer if you damage my heart, lungs, liver or kidneys. Then I told him I was not proceeding and started my research.

I decided on Focal Laser Ablation with the Sperling prostate Clinic in Florida. You may want to look into that they are very accommodating. They were the only people that actually came back with 3 references of patients I could talk to. My first treatment I did not have a catheter procedure was simple, next day I was in the swimming pool having a drink. About 4 years later I had another treatment (at no cost) and that was more intense and I did have a catheter for 5 days.

If your husband would like to talk to me I am open to that. Please send me a private message and I will share my email address. I live in Canada.

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@waynen

I can't advise you on your question, since it wasn't my form of treatment. I had 20 doses of proton beam therapy. I didn't have any reaction to the therapy until after my 5th treatment when I had some pain during urination. I don't think one treatment would have an effect. What I don't understand is that you said a one time HDR. There's a fair amount of prep for the HDR, if they are talking about either Photon or Proton radiation. You have to know the size and location of the prostrate and be able to aim the radiation precisely at the target. Also, they take turns radiating one side and then the other. Not sure how they would ensure that the whole prostrate would be covered. The LDR and HDR are very different types of treatment. It seems like they would do one or the other. By the way, the proton beam therapy is painless and takes less then a minute for each treatment. The only issue may be some urination pain that can be treated. I think the latest photon treatment is similar.
You mentioned that hormone therapy is out of the question. My Gleason score for my worst cancerous cells was 4+4. Yours would be considered medium risk and mine is high risk. Since mine was high risk my doctor at Mayo prescribed 3 shots of Lupron with my radiation treatment. My survival chances increased by 20% with the Lupron. Although you can get by without it, I think the research says it also improves the survival rate for your situation. The hormone therapy does have some side effects but they do go away and at least in my case were tolerable.

Best of luck with your decision. Ask a lot of questions and go with what you feel most comfortable with.

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The LDR is a 5 – 8 week, 5 days a week treatment. It's not Proton though. One of the Oncologists is recommending that I do the shorter 5 week LDR and then do the newer version of the HDR where you are put under and these long catheters are inserted through the skin into the prostate at several points. Then they wake you and take you elsewhere and at a certain point they hook you up to this machine that introduces temporary high dose radioactive seeds (not permanent) directly into the Prostate.

There are so many side effects, not to mention the invasiveness of the procedure, that I am considering just telling them I would rather go with the longer term LDR alone.

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@semeon

I know what you mean as I went through the same thing in 2014. I almost decided on brac therapy (radiated seeds placed in you) but when I told him I wanted to delay since my grandson was coming to visit. He then told me that I could not have children near me because of the radiation. So then I asked him well what will the radiation do to my other organs and his response was “there is a 95% chance we cure your cancer” my response was I don’t care about my cancer if you damage my heart, lungs, liver or kidneys. Then I told him I was not proceeding and started my research.

I decided on Focal Laser Ablation with the Sperling prostate Clinic in Florida. You may want to look into that they are very accommodating. They were the only people that actually came back with 3 references of patients I could talk to. My first treatment I did not have a catheter procedure was simple, next day I was in the swimming pool having a drink. About 4 years later I had another treatment (at no cost) and that was more intense and I did have a catheter for 5 days.

If your husband would like to talk to me I am open to that. Please send me a private message and I will share my email address. I live in Canada.

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Hi @semeon please note that I removed your email address. We recommend that you use private message to share personal contact information to protect yourself from getting unwanted spam.

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