Surgery? Radiation? Can I have an independent suggestion?

Posted by hanscasteels @hanscasteels, Dec 19, 2024

As a Canadian, I apologize in advance for my self-centered question. I have done all the preliminaries and now must make a choice. When asking urologists, they’d advocate for “cutting”. When talking to radiation oncologists, they’d say “radiate” - statistically, the odds are equal or better, and the side effects - well, perhaps, eventually, you might have to deal with those. Which leaves me, as someone reluctant to understand issues related to cancer that I never wanted to know, to make a decision.

In short, here are the parameters: over 4 months, PSA readings of 26, 21, and 25. Biopsy showed cancer in the left nodule, Gleason 3+4 in 5 out of 12 cores. Cribriform and suspected perineurial invasion. Bone scan and CT scan showed no metastasis. PET scan shows a significant uptake (3.7) in the prostate but also, no metastatic activity, except for a minuscule uptake in L4 lumber (but judged to be benign). That doesn’t eliminate microscopic events, I suppose. Also had a prior appetizer of a heart attack and had CABG (9 bypasses).

The question now: what would be an optional approach for me, specifically. ChatGPT says a short course of agonist/antagonist ADT, Brachytherapy, and EBRT. The urologist says “if you want it gone, call me”. The radiologist says “the isotopes are at your service”. How on earth can I make an informed decision that’s best for me if everyone advocates for what they do/know as the best approach?I suspect some answers might be - it depends what consequences you want to deal with - granted. But medically, what gives me the best chance to conquer this, well, shit?

Where would you take it?

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

@pwhisnant

70 year old. PSA 8.8, Biopsy Gleason 9, predominately right side, PET scan all contained within gland. Chose prostatectomy surgery over radiation. I understand there's no 100% guarantee with either option. Was told by two urologists that if you have surgery and it comes back, you can then do radiation. But it doesn't work the same in reverse. If you do radiation, surgery later is not an option because there is too much burn damage. Plus, for me surgery is more of a one time event, then recovery, and simple life practice adjustments. Radiation drags out any understanding of if it is working or not for some undetermined amount of time. Surgery took out gland, plus right side nerves and lymph nodes. At 70, married for 52+ years to high school love, pecker performance has a different priority these days........today, 19 Jan 25, 11 days, post surgery, leakage is the main frustration, but I expect manageable over next weeks......pathology report just in yesterday. Post op appointment with doc this coming Thu, 23 Jan 25....staying positive....

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I am 68. I have been reading a lot the past two weeks, as well as watching oncologists on videos. Your post is among the more helpful ones that I read.

Given all the information that I have gathered and given deep thought, I chose Robotic-Assisted Radical Prostatectomy. My oncologist will give me the earlier possible day, between the two Toronto Ontario hospitals where she does RARP. Her assistant indicated that it could be by end of March 2025; I said earlier than that, if possible; I want to eliminate or reduce the possibility my PC can spread outside the prostate before surgery.

Others may choose a different treatment that they think fits them. Whichever treatment they choose, I wish everyone well in this our journey. In due time, I will update you of my progress.

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