1. < Prostate Cancer

Radical prostatectomy (RP) vs radiation post age 70

Posted by milans @milans, Mar 28 9:02pm

I am considering options of RP vs radiation for Gleason 9 Stage 2b cancer without metastasis or extension. Surgery says I am a good candidate for surgery given my overall good health in spite of being 71 y.o. I am concerned about urinary incontinence post of long duration. Everyone I have talked to has not had problems but were much younger when they had surgery. Anyone with RP post 70 out there willing to share experience?

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kenpelan | @kenpelan | Mar 29 5:08pm

There is an app called Easy Kegel that takes the brainwork out of doing Kegels. Try it, use the free version. It has helped me.

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joecontheroad | @joecontheroad | Apr 1 10:10am
In reply to @bens1 "Milans: I had the same choices as you did. I chose a narrow margin, Radiation machine..." + (show)
@bens1

Milans: I had the same choices as you did. I chose a narrow margin, Radiation machine specifically with 2 mm margins to avoid over exposure to my healthy tissue. It had a built-in MRI so that what you could see is what you could treat with automatic shutoff and dynamic planning. Most of the other radiation treatments use 3 to 5 mm margins. I had five hypo fractional treatments. I had some urinary restriction, but that was taken care of by Flomax. I had no ED issue, pain issue, no catheter issue to deal with and was happy with my treatment. Like many, I was happy with my choice and would do it over again if I had a biological reoccurrence. I consulted with five radiation oncologists, one urologist and spent a good deal of time on this web site, before I made my decision. I also had spaceoar inserted.

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How long since your RT, bens1?

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1 reply
larry56 | @larry56 | Apr 1 10:15am

I'm only 68 but had surgery mid January.

I still leak a bit but it gets a little better each day.

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bens1 | @bens1 | Apr 1 10:29am
In reply to @joecontheroad "How long since your RT, bens1?" + (show)
@joecontheroad

How long since your RT, bens1?

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Joecontheroad: I finished my 5 treatments in February of 2023

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retiredboomer71 | @retiredboomer71 | Apr 2 12:41pm

"With high-risk patients [Gleason 9-10], it's indisputable that the cure rates are far better with radiation plus hormones than they are with surgery..."

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retiredboomer71 | @retiredboomer71 | Apr 2 12:46pm

Much like the OP (milans), I'm 71, Gleason 9, Stage 2; PSMA PET Scan shows no metastasis and no spread, one tumor (~1.5cm) inside my enlarged prostate (~65ml). Reasonably fit & healthy.

After much research and several consultations, I decided on a radiation treatment plan: 12-18 months ADT (Orgovyx), HDR Brachytherapy "boost" (temporary seeds), and 5-session SBRT. Except for ADT, I finished last week (3/28/2024).

Very pleased with my radiation treatments by Dr. Chang at UCLA. I highly recommend him.

Whatever treatment you decide, seriously consider a Center of Excellence. None nearby? Fortunately, nowadays phone and/or video consultations are common. But some testing and treatments must be at the treatment Center. For me, that meant 200-mile one-way travel and one extended stay of 3 weeks. IMO definitely worth the effort & expense.
Best wishes.

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Moderator
Colleen Young, Connect Director | @colleenyoung | Apr 3 4:51pm

@milans, how are you doing with your treatment decision making?

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2 replies
solidwater | @solidwater | Apr 3 5:11pm
In reply to @colleenyoung "@milans, how are you doing with your treatment decision making?" + (show)
@colleenyoung

@milans, how are you doing with your treatment decision making?

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terrible it seems like I will again never be able to live in the body i started with. Thank you lupron,ugh. wish we'd find some improvement in ones QOL .

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milans | @milans | Apr 3 5:35pm
In reply to @colleenyoung "@milans, how are you doing with your treatment decision making?" + (show)
@colleenyoung

@milans, how are you doing with your treatment decision making?

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Have surgery scheduled for May but a Radiation consult in a couple of weeks.

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mgmathisusa | @mgmathisusa | Apr 3 8:54pm

I’m 75 and 6 weeks post surgery. The Depends thing is somewhat problematic, but as someone else said, everyday is indeed better. Tomorrow is my first PSA. News at 11.

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