Second guessing or being sure.

Posted by kjacko @kjacko, Oct 31, 2023

I am scheduled to have my prostate removed next week. In the past few days I have received comments from a number of men who have a similar situation to me. They ended having additional testing on their cancerous prostate and were told they didn’t need surgery, either because their Gleason score was lower than first reported or their cancer was determined to be very slow growing. I started wondering if I should get another opinion. I know it’s close to surgery time but I want to do what will provide me with the best outcome. My biggest fear is that if I do get another opinion and they agree surgery is best, I might regret doing it in the first place. I don’t know if this is being smart or as the day of surgery gets closer, I’m having “buyer’s remorse”. Any of you ever felt this way? Thanks for responding.

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hbp | @hbp | Oct 31, 2023

If your doctors have advised that your apparent gleason score is 8 or above, then if I were you I would have the surgery now. Otherwise I think that you have time for a second opinion. Also, in my opinion if you are 75 or more then radiation is ok. Younger than that go with the gold standard of surgery Good luck I had surgery at 74 and I think that I did the right thing

kjacko | @kjacko | Oct 31, 2023

Thanks for responding. My Gleason score is 3+4=7. I’m 71 in darn good physical condition.👍. What do ya think?

hbp | @hbp | Oct 31, 2023

In reply to @kjacko "Thanks for responding. My Gleason score is 3+4=7. I’m 71 in darn good physical condition.👍. What..." + (show)

Get a second opinion from an experienced urologist at an excellent facility and be a very good listener ( don’t be influenced by your own prejudice, we all go in with our own prejudices).
Often after surgery they reevaluate the diagnosis and increase or decrease the Gleason score. That is one of the benefits of surgery.
The key here is living longer with a decent quality of life.
Good luck.

ozelli | @ozelli | Oct 31, 2023

Better to wait a while if you are not 100% sure. The lifestyle changes you may have to make are not insignificant. Your numbers seem on the lower end of the spectrum imo. 7.7 and Gleason 3+4, right?
How many cores were positive and how much grade 4 in each? Those stats can really move the needle in terms of assessing the need for immediate action or not.

kjacko | @kjacko | Oct 31, 2023

Grade group 2. 30% Gleason pattern 4. 2 of 9 tissue cores: Cancer is 50% in one core and 20% in the other.

ozelli | @ozelli | Oct 31, 2023

It really comes down to your personal risk profile. At what level do you feel that treatment is probably necessary, necessary or definitely necessary.

Personally, I would be happy to continue monitoring with your numbers. Others would not feel comfortable at all with that approach.

I watched my PSA go from 5.75 in 2016 to about 17 in late 2022. I had in my head a PSA number of 15 that I would definitely treat at. I foolishly didn't check my numbers for 12 months and they spiked from 12 to 17 over that time period. Did I leave it too late? Do not know but I was very pleased with my personal treatment outcome.

Certainly you should get a 2nd opinion. I presume you have spoken with a professional who isn't a surgeon.

It is a big decision but not one that should be constricted by time. Most prostate cancers are quite slow growing.

I wish you well.

jc76 | @jc76 | Nov 1, 2023

You really need to get second opinion regardless of diagnosis. Are you going to a major facility for your testing and the procedure? This is an important decision for you and second opinions on this are important.

My Gleason score worse biopsy was 3+4=7 like yours. I was not given surgery as option due to age and heart failure. However I am a very active person and do sprint triathlons.

Have you had a Decipher test? That will further rate the seriousness of your cancer. Mine was originally intermediate and was changed to low risk after Decipher. That is why additional test are so important.

Have you considered the new radiation treatments. If you cancer has not spread outside prostrate they have an excellent cure rate. Mine was proton 30 proton treatments over 6 weeks. Others have had a new version with only 5 treatments over 2 weeks. The radiation is far less side affects and complications and is done without any sedation at all. It takes about 10 minutes and you would not know you even had the treatment.

There are some side affects but everyone is different on how much they affect you. I had minor side affects. Do some more research on proton and photon radiation treatments. They use different type radiation. Get a second opinion. And consider (strongly advise) having a Decipher test, PSMA, and bone scan. If those last two are negative you should really discuss those findings with your second opinion and present provider.

You will read a lot of post that some urologist want to do surgery. Some radiologist/oncologist will want proton, some photon. I think you should see a radiologist/oncologist to go over different radiation treatments and their cure rates versus surgery.

Again don't know your specifics and if your cancer is still inside prostrate only, but your Gleason score is not that bad? What was your PSA level? Get a GOOD second opinion and asked about all options of treating cancers and the pros and cons of each. I am 76 and happy with the proton radiation treatments done at UFPTI. I did get two opinions and did a lot of research prior to deciding.

mar1957 | @marshallfeller | Nov 1, 2023

I would definitely get a second opinion and a consult with a radiation oncologist. Ask about side affects, recovery time and recurrence rates. From my research low to intermediate cancers, like yours, has a recurrence rate between 4-10% with radiation and surgery has a 22-25% recurrence rate.