SBRT vs. Robot-assisted radical prostatectomy

Posted by dandl48 Dave @dandl48, Jun 11, 2020

Well, my last visit to Mayo didn’t go as well as I wanted. I’m 72 years old and I had an Ultrasound-guided transperineal prostate biopsy and the results came back positive for cancer with a Gleason score of 4-3=7 and the Grade Group of 3 which is a Risk Group of Intermediate Unfavorable. With these results active surveillance is out and it’s either radiation or radical prostatectomy . If I choose radiation SBRT is available to me using protons for 5 treatments over a 10 day period. The downside of this treatment is I will have to have a 4 month Lupron injection before radiation and that if the cancer returns removal of the prostate would probably off the table. Choosing the radical prostatectomy which would be robot assisted, comes with its own problems, infection, incontinence and impotence. Decisions, decisions, I’m open for your input.

Thanks, Dave

Sorry, I thought this was clear in my response. Looking at a combination of factors — age, progression of my cancer and likely side effects of each treatment option (surgery and radiation) — the urologist concluded that the opportunity for a normal lifestyle for the foreseeable future for me post-radiation treatment was greater than the choice of surgery. Put differently, if you could have 5-6 years of a healthy, normal lifestyle and cancer-free post radiation treatment, knowing that as you approach 80 you will likely be confronted with new medical issues — or even death — that will create a new set of health challenges, would this be a good option for you? Contrast this with the same aging scenario with surgery, where you may have a greater likelihood of side-effects (e.g., incontinence, ED, etc.) that are difficult to manage in the same timeframe, only to be faced with new medical issues. Again, I don't want to oversimplify things and I don't want to diminish the benefits of surgery, for which some individuals have little to no side effects. Note that there is data available the will provide you with the odds on various side-effects from surgery. Your urologist should be able to share this with you. The treatment choice is yours based on the considerations/trade-offs I outlined as have others. Sorry, no easy choices here. Research. Talk. Weigh the risk of each approach. Weigh what's important to you post treatment. And then make a decision from there.

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@dandl48

@vernonkent you don't mind me asking, what did the surgeon say to you that convinced you to do radiation? Was it the 5, 20 or 40 treatments that you got?

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My radiation oncologist seemed to bounce between 5 and 28 days, implying that the choice was mine. I probed on why the shorter treatment wouldn't be everyone's choice. Less time. Same effect — yes? Frankly, he wasn't able to provide a satisfactory answer. I was left with the impression that based on his hospital's experience, they were seeing little difference in the longer vs. shorter treatment options. Bottom line: The research and experience with the longer treatment span is extensive and proven. The shorter plan, while perhaps as effective and with no greater side-effects, is still being trialed in a fashion until they have definitive results.

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@dandl48

@dmadi61 Thanks for your response. Hopefully my hasn't spread (the MD's feel it is contained to the prostate) The Lupron does concern me though.

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Lupron is the most powerful drug I have ever taken. You will immediately feel the side-effects, the extent and intensity of which can vary from patient to patient. No fun for anyone. That said, it does immediately drop your testosterone, which is the food for your cancer cells. Probably good to start on this drug for 30-60 days prior to either radiation or surgical treatment. It also can shrink the tumor(s) on your prostate. Also, continuing on the lupron post-treatment is also advisable in my opinion for a short period time. Think of post treatment lupron as cleaning up any cancer cells that may be hiding in the corners of your prostate. Unlikely after treatment but better safe than sorry.

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@vernonkent

@bruto1 This is a superb post. Thanks for taking the time to write it.

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Feedback appreciated. Glad my post was helpful. As we both know, personal insights are important to making the tough choices regarding treatment options.

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@horace1818

I understand your reaction but, please remember that neither Mayo nor any other physicians are responsible for decisions on your healthcare; you are. That is why they always explain the situation to you and then they wait for your decision on the options. This means that, in addition to Q&A with your physician, you need to analyze all other sources of information such as second opinions, your own research (there is an incredible amount of information available), experience of others, etc. etc. It is painstaking work and takes time but you need to do it and then you will be in a position to make the most informed decision based on your situation. Medicine is not a precise science since it deals with variable things: humans. Biology is not as precise as physics (except at the quantum level) and deals with statistics and probability! Everything in medicine has a risk/reward aspect to the decision. I wish there were an easier way to make these decisions.

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Spot on. Each individual needs to take personal responsibility for their health and related treatment decisions, whether cancer or any other disease. The hard truth: It is your future, own it.

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Dave, Robotic prosectomy would be my choice. That was my option 9 years ago and even though I'm still a cancer patient its being managed fairly well. I was 69 at the time of the surgery. Make sure you have a surgeon who is very experienced at this type of Robotic surgery. My Gleason had a couple of 8's and a 9. The surgery did not, even though the margins and glands tested to be clear following surgery, get all the cancer. I do have residual microscopic cancer but kept in control mainly with quarterly Lupron injections. After my surgery I did have radiation and Chemo but my PSA never went to zero. Incontinence never a real issue, ED somewhat of a problem until I started Lupron about three years ago. My testosterone is now less than 5 so no sex drive at all. I'm now 78. The processes today have been refined and I believe more effective but of course no guarantee. I'm in good health today with no other serious issues but still always concerned that my next visit may not be favorable. I visit my oncologist quarterly and PSA has been less than 1 for last two years. I do get occasional scans and MRI's. Whatever you do make your best effort to keep your body in good shape and visit with a nutritionist to get recommended foods to eat. Glad to answer any other question you may have.

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@alanr Thanks for the reply. You gave me alot to think about. Today is the day we make our decision. Hopefully my second guessing of the decision won't be bad.

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I’m sure you’ll make the right decision based on your personal situation. Take confidence in the fact that you have multiple perspectives and tons of info to help you make it. Once committed, stay positive. It helps! The vast majority of prostate cancer patients have very high and good survivability rates.

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Similar situation trying to figure out what to do. I was 3 + 4 Gleason but it turned into 4 + 3 by the time I acted. I actually went a little over a year before making the real decision. Went to Mayo to talk about some of the newer treatments and trials but didn't work out for me so that put the decision back to radiation or Surgery. I opted for surgery at 66 for 2 reasons that the radiation can cause complications in later years, and radiation can screw things up if you do want to do surgery at a later date. Some of that decision has to do with what age you are and life longevity after the procedure…………Just had my 3 month PSA and it is now undetectable, down from over 10, so hopefully it stays there. Yes the incontinence can be a pain but it is mild now at 3 1/2 months. Don't know yet about the ED. Hopefully goes away eventually. Remains to be seen. The Dr just prescribed viagra but haven't tried it yet.

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@ronan2011

Similar situation trying to figure out what to do. I was 3 + 4 Gleason but it turned into 4 + 3 by the time I acted. I actually went a little over a year before making the real decision. Went to Mayo to talk about some of the newer treatments and trials but didn't work out for me so that put the decision back to radiation or Surgery. I opted for surgery at 66 for 2 reasons that the radiation can cause complications in later years, and radiation can screw things up if you do want to do surgery at a later date. Some of that decision has to do with what age you are and life longevity after the procedure…………Just had my 3 month PSA and it is now undetectable, down from over 10, so hopefully it stays there. Yes the incontinence can be a pain but it is mild now at 3 1/2 months. Don't know yet about the ED. Hopefully goes away eventually. Remains to be seen. The Dr just prescribed viagra but haven't tried it yet.

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@ronan2011 Glad there is another person that had a hard time deciding on what procedure to do. I just know that one has to be done. It is the incontinence that is/was steering me away from surgery. Once I decide I pray that it's the right one and the stress & anxiety get reduced, realizing that it will return the closer I get to the appointment time. Thanks again for posting!

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@bruto1

I’m sure you’ll make the right decision based on your personal situation. Take confidence in the fact that you have multiple perspectives and tons of info to help you make it. Once committed, stay positive. It helps! The vast majority of prostate cancer patients have very high and good survivability rates.

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Thanks for your detailed postings. It is helping in making my decision. Today is the day I want to decide.

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@dandl48

@ronan2011 Glad there is another person that had a hard time deciding on what procedure to do. I just know that one has to be done. It is the incontinence that is/was steering me away from surgery. Once I decide I pray that it's the right one and the stress & anxiety get reduced, realizing that it will return the closer I get to the appointment time. Thanks again for posting!

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It was my conclusion that there is a greater chance of serious incontinence from radiation than robot-surgery. None of my friends that has had the surgery has an incontinence problem

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