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!

@johalla

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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This is new procedure for me. I'd be interested in how it works out for you.

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Being that he has had several surgeries and his age I would avoid surgeries and choose the radiation. I had 44 proton treatments at Mayo in Scottsdale, with the 6 month Eligard shot and no SpaceOAR. There is a new alternative to the Eligard shot which is a pill with much less side effects. I am 79 and my urologist told me that his experience with surgeries and older people hasn’t been too good. My GS was 7(3+4). I also had a Decifer genetics test that was worthwhile. Good luck in choosing. Jim

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As a result of psa in the .27 range for last 3 months, all my doctors (3 surgeons and 2 radiation oncologists), have recommended 3months on orogovyx( a new adt oral pill) and 36 radiation treatments. I have agreed to this starting tomorrow. What does the group think of this approach.

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@wrig1jam

Being that he has had several surgeries and his age I would avoid surgeries and choose the radiation. I had 44 proton treatments at Mayo in Scottsdale, with the 6 month Eligard shot and no SpaceOAR. There is a new alternative to the Eligard shot which is a pill with much less side effects. I am 79 and my urologist told me that his experience with surgeries and older people hasn’t been too good. My GS was 7(3+4). I also had a Decifer genetics test that was worthwhile. Good luck in choosing. Jim

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Jim can you let me know what this pill is. I am on Lupron and I want to take a holiday from it. Thanks

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@itterac

As a result of psa in the .27 range for last 3 months, all my doctors (3 surgeons and 2 radiation oncologists), have recommended 3months on orogovyx( a new adt oral pill) and 36 radiation treatments. I have agreed to this starting tomorrow. What does the group think of this approach.

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I do not understand why you are taking a treatment approach like what you have described when your PSA is .24. I think you should talk with your urologist and consider active surveillance and what he your PSA every 3 months. I believe you could go many years before needing radiation and they may likely have something much better in 5 years. Once you do radiation you don’t have many alternatives. I would consider FLA it could possibly buy you 5-10 years then you make another treatment decision.

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@semeon

Jim can you let me know what this pill is. I am on Lupron and I want to take a holiday from it. Thanks

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Orogoyvx, as interactive mentioned

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First, you need to find out if you have a slow growing or fast growing cancer. Your PSA should tell you. If it goes considerably higher or if it increases at a very fast pace, then choose a treatment/ Otherwise do active surveillance. My Gleason score was a 4+3 seven. I had an enlarged prostate so I chose removal. My cancer jumped to my lymph nodes so I did 44 photon radiation treatments and two years of Lupron injections. I have no energy or muscle. My libido is gone. I wear a depends and have to urinate often. I get very little sleep. I was a healthy 72 year old when it was discovered. I am now 75 with a body that does not work very well. The good news is I am still alive.

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@wrig1jam

Orogoyvx, as interactive mentioned

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new lupron substitute approved my fda 12/20 works faster and better than lupron w lesser side effects

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@ken1946

First, you need to find out if you have a slow growing or fast growing cancer. Your PSA should tell you. If it goes considerably higher or if it increases at a very fast pace, then choose a treatment/ Otherwise do active surveillance. My Gleason score was a 4+3 seven. I had an enlarged prostate so I chose removal. My cancer jumped to my lymph nodes so I did 44 photon radiation treatments and two years of Lupron injections. I have no energy or muscle. My libido is gone. I wear a depends and have to urinate often. I get very little sleep. I was a healthy 72 year old when it was discovered. I am now 75 with a body that does not work very well. The good news is I am still alive.

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4 surgeon and two rdition oncologists all recommended this course. i did 6 consults. 5/4/21 pet scan was neg they said its more effective when done early. still think i should wait

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Here is more information on Orgovyx (relugolix)
– FDA Approves First Oral Hormone Therapy for Treating Advanced Prostate Cancer (Dec 2020) https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-hormone-therapy-treating-advanced-prostate-cancer
https://www.mayoclinic.org/drugs-supplements/relugolix-oral-route/description/drg-20506394

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A PSA of .24 may not constitute a reason to initiate treatment. What may be useful is additional PSA tests which would provide clinical data of continued progression, calculation of doubling and velocity and imagining with recently approved FDA PMSA scans which could locate the recurrence, these imaging tests can locate recurrence below .5 though as PSA increases, so does the their ability to locate the recurrence. .5 is considered a good "trigger" to image.

Informed by additional clinical data, you can then make a decision, treat, continue to actively monitor with decision points when to initiate treatment and with what.
https://www.mskcc.org/news/finding-hidden-cancer-cells-fda-approval-new-imaging-tool-could-transform-treatment-decisions-advanced-prostate
Kevin
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@itterac

As a result of psa in the .27 range for last 3 months, all my doctors (3 surgeons and 2 radiation oncologists), have recommended 3months on orogovyx( a new adt oral pill) and 36 radiation treatments. I have agreed to this starting tomorrow. What does the group think of this approach.

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With PSA of .27, why do anything but AS

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