Surgery? Radiation? Can I have an independent suggestion?

Posted by hans_casteels @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.

Profile picture for jeff Marchi @jeffmarc

This sounds like a real interesting technique. One of my wife’s best friends husband is a pathologist who worked in a hospital analyzing tissue. One of the things he did was analyze the tissue as the surgery was going on to make sure that the margins were clean. He did this with many different types of surgeries, and this was pretty standard.

It makes me wonder why prostate cancer surgeries don’t always get this treatment.

He was good to have around when I Was diagnosed with prostate cancer 15 years ago. He had me bring him the slides, and he reviewed them to tell me if they confirmed what they had diagnosed. He did agree with what they had told me.

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They did ‘frozen sections’ like this for decades - EVERY cancer surgery used it.
Hate to say ‘time is money’ but there it is…
The advent of more sophisticated radiation techniques and chemotherapy took on a ‘mop up’ approach to whatever the surgeon didn’t get…
Forty years ago a close female friend had aggressive adeno CA of the bowel. Her father, a doctor, told the surgeon ‘NO chemo or radiation, understand? You f***ing get it all!”
After tumor removal, they took all her intestines out of her body and hosed them off with sterile saline; her body cavity as well. No
Cells could be left behind. Multiple frozen sections were employed.
To date she has never had a recurrence or complication. THAT’s how it used to be done…
Phil

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