Connect
time to decide and I'm stuck....
PSA: 9 ng/mL
Prostate size: about 30 cc (MRI 3.3 × 4.2 × 4.1 cm)
Gleason score:
One core: 3 + 4 = 7 (Grade Group 2, favorable intermediate risk)
Seven cores: 3 + 3 = 6 (Grade Group 1, low risk)
Positive cores: 8 of 12
I'm considered favorable-intermediate risk, I have the option of radiation (inter or external) and surgery. I think I've reached the point of information overload. The RO called and wanted to proceed after reviewing my PET and MRI. I told them I need some time. I like the idea of eliminating the cancer by getting the prostrate removed, I'm not looking forward to staying in the hospital, going under the knife, wearing a catheter for a week, and when the doc said he was gonna pull back (my little friend, lol!) that gave me some pasue as well.
I've reached an impasse. while I like the idea of getting rid of the prostrate to get rid of the cancer, with surgery, but the physical side effects don't appeal to me. Radiation is appealing but I do fear the long-term effects.
This is what understand
surgery: immediate side effects
radiation: gradual long-term effect develop over time.
Is it safe to say regardless of the treatment it come down to do I want to physical side effects up front or roll the dice that I may not develop long term effects due to radiation exposure.
how did you decide?
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
A pivotal factor for me was my MRI report's identification of a lesion as touching the edge of my prostate gland. I decided on SBRT radiation because I was concerned about possible microscopic extension of the PCa moving outside the prostate gland.
Stated differently, if microscopic PCa extension already occurred outside of my prostate, then surgery would not cure me. This made the SBRT radiation decision an easy one.
@heavyphil Erring on the side of caution is worthwhile.
To paraphrase from Falstaff in Shakespeare’s King Henry 4th, Part 1 - “Discretion is the better part of valor.” (Caution is preferable to rash bravery.)
-
Like -
Helpful -
Hug
4 Reactions@kujhawk1978 I am in the verge of going to Sarasota and having Dr Scionti do Tulsa Pro. His website reviews are fabulous. I am 69, Gleason 3+4, contained, PSMA clear. Does anyone know why Tulsa Pro is not recognized by NCCN? I went to their website, and no mention. Also Walsh’s book does not mention it. Mayo Jacksonville offers Tulsa along with every other option. I tried to make an appointment but first available is December 15. How do they decide which therapy is appropriate??
@brianjarvis Falstaff was likely referring to Ozempic rather than to ADT.
-
Like -
Helpful -
Hug
2 Reactions@brianjarvis My Gleason is 4+3, like yours. I just had an ArteraAI test, recently approved by NCCN, and it indicated that ADT would NOT improve my chances of a successful outcome in any significant way. In other words, it would be a waste of time, resources, and hot flashes to add ADT therapy. I would have forgone radiation just to avoid ADT, but now that is not a concern. Almost makes my decision harder...now I'm truly between RP and RT.
@ksellers3
They decide based on how aggressive your cancer is and how much it has spread. It seems that people with lower Gleason scores, and where the cancer is isolated to the prostate and not all over the prostate are more likely to be candidates for Tulsa pro.
It sounds like you would be a good candidate.
It is approved by the FDA. The NCCN requires longer-term data to include a treatment.
-
Like -
Helpful -
Hug
1 Reaction@jesse65
Do you have any IDC or cribriform glands in you pathology report ?
If yes, according to some research papers and according to both RO and the urologist that my husband saw, RP might give you better chance for PC eradication.
-
Like -
Helpful -
Hug
1 Reaction@jeffmarc
I agree. We had consult. for TULSA at Stanford and even though my husband was unfavorable 7 , he would have been a good candidate IF his lesion was closer to urethra. It was on periphery and in that case heat does not work well.
So yes, there are certain requirements for TULSA to work properly.
-
Like -
Helpful -
Hug
2 Reactions@jesse65 So, with success rates comparing surgery with radiation being statistically equivalent no matter what treatment chosen (https://www.nejm.org/doi/full/10.1056/NEJMoa2214122), looks like your decision goes back to just side-effects and quality-of-life (or as that paper concludes, “… the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.”).
@ksellers3
I do not have the experience to answer your questions about Tulsa Pro and NCCC, Walsh
As to "how go they decide which therapy is appropriate...?"
That answer is as I and others have said, starts with the science, the clinical data and the guidelines.
After that, a lot of variables in play, mostly data emerging from clinical trials that is working it's way into mainstream clinical practice but because of the NCCN process which is rigorous and requires a longer time, are not yet part of the guidelines.
How do they decide...the better question to ask may be how do you decide with the support of your medical team..?
The latter requires you to do the homework, know the terminology, definitions, and take advantage of patient centric resources that organizations such as PCRi, PCF and others work do tirelessly to make available.
The support of your medical team is their training, education and experience.
There is a shared decision making model that depending on you and your medical team's personalities may be best suited for decision making in a complex environment where there are many variables.
Of the four treatment decisions I've had to make, two have been based on the clinical data and the NCCN guidelines, they ultimately were "unsuccessful." The other two were based on the clinical data but we parted ways with the NCCN guidelines and leaned more to the data from clinical trials. Even then, we modified the final treatment decision.
Kevin
-
Like -
Helpful -
Hug
1 Reaction