Where to draw the line between active surveillance, removal, radiation

Posted by robo45vt @robo45vt, Dec 17, 2023

Where do you draw the line between active surveillance and removal or radiation? Gleason 3+3, 4 cores positive out of 12 in biopsy. No more biopsy s due to two infections, UTI and CDiff from one antibiotic. Does radiation work better with a lower Gleason score? Lesion contained to prostate from two MRI s. Size is 2.7 CM. Worried about removal, wearing a bag, and getting infection from hospital. CDiff infection. Thank you,
Robo

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@hammer101

Robo, there is a lot of great advice previously mentioned. Given your relatively young age of 64 and being healthy, I would lean toward a more aggressive treatment plan. For me, active surveillance would off the table. When I was diagnosed with PC last September, I was praying the biopsy would come back 3/3. Fortunately, my prostate cancer was confined to the prostate (as far as any doctor can say), but Gleason Score was 4/3. I elected for surgery because I wanted the best chance for 30+ years of prostate cancer free life (obviously, no treatment will guarantee this outcome). Surgery allows for a complete biopsy of the prostate, seminal vesicles, and any lymph nodes that were removed. For myself, this was very important. I did not want to rely on imperfect imaging tools and biopsies to direct the treatment. Rather, I wanted to remove all known cancer from my body and have the margins physically defined. Also, given my age (56), I did not want to deal with the potential side effects of radiation and the inability/difficulty to perform a radical prostatectomy after radiation. For myself, the surgery was not that bad, with the worse part being the 1 week long catheter experience and the referred shoulder pain that lasted about a week. Outcome for me - Cancer confined to prostate, PSA undetectable 1 year out from surgery (praying this will continue for 30 more years). With surgery or any other treatment plan, you definitely want to go to a center of excellence - Your quality of life, for the rest of your life, will depend on the competence of the surgeon/oncologist/...

I agree with the other posts, don't let anyone tell you there is only one treatment plan. Every man and his situation is unique and you need to make the decision for your personal life expectations.

Best of luck with your decision.

Have a merry Christmas and a happy/healthy new year!!

Jim

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Thanks I appreciate that. I am kinda leaning toward surgery. I think in the long run that is the best option. Just not looking forward to catheter and recovery.

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@robo45vt

Thanks I appreciate that. I am kinda leaning toward surgery. I think in the long run that is the best option. Just not looking forward to catheter and recovery.

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Given your age and good health, I completely agree. I found the surgical pain to be very minimal. The catheter is horrible, but it is only for 1 week. Referred shoulder pain for myself was an issue, but only when standing or sitting up for about 5-6 days. After that, it went away. I was not concerned about erectile function implications, but after a year, I am back to pre-surgery erections. Continence was an issue for a few weeks, but got better rather quickly. I used an absorption pad on the mattress and wore a nighttime diaper for about 6 months out of caution. I probably could have stopped after 4 months, but wanted to make sure there were no issues.
I attribute my good recovery to the following:
1) Doing the surgery at a center of excellence and picking a doctor that has done thousands of radical prostatectomies and is an expert performing the robotic surgery. For myself, that was choosing Mayo-Rochester and Dr. Igor Frank. Amazing hospital, surgeon, and staff.
2) Good physical condition prior to surgery and positive attitude with recovery.
3) Following post surgery recovery process - i.e. performing Kegels, keeping active, etc.

If you chose a radical prostatectomy, good luck with the surgery!!

Jim

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@robo45vt

Thanks I appreciate that. I am kinda leaning toward surgery. I think in the long run that is the best option. Just not looking forward to catheter and recovery.

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Just as support, at 72 I recovered quickly and very well from my RP at Johns Hopkins.
Everyone is different, but, gratefully, I did not have continence problems. And my 10 days with the catheter went well and quickly.
Actually played 18 holes of golf 6 wks postop (w/ cart & I am not a hero).
Best tip: go to a couple of PT sessions for Kegel exercises before surgery; extremely helpful to me during recovery.
Best wishes for a successful outcome.

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@robo45vt

Thanks. I ll look into it. I live in Vermont. Not sure if they offer the proton beam therapy here. Meeting radiation doctor on 12/29

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Hopefully your not being treated at RRMC or under the treatment of the Bove Ficco group. It is worth the drive to Dartmouth Hitchcock to see a competent doctor.

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I/ Urologist waited to long. Four years on Active Surveillance then Radical prostatectomy that left me with impotence, incontinence and metastatic stage 4 cancer.
With what I now know I think I would have done early radiation.
Lots of videos on pcri.org.

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@narus

Hopefully your not being treated at RRMC or under the treatment of the Bove Ficco group. It is worth the drive to Dartmouth Hitchcock to see a competent doctor.

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I met a surgeon at UVMMC today. Dr King. Has done over 300 radical prostate removal. I feel pretty comfortable dealing with him. Meeting a radiologist next week

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Cancer found at age 75, High Gleason so almost immediately began a series of 23 radiation treatments and then Brachy Therapy, had a symptom free 5 1/2 years but now found cancer back in a couple of lymph nodes and PSA bouncing between almost 5 and 7. Of the 4 captions given me, (wait and see, targeted radiation, monthly chemo or quarterly chemo), I'm leaning toward Quarterly Chemo.
Any suggestions? I am the caregiver for my wife who is in Hospice and I can't be disabled to the point that I can't tend to the daily household routine, like meal prep.

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@ronc320403

Cancer found at age 75, High Gleason so almost immediately began a series of 23 radiation treatments and then Brachy Therapy, had a symptom free 5 1/2 years but now found cancer back in a couple of lymph nodes and PSA bouncing between almost 5 and 7. Of the 4 captions given me, (wait and see, targeted radiation, monthly chemo or quarterly chemo), I'm leaning toward Quarterly Chemo.
Any suggestions? I am the caregiver for my wife who is in Hospice and I can't be disabled to the point that I can't tend to the daily household routine, like meal prep.

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@ronc320403, Back when you had your treatments did you get a PSMA test? That would have shown in prostrate cancer has spread outside your prostrate.

You asked about being able to be a caregiver. I think it very important to talk to your oncologist about this and side affects. Some tolerate chemo very well and some don't. The targeted radiation should not cause any major side affects to keep you from being a care giver. I guess if you did both radiation and quarterly radiation you could attack if from two different options. But I am a layman not a doctor and advice should come from medical experts not us layman as our opinion are just what we would do for us not what is best for you.

If was me, and we are all different, so just my opinion if in your position I would chose the targeted radiation and chemo. Ensure you talk to the oncologist about being a care giver and what side affects you would get and make the best decison for you.

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Ronc, I also was a caregiver for my wife who had MS and was quadriplegic for some 15 years when I was diagnosed with PC.
When my RRAP was scheduled my role had to become just “being there” for her. Attacking the PC had to be the top priority so I could be the best caregiver possible. (We lost her just before my RP. But thanks to video chat our adult sons and I were with her just 2 hours before she passed quietly, peacefully.)
We found help for some daily chores through our local Area Agency on Aging (a national program managed locally). Hopefully you might benefit from them.
When she was in hospice we found they provided significant ‘wraparound’ help. Maybe they could assist in the daily chores if no AAonA?
My heart goes out to you. You are a hero to stay by your wife and provide her the best possible quality of life. So many folks can’t handle that responsibility.
Do your best taking care of her by taking care of yourself.
Blessings to you and God Speed.

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