Surgery or Radiation?

Posted by ava11 @ava11, Mar 9, 2024

Got my Biopsy results today at 5PM. 5 cores Gleason score 4+3
2 cores Gleason score 4+5
Cancer still in the gland but it is close to periphery.
I have an appointment with Dr LEE at UCI who did my biopsy on March 5th. He does RP, so I am assuming he would suggest surgery?
I am 88-year-old but fit and healthy.
Any suggestions what my next steps should be to make a decision.

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mrscott | @mrscott | May 29 2:23pm

Writing this for the OP and for those newer to the topic.

Welcome to the club that nobody wants to join!

1. Urologists may be in charge of a patient's PCa treatment simply because they're the ones who usually find the PCa. Urologists do lots of things. They may not have the bandwidth to keep up with the fast-moving field of PCa treatment, and are surgeons, who presumably made that career choice because they value surgery. Do what you would do for any *other* kind of cancer: see a full-time, board-certified oncologist specializing in PCa to discuss treatments.

2. PCRI.org's YouTube channel has lots of videos, many by Mayo Clinic Cancer Center docs. Start with the latest Annual Conference for background. PCRI was started by a luminary oncologist, who 'doesn't have a dog in this fight' -- he advises on treatment, he's not a surgeon or a radiation therapist.

3. PCRI.org has a free helpline, staffed by trained volunteers, for advice.

4. On average -- but this is NOT a rule -- radiation therapy has fewer negative effects than surgery. However in your case either could be better. Given Gleason 5 cells, Active Surveillance may be out.

5. I suggest watching Dr. Mulhall's presentation; he is a sexual medicine clinician, and works with patients post-therapy. You may not get this material from surgeons or RTs, as they aren't trained in these discussions, surgeons HAVE TO churn patients through to keep their numbers up, and won't be able to follow up with patients. This particular video may be a bit dated; I haven't kept up. https://www.youtube.com/watch?v=4ELsojPFNV8&t=20s

6. PCa is in among some important plumbing; hard to get at, and PCa cells aren't different enough from normal cells to be easy to kill without damaging other tissue. The PCa treatment options aren't things we would do for fun. Each causes damage, including hormone therapy; however leaving PCa untreated has its own risks (low for Gleason 3; high for Gleason 5) of an early, painful death. It's a question of choosing the least-bad option(s), based on what matters to you.

For Gleason 3+3=6, there was a study of 20,000 patients: NONE died from PCa. HOWEVER, Active Surveillance is a good idea: you weren't born with Gleason 3, so those cells changed. They could change further. Or, the biopsy may have missed Gleason 4 or 5 cells.

Note that there are treatments for the side-effects (see Dr. Mulhall's video).