Trying to choose between radiation and surgery

Posted by ginger38314 @ginger38314, 4 days ago

Diagnosed 7/15/26, 2 of 12 cores 3+4 on both 20% and 30%involvement t1c, have oncologist appointment on 8/20 and Urology surgeon on 9/28, asked my main urologist for a decipher test hopefully it reaches the oncologist before the appointment. If it comes in lower considering optional treatments without adt but if not probably will proceed to nerve sparing surgery also if that was the case I was hoping I could get a lower groin hernia fixed at the same time.

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

therock | @therock | 3 days ago

Has anybody done the Nanoknife for Gleason(3+4)7 with <10% 4?

ginger38314 | @ginger38314 | 3 days ago

In reply to @charlesprestridge "@ginger38314 I am in the process of getting ready for treatment. Have been making the decision..." + (show)

@charlesprestridge

@ginger38314

I am in the process of getting ready for treatment. Have been making the decision of RP vs Radiation. I am 61, so younger than you. I have RP scheduled for September 16th. This is over 1 year from initial biopsy in 2025.

Some thoughts:

1. From your information, you do not want to rush a decision. With current information, I would not worry about taking 6-12 months to make a decision.

2. Most important decision is finding (if you haven’t already) a very good Surgeon, Radiation Oncologist, and treatment center.

3. For the surgeon, you want retzius sparing RA surgery. My surgeon converted to this procedure over 2 years ago.

4. To evaluate radiation options, I would want a center and doctor(s) very skilled in SBRT and HDR. I “think, but do not know” Doctors and Centers good at HDR, will be good at IMRT, SBRT, and other versions of Radiation.

5. Piece together as much information possible. Every person is different and unique. You have to understand, best possible, your information.
-PSA velocity over the past few years. Understanding a low PSA may be seen with significant cancer and a high PSA with no cancer.
-MRI imaging. Do you have visible lesion(s)? If so, Pirads rating. My initial biopsy tested at 3+3, but MRI lesion was Pirads5, this led to more tests and 2nd MRI biopsy showing 4 cores of 3+4. Your MRI image may indicate you may likely only have a small percentage of gleason4. With a small percentage of 4, your case may be closer to 3+3.
-MRI imaging to help understand location of lesion. Is lesion (if seen on MRI) showing symptoms of Extracapsular Extension or any other indication of risk profile for cancer escaping the prostate prior to treatment.
5. I sent my information to TULSA Pro treatment center. Due to size and placement of my lesion, I am not a candidate for TULSA Pro. It was a relatively simple process to be evaluated. You want to do understand your options for focal treatment.

At 61, I have chosen RP. Prostate cancer is slow growing. Looking back at yearly PSA results and the size of lesion, my cancer probably started 15 years ago. Cancer starting in my mid 40’s or at least early 50’s has played a role in my selection of RP over radiation.

I have felt, If I was closer to 70, I would be choosing radiation. However, Each person and decision is unique.

Another good tool is to join ANCAN group. They meet twice per month for low and intermediate group. https://mailchi.mp/ancan/ancan-low-intermediate-prostate-cancer-group-august-10th-8-pm-est

Next Meeting is this next Monday night. Join a few minutes early and tell them you are new.

Best wishes as you learn and go through this process.

Jump to this post

I was referred to OHSU knight cancer center which is the #1 Urology and
radiation center in Oregon, so they have the latest technology and nerve
sparing surgical procedures. it's been 8 months since my retest for
elevated psa of 5 so probably will be close to a year by the time I get
treated, my urologist ordered a decipher test so hopefully that will be
ready before my oncology appointment on 8/20, that will weigh heavily on my
decision which way to go. Thanks for responding.

ginger38314 | @ginger38314 | 3 days ago

In reply to @charlesprestridge "@ginger38314 I am in the process of getting ready for treatment. Have been making the decision..." + (show)

@charlesprestridge

@ginger38314

Some thoughts:

1. From your information, you do not want to rush a decision. With current information, I would not worry about taking 6-12 months to make a decision.

2. Most important decision is finding (if you haven’t already) a very good Surgeon, Radiation Oncologist, and treatment center.

3. For the surgeon, you want retzius sparing RA surgery. My surgeon converted to this procedure over 2 years ago.

I have felt, If I was closer to 70, I would be choosing radiation. However, Each person and decision is unique.

Another good tool is to join ANCAN group. They meet twice per month for low and intermediate group. https://mailchi.mp/ancan/ancan-low-intermediate-prostate-cancer-group-august-10th-8-pm-est

Next Meeting is this next Monday night. Join a few minutes early and tell them you are new.

Best wishes as you learn and go through this process.

Jump to this post

Also I'm extremely active before 10 miles walking per day for 12 years and
weight lifting for fifty years so my age is not an issue in this juncture
of my life.

ginger38314 | @ginger38314 | 3 days ago

In reply to @charlesprestridge "@ginger38314 I am in the process of getting ready for treatment. Have been making the decision..." + (show)

@charlesprestridge

@ginger38314

Some thoughts:

1. From your information, you do not want to rush a decision. With current information, I would not worry about taking 6-12 months to make a decision.

2. Most important decision is finding (if you haven’t already) a very good Surgeon, Radiation Oncologist, and treatment center.

3. For the surgeon, you want retzius sparing RA surgery. My surgeon converted to this procedure over 2 years ago.

I have felt, If I was closer to 70, I would be choosing radiation. However, Each person and decision is unique.

Another good tool is to join ANCAN group. They meet twice per month for low and intermediate group. https://mailchi.mp/ancan/ancan-low-intermediate-prostate-cancer-group-august-10th-8-pm-est

Next Meeting is this next Monday night. Join a few minutes early and tell them you are new.

Best wishes as you learn and go through this process.

Jump to this post

Also my original mri was ambiguous so had a exodos test which came in high
so then the biopsy and diagnosis.

Cannondale | @tactive | 3 days ago

In reply to @chuy10 "I want to continue to ride bikes after surgery…. What saddle do you recommend to use..." + (show)

@chuy10 hey Chuy, I have tried a bunch.

Look at the SQlab saddles, also the Selle Italia SR Boost. SQ lab saddles are designed to keep pressure of the perineal area. Just make sure you talk to the company for the right size saddle.

Jeff Marchi | @jeffmarc | 3 days ago

In reply to @ginger38314 "I was referred to OHSU knight cancer center which is the #1 Urology and radiation center..." + (show)

@ginger38314
OHSU has one of the best oncologist in the country. She moved there recently from Houston. If you can get an appointment with her, you will be extremely pleased with everything going on she Is very thorough and people really like working with her.

OHSU Portland Oregon
Eleni Efstathiou, MD, PhD

ginger38314 | @ginger38314 | 3 days ago

Thanks I will see if I can get her and call them tomorrow because my appointment is set with Dr. Hong on 8/20.

rickdent | @rickdent | 3 days ago

77y/o
Diagnosed 5-1-26
Some Gleason 8/8, Decipher .93
In good overall health.
Have had Lupron injection just over a month ago in preparation for radiation. I am equivocating now between surgery and radiation.
Any help from those who have been there would be much appreciated.

Jeff Marchi | @jeffmarc | 3 days ago

In reply to @rickdent "77y/o Diagnosed 5-1-26 Some Gleason 8/8, Decipher .93 In good overall health. Have had Lupron injection..." + (show)

@rickdent
At 77 surgery is not the greatest idea. Radiation would take care of this for you and would be just as effective, and last a long time. If you had surgery, it might come back soon and you’d have to have radiation then.

I’m 78 and had my diagnosis at 62. Had surgery because my father died of prostate cancer and had radiation, It came back after 3 1/2 years and I had to have radiation. It has come back three more times, but the drugs they have today work very well And keep me undetectable.

My brother at 77 had five sessions of SBRT radiation. He’s 80 now and doing just fine.

I know people that had Gleason nine and had radiation and it didn’t come back for 15 or 20 years. Rick, The guy who runs the ancan.org Advanced prostate cancer meetings had Gleason eight and had SBRT radiation 17 years ago and is Having no reoccurrences.

I don’t think there’s really a lot of decisions to make, Radiation will work just fine And give you plenty of years.

ginger38314 | @ginger38314 | 3 days ago

Have an oncology appointment for 8/20 low volume 3+4, if my decipher score comes in High more than likely will opt for surgery because I want to avoid adt.