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options for radiation with enlarged Prostate
I'm 72, diagnosed in Dec 25 with Gleason 8, Decipher.29 enlarged 77ml prostate, PSA was 6.2. Single small tumor no involvment/ contained per PSMA. I was having some urinary issues and was concerned enough about the outcomes after either Surgery or Radiation. I started on Orgovyx to buy some time to fix the enlarged prostate and decided on a PAE procedure that I just had on 3/27 at Mayo Rochester. The procedure went well and is painless. It took about 4 hours on the table. The procedure is starting to get popular but I haven't seen it mentioned on this site yet.
Hopefully, the shrinkage I get from the Orgovyx and the the PAE will help with urination and also offer a much smaller radiation target for my 5 SBRT treatments. They estimate the shrinkage could be 30-45%. My doctor says the reduced blood flow to the prostate will also impact/hinder the tumor growth some.
I have to wait for the prostate to settle down and radiation won't happen for 6-12 weeks. That was a concern, waiting that long with a G8 tumor. The Drs. were ok with it because the Orgovyx keeping it in check. I'll keep updating my outcomes as I move through this.
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I had PAE, it definitely helps shrink but it takes 6 months to fully do the job, but that is without added Orgovyx at same time. PAE is a piece of cake, for me it was as easy as it goes.
If you are near Mayo, they have just about every machine. Not sure I would opt for SBRT. They have proton, Brachy probably, maybe the Linac but probably just the Varian Truebeam or Varian Ethos, and not the MR Linac I think. But they have everything at Mayo so I would not go for SBRT if it were me. They also have other stuff too other than radiation. But of course a lot is skill on these machines, Mayo should have skilled people but who knows on any one machine. Good luck whatever you go with.
Even though you are a Gleason eight the Orgovyx Should really keep things under control. Prostate cancer grows very slowly, and the drug will stop it from growing and spreading.
If you have the prostate removed your urinary flow problem will probably be fixed. If you have radiation and have problems they still can do a TURP to clear out tissue that’s in the way. Gives you a couple of options at least.
Ask the doctor if they can spare the nerves if they do a prostatectomy. If they can do that, then you will usually Still have the ability to get an erection. Then you’re only issue is incontinence, which is almost always resolvable, but may take some time after surgery.
With radiation, a percentage of people lose the ability to get an erection after a few years since the nerves get burned, but the urinary issues are usually minor cases of proctitis fixed with Flomax.
The large prostate is not really a problem when it comes to radiation, And your isn’t that huge especially after the PAE.
@bjroc thanks
The plan now is proton Sbrt. I may be off on this but SBRT can use proton or photon
@dribbles
Yeah that sounds like worth the trip, maybe they have the Varian Probeam or something. Those are proton sbrt 5 sessions I think. Neat!