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Surgery or radiation?

Posted by freed58 @freed58, Sep 1 5:47am

I’m sure questions like this have been raised here before, but I welcome your inputs.
I am an otherwise healthy 68 year old with a BMI under 21. A 20 core biopsy randomly found a single positive core graded as a Gleason 4+3. Core is defined as located in the left lateral apex. My PSA is 4. My prostate is 73g. My PSA density is 0.055. I do have BPH and a weak stream. PSMA PET verifies cancer is contained to the prostate. Decipher test and pathology 2nd opinion in process.
The docs I’ve seen in northern Virginia area say to pick your treatment path. They’re both reasonable but carry different pluses and minuses. They did say if I picked radiation I’d first need an outflow procedure such as TURP or HoLEP.
I welcome your inputs from your experiences.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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freed58 | @freed58 | Sep 3 6:44pm
In reply to @toomany "I was diagnosed in early 2018 following a biopsy, with a Gleason score of 9 and..." + (show)
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I was diagnosed in early 2018 following a biopsy, with a Gleason score of 9 and a PSA of 90. I subsequently underwent what was called a treatment "triple-play", which was 1) ADT (Casodex + Lupron), 2) Low-Dose Brachytherapy, and 3) Seven-weeks of daily IMRT Beam Radiation. I have been cancer-free (PSA = non-detect) for eight (8) years ever since, until January of this year, when my 'rebounding' PSA was first detected to be 4.5.

Over the eight-months since, my PSA has slowly risen to its current level of 13.4, and a recent PSMA-PET scan shows recurrent 'localized' cancer, restricted to the gland itself and the right seminal vesicle. The potential for post-radiation surgery (partial or holistic prostatectomy), is unlikely, and I am actively seeking future treatment recommendations from several oncologists, including my original (treating) oncologist, the latter of whom is likely to call for Orgovyx, plus Abiraterone. There may in-fact be, no other treatment options available to me, and of course, I have no real idea what my newly projected life expectancy might be (could be months or years)!

Anyway, I'll hope that some of this information (surrounding my own journey), might be of help to you in your decisions going forward, but I'll close by noting two key things . . . 1) I did NOT need any outflow procedure(s) to undergo radiation back in 2018, and 2) Radiation treatment(s) MAY preclude you from any future surgical options, should recurrence take place thereafter.

Best of luck to you!

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@toomany
And to you my friend. Thank you for sharing your journey.

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freed58 | @freed58 | Sep 3 7:05pm
In reply to @toomany "I was diagnosed in early 2018 following a biopsy, with a Gleason score of 9 and..." + (show)
Profile picture for Too-Many @toomany

I was diagnosed in early 2018 following a biopsy, with a Gleason score of 9 and a PSA of 90. I subsequently underwent what was called a treatment "triple-play", which was 1) ADT (Casodex + Lupron), 2) Low-Dose Brachytherapy, and 3) Seven-weeks of daily IMRT Beam Radiation. I have been cancer-free (PSA = non-detect) for eight (8) years ever since, until January of this year, when my 'rebounding' PSA was first detected to be 4.5.

Over the eight-months since, my PSA has slowly risen to its current level of 13.4, and a recent PSMA-PET scan shows recurrent 'localized' cancer, restricted to the gland itself and the right seminal vesicle. The potential for post-radiation surgery (partial or holistic prostatectomy), is unlikely, and I am actively seeking future treatment recommendations from several oncologists, including my original (treating) oncologist, the latter of whom is likely to call for Orgovyx, plus Abiraterone. There may in-fact be, no other treatment options available to me, and of course, I have no real idea what my newly projected life expectancy might be (could be months or years)!

Anyway, I'll hope that some of this information (surrounding my own journey), might be of help to you in your decisions going forward, but I'll close by noting two key things . . . 1) I did NOT need any outflow procedure(s) to undergo radiation back in 2018, and 2) Radiation treatment(s) MAY preclude you from any future surgical options, should recurrence take place thereafter.

Best of luck to you!

Jump to this post

@toomany
One more comment/question, if I may. In my recent consult with a radiation oncologist he suggested to me 8 weeks of low dose external radiation coupled with temporary (6 months) of ADT, after the outflow procedure. When I asked about the treatment course upon recurrence, he said he could radiate again. Do I read your post correctly that that is not an option for you? If not did they explain why?

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Too-Many | @toomany | Sep 3 9:55pm

Well, when asked the hypothetical immediately after my various treatments in 2018, my original oncologist stated that in theory, I could have brachytherapy again, but the topic of beam radiation did not come up. So I'm afraid I don't know the answer to that. I have a tele-health visit with that same (2018) radiation oncologist late next week, which I hope will shed more light on it. But an unrelated (local) oncologist has advised (rightly or wrongly), that its likely because of "scar tissue produced during my combined 2018 radiation treatments" (i.e., brachytherapy and beam radiation).

I hope that helps answer your question, and I'll try to follow-up with you after my tele-health visit next week with more specific info.

All the Best.

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Too-Many | @toomany | Sep 3 11:37pm
In reply to @jeffmarc "@toomany Here are some other options Recurrence after radiation, focal therapy and surgery People who have..." + (show)
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@toomany
Here are some other options

Recurrence after radiation, focal therapy and surgery

People who have radiation as their primary treatment have been told by doctors that surgery isn’t really an option if there’s a reoccurrence. Other options are not really mentioned..

This study shows that both salvage focal therapy (HIFU and cryotherapy) and salvage surgery were equally effective at extending the life of a patient that started off with radiation.

Those that had focal therapy had fewer perioperative complications.
https://jamanetwork.com/journals/jamaoncology/article-abstract/2844900

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@jeffmarc XLNT! Thanks for this added information, Jeff. This is detailed, helpful and encouraging, and precisely the kind of information that I’ve been seeking. I will start looking into these options and discussing them with my doctors.

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