Treatment Options

Posted by rpacheco23 @rpacheco23, Jun 19, 2023

My 84 yr old husband was recently diagnosed with Intermediate Prostate Cancer (Gleason score 4.3 = 7) PSA of 7. His urologist recommends 40 treatments of Radiation over 2 months? He's in overall good health -diabetic but controlled with meds and diet, active and doesn't look his age. I've heard radiation treatment can cause burns and other side effects? I really don't want him to suffer! What other options are there? We haven't met with the oncologist yet.

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There are a variety of options for radiation which the radiation oncologist will explain to you. Depending where you live and or your ability to travel, this may limit your choices. The larger medical centers such as Mayo have the newer and more advanced proton machines that can treat him in 5-6 treatments over a 2 week period. Regarding your questions on burns if this happens, from what I see on this forum they tend to be minor and not a serious issue. My thought you should always get a second or third opinion. Considering your husband’s age, Gleason score and PSA, I would not be surprised if another urologist would recommend active surveillance. If travel is an issue, I did several virtual visits with urologists and oncologists.

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Don't have enough of the diagnostic details to fully respond, but if you're talking a single 4+3 core, he's asymptomatic, and it's localized, at 84, I'm surprised active surveillance (AS) wasn't at least offered as an option, especially if he has any co-morbidity issues. A genomic test, which could be done with the existing biopsy tissue, might give you more confidence in AS if the results indicate low risk disease. As mentioned, please get at least a second opinion from a well known prostate cancer institution. Best wishes.

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At 84 does he really need treatment? A genetic test could give you a better idea of how aggressive his cancer is if at all. Do the people in his family life to be 100 or something? I am 74 with 4-3 in two cores and just finished 5 proton radiation treatments at Mayo Phoenix. The only "burns" I got from the five 725 cGY fractions were two approximately 5 inch tan circles, one on each hip where the radiation went in. 40 treatments over 5 months you two must like hospitals or something. My treatments were on Monday, Wednesday, Friday, Monday, and the last one on Wednesday.

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Rpacheco23: you also may want to look at the MRIdian radiation machine from viewray (viewray.com).5 treatments for me. 2 mm margins instead of 4-6 mm margins for all other machines, including proton. Protect healthy tissue. Slight urine restriction was the only side effect and Flomax handled it. Now off Flomax. No side effects.

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@marshallfeller

There are a variety of options for radiation which the radiation oncologist will explain to you. Depending where you live and or your ability to travel, this may limit your choices. The larger medical centers such as Mayo have the newer and more advanced proton machines that can treat him in 5-6 treatments over a 2 week period. Regarding your questions on burns if this happens, from what I see on this forum they tend to be minor and not a serious issue. My thought you should always get a second or third opinion. Considering your husband’s age, Gleason score and PSA, I would not be surprised if another urologist would recommend active surveillance. If travel is an issue, I did several virtual visits with urologists and oncologists.

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Thank you so much for your feedback. We will be meeting with his primary doctor tomorrow and will certainly bring this up. Thank you and God Bless.
Ruth

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@bens1

Rpacheco23: you also may want to look at the MRIdian radiation machine from viewray (viewray.com).5 treatments for me. 2 mm margins instead of 4-6 mm margins for all other machines, including proton. Protect healthy tissue. Slight urine restriction was the only side effect and Flomax handled it. Now off Flomax. No side effects.

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https://www.pcf.org/c/breaking-news-fda-approves-talazoparib-enzalutamide-for-metastatic-castration-resistant-prostate-cancer/
Breaking News: FDA Approves Talazoparib + Enzalutamide for Metastatic Castration-Resistant Prostate Cancer
The FDA has approved a new medication, talazoparib, in combination with enzalutamide for patients with metastatic castration-resistant prostate cancer (mCRPC) who also have mutations in certain genes involved in DNA repair. This means that patients with mCRPC (prostate cancer that has spread beyond the prostate and continues to grow despite low testosterone) have an additional treatment option.

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@mikewo

At 84 does he really need treatment? A genetic test could give you a better idea of how aggressive his cancer is if at all. Do the people in his family life to be 100 or something? I am 74 with 4-3 in two cores and just finished 5 proton radiation treatments at Mayo Phoenix. The only "burns" I got from the five 725 cGY fractions were two approximately 5 inch tan circles, one on each hip where the radiation went in. 40 treatments over 5 months you two must like hospitals or something. My treatments were on Monday, Wednesday, Friday, Monday, and the last one on Wednesday.

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We're considering an active surveillance approach or the seed implants. Something this is not invasive or would cause side effects. His doctor assured us we are not at the "quality over quantity" stage yet and may never have to face that. I really don't want him to suffer from any of the side effects and he's comfortable for now. We meet with the oncologist next Monday and we'll go from there. Thank you for your feedback and your eye-opening question about needing treatment. Congratulations on your concluding treatment!

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I am a couple of months shy of 74 and I had a very hard debate with myself weather to get into the medical industrial complex to treat my PC . I have detailed blood work going back to 2008 including all my PSA results. I have been between 2.3 and 2.9 for five years and it was not a steady increase yet no of the doctors would even venture a guess how long my 7 mm lesion was there and growing. Did I really need treatment knowing that my life expectancy was about 15 years if I did nothing and that I would probably die of something else anyway? 74+15= 89 years old. Not sure if I want to live that long. Nursing homes are not high on my places that I want to visit.

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