Overtreatment of Prostate Cancer

I'm at the other end of the spectrum because my PC wasn't discovered until stage 4, when it had already metastasised to my spine. In the past, the treatment emphasis for stage 4 was always palliative (minimal intervention, manage pain, help quality of life), but recently there's been a push to treat oligometastatic cancers (< 4–5 metastatses) with curative rather than palliative intent. My onco team was already on top of that — thankfully, my city's cancer centre is associated with a research university, and is on top of the latest thinking — but once I understood what was happening, I encouraged it. I requested and received a full curative-intent dose of radiation (SBRT) to my prostate, knowing that it might cause complications, because I'm relatively young (56 at diagnosis; 58 now) and wanted to give myself the best chance possible. In the end, I did experience benign radiation damage to the bottom of my bladder, and it's been a bit of a challenge pain and lifestyle-wise, but my quality of life is good and I have no regrets about going for the max treatment in my particular case. Even if it doesn't work out, my family will know that I left no reasonable stone unturned.

It appears you made appropriate decisions and I hope you reap benefits from the treatment you’re receiving. It sounds like you already have. My concern about overtreatment would be generally at an earlier stage when a diagnosis of Gleason 7 (3+4) favorable is made. That seems to be the level that’s unclear as to treatment or surveillance. Many people at that stage do opt for treatment, even RP, because they don’t like the idea of having any cancer in their body. If that’s their preference, then I’m all for them doing it. It’s very much an individual decision in cooperation with one’s urologist and oncologist. Wishing you much success on your journey.

You are on the right track. Occasionally people will say they are doing AS but in reality they are denying the situation, ignoring the lead time for readiness, and acting like the PCa will disappear. At your age and condition I think you are well positioned to do AS and also plan, adjust and be comfortable with the road ahead. There is much to learn, it's like owning a home... you need not be an expert at all trades, but at some point you'll need to talk the talk and walk where needed. Keep the faith!

When did you learn you had bladder damag?How was it diagnosed.I am getting ready for third sbrt and am urinating 6 times per night.Having trouble keeping bladder full and rectum empty.Took miralax last night and still have not had bm,

I was diagnosed with localized PC, (determined by a CT and bone scan), having a PSA of 11 and a Gleason of 9, in March. I went on Firmagon for 3 months, in July I got a 6 month shot of Eligard and began a 30 session stint of IMRT finishing this past October. The plan for the future is to keep me on Eligard for 12 months beginning in February.

I have been monitoring this site for about 3 months and one thing I have come away with is there are numerous paths one can take to treat their cancer. My path began by finding a urologist associated with my hospital network I did little research other than reading his short online resume. The main reason I initially went with him is his 20+ years treating PC. When selecting my oncologist I was directed, by my doctor, to the radiology clinic used by the hospital who then assigned me a doctor. I did do some research on the Internet finding he too had many years treating PC.

I have put my health into these two doctors' hands having complete confidence in their approach to my treatment. I never considered getting multiple opinions on different treatment options in part because I think I would be overloaded with too much information possibly suggesting different options. Perhaps I am not smart enough to sift through different options allowing me to be the ultimate decider. To me it was more personal, responding to the doctors' demeanor, that allowed me to put my health into their hands accepting their approach in my treatment.

I had SBRT #4 on Tuesday, and I am going for #5 in 2 hours and 45 minutes ( but who's counting....). Yesterday I had a minimal extra urge to pee, today no symptoms. As far as bowels go no symptoms there. I am on Flomax and pee once a night. I also had a Barrigel spacer placed and my RO is using a urethra sparing technique where the urethra receives no "hot spots" (read doses higher than the whole prostate dose
of 7.25 Gy per fraction.) Additionally I am getting a focal boost at the main lesion to 40 Gy. I am 68, one 4+3, one 3+3, PSMA shows confined to prostate, Decipher high at .84, PSA 7.8.
My prep includes two Dulcolax the night before, and an enema 2 hours before.

Stay Strong Brother.

I discovered the bladder damage a year later though a cystoscopy. That's also unusual, but not unheard of (usually any problems emerge a few weeks after radiation therapy and clear up in a few months). It's not serious— just at the very bottom of the bladder— but it gave me a rough time over the summer after a UTI aggravated it. It's not bothering me much now.

The uretha sparing sounds good.My radiation oncologist said he did not reduce radiation around uretha as some cancer could be missed.Had 4th sbrt today and he said all went well.Showed me how planning had been set up and images of spacer and fudiciary markers.Starting flomax tonight.Urinated 7 times last night.I have been using Mirolax.Think I will try Ducolax. Thanks and you stay strong also Brother.

Sounds good. While the radiation is not reduced in my case "urethral steering" apparently has a benefit in regard to GU toxicity.

#5 went great today. Got home, took a 3 mile walk, an hour nap, and it's time for dinner. Hope to hit the gym in the morning.

One more for you to go vshirely.....you absolutely got this.

I completely agree with your comments. Every individual is unique in their level of risk acceptance and in their desire to obtain information regarding possible treatment options of their particular PCa situation.

I was also diagnosed with 3+3 and very low level 3+4 PCa, in mid-October.

I am still in the initial stages of my first response…confirm…confirm…confirm.

I’m awaiting the report of a 2nd opinion, regarding the pathology of the biopsy, and a Decipher score.

While waiting, I’ve started what I call an “aggressive active surveillance” program.

I immediately began a PCa targeted plant based diet and doubled my exercise routine, upto 180 minutes/week of vigorous/moderate heart rate activities.

These changes have caused me to lose 15lbs in two months and have already provided significant beneficial side effects (no more shoulder inflammation pain, lowest cholesterol and Cholesterol/HDL levels in 38 years and no need for the CPAP machine I have used for 17 years.

The best thing is that I enjoy my new diet/exercise regiment and plan to make it a permanent lifestyle change, regardless of what I may decide regarding future PCa treatments.

I am also investigating Integrative Oncology and will definitely pursue an individualized integrative medicine approach; should my “aggressive active surveillance” require additional action.