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Cant make decision between Surgery or Radiation

Posted , 19 users are following.

jerald1234
jerald1234

Hi! 68 years old, just diagnosed with prostate Cancer. Thankfully localized however 7 positive cores, Gleason 7 in 6 and Gleason 6 in only 1. Psa 9.6. Seems results are the same with either radiation or Surgery and can't understand how to make this decision as doctors are telling me all present with same odds. 2 biggest things on my mind is 1) why surgery if results are the same as radiation and 2) with radiation, I am frightened of having to look over my shoulder for 2 years, watching PSA potentially bounce up and down and not know if cancer really gone. And if unsuccessful, there's no surgery as an option after that. Please help!

0 likes, 49 replies

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  • aksns61
    aksns61 jerald1234

    Posted

    (We are in the USA) My spouse was age 64 when he was diagnosed with advanced PCa, localized in prostate, Gleason 8 and 9, otherwise in excellent health, normal sized prostate gland. He had 6 months of ADT, also had seed implants and at the 5 months of ADT, he had EBRT. Few, if any side effects. We hike, ski, climb, etc and do everything we did before his treatment. BUT, he has no sex drive. NO bladder problems, His testosterone level is low. There is NO evidence of any cancer. Its been 4 years, He is fine with the results, and is happy he did NOT have surgery. At 74, Ive just been diagnosed with intermediate PCa, Gleason 6, 2 with 7, excellent health, decided to do 6 months of ADT plus seeds. National Cancer treatment guidelines do NOT suggest surgery for men with low or intermediate PCa. PS, I was on watchful waiting for 3 years.
    • jerald1234
      jerald1234 aksns61

      Posted

      Thank you for your response. I am surprised you said National Cancer guidelines say not to do surgery at low and intermediate,. I thought it was the opposite because these groups supposedly have longer life span hence if recurrence occurred other options possible. Did u choose ADT to be more aggressive with radiation? How is your recovery going?
    • jerald1234
      jerald1234 aksns61

      Posted

      I'm also very curious, when were seeds placed? During ADT? And why EBRT, were his numbers rising or the doctors just wanted to be as aggressive as possible? Thanks!

    • barney34567
      barney34567 aksns61

      Posted

      May I ask why you decided in ADT and not active survellieance? I ask because Gleason 6 is low grade cancer which may or may not get worse.
    • barney34567
      barney34567 jerald1234

      Posted

      the guidelines don't push any radical treatment for low grade cancers above a certain age, not sure what it is, because it is likely that say a 70 year old with recently diagnosed Gleason 3+3=6 will die with PCa but not from PCa 

    • barney34567
      barney34567 jerald1234

      Posted

      Surgery is often recommended above all other treatments if the PCa is thought to be localised and the patient is expected to live >10 years.

    • aksns61
      aksns61 jerald1234

      Posted

      The new 2016 National Cancer guidelines for LOW or Intermediate do not recommend surgery because the findings  show the same outcomes as with ADT with seed implants (brachytherapy) as is surgery without the risks. 10 year and 15 year survival rates are very high. Seed implants done at the 10 week mark after intial ADT. Radiologist suggested a 3 part treatment, with ADT, then seeds followed by EBRT. I nixed the EBRT and thought it was overtreatment in my case- the radiologist was OK with my decision. There are now several reports/studies by ASTRO, the radiologists national organization which have modified the treatment guidelines for low to intermediate risk cancer. This January (2017) the NCCN will release a revised low/intermediate risk guidelines. Keep in mind my prostate is very normal and only 2 cores were Gleason 7, all the others were 6.  The October 2016 ASTRO research and the NCCN reports are available online. I should mention that with the 6 month ADT and seed implants, your sexual life is almost normal.
    • jerald1234
      jerald1234 aksns61

      Posted

      Want to do seeds but based on my Gleason 7 in 6 out of 7, I am high intermediate risk and scared if cancer returned I won't have second option. ??

    • robert-CA
      robert-CA jerald1234

      Posted

      One correction for you.  It *is* possible to have surgery after raditation treatment.  It's called a "salvage" surgery.  It's difficult, a many surgeons won't do it.

      I had a successful salvage surgery after a failed radiation treatment.  My surgeon has done well over 600 prostatectomies, and only 6 salvage operations, including mine.  But again, it is possible.

       

  • Deeks33656
    Deeks33656 jerald1234

    Posted

    Hi Jerald, 

    THe data these days tells us to wait and keep an eye on it? But please don't take my word. I'm no doctor. I had surgery 16 months ago and still have NO normal sex life. 

    Bladder ok. Do Wonder if I had kept an eye on it  (PSA was 4.7) rather than have gone through the mental torment that is a sex life that is non existant and/or otherwise a trial. DIdn't realise it before and took a normal sex life for granted. Get as much advice as you can. It's a lottery. 

     

    • j12080
      j12080 Deeks33656

      Posted

      I am in conversation with a very good Interventional Radiologist who is treating  lower and intermediate PCa in Prostate with a 3TMRI and doing  focal laser targeted biopsy and he is also treating the lesions with focal laser ablation for cancer removal. The benfits are termendous with little to know side effects especially no sexual side effects as all of the ablation is mapped out and is done with the real time 3T MRI. No radiation, No hospital stay, no ed,  Over 1000 of these have been done in the U.S. A prostate laser center has been set up in Houston texas under that name. In fact you can look it up under that name or you can personal message me and I will give you all the contact info and the doctor who is the director of the center. He has place a portal at that site for anyone to upload with no effort their MRI if they have one and he will analysis the MRI and provide a second opinion or provide a free consultation. That is he does at no charge for this. He spent 3 hours talking to me and my wife so far and we have learned so much. Please do all the research you can but this is a very promising treatment that is the most minimally invasive and little to no side effects. Let me know and I will answer your PM>

    • Deeks33656
      Deeks33656 jerald1234

      Posted

      Hi Jerald,

      I live in Scotland where prescriptions are mostly free. 

  • romneyj
    romneyj jerald1234

    Posted

    Hi Jerald1234,

    Faced with the same decision I opted for surgery for four main reasons:

    1. Surgery is impossible after radiotherapy but radiotherapy is possible after surgery (and may be necessary if surgery has not removed cancerous cells with a wide enough margin).

    2. Radiotherapy requires anti testosterone treatment first - the side effects are not wonderful

    3. The collateral damage from radiotherapy can be enduring and not at all nice - especially to the rectum and bladder.

    4. Both surgeons I discussed this with (one in UK oe in Australia) accepted that surgeons and physicians would never agree but said that there was no way they would put themselves through radiotherapy unless it was impossible to avoid it. They also felt that with robotic surgery there was a greater chance of regaining normal continance and erections after surgery than after radiotherapy.

    Good luck whatever you decide. It's not as black and white as I have made it seem or the decision would be a no brainer.

    • romneyj
      romneyj jerald1234

      Posted

      Lol, I'm waiting for the op. It's set for 24th January.

    • charles61038
      charles61038 jerald1234

      Posted

      Sounds like you can avoid surgery and opt for other treatment options. The seed implants work... some guys have the seed implants along with radiation depending on the degree of cancer in the prostate. There is a good website for the Prostate Treatment Research Foundation. This website shows different treatment options and their success rates. It would be a good one for you to check out. I had the seed implants - Brachytherapy nearly 8 months ago. So far, I am doing well. At my 6 month follow up, my PSA was down to 0.15. A few side effects in the first 2 to 3 months, but nothing servere. Ibuprofen helps with discomfort from the inflammation caused by the radiation. The good thing about the seed implants is that the radiation is very low. It is consentrated to the prostate which cuts down on the exposure to the bladder and rectum. After several months, the radiation is gone... it has done its job. Good luck to you... keep us posted on your decision.
    • stewarta
      stewarta romneyj

      Posted

      I agree entirely with you.

      1) PSA is meaningless relative to having a 3T MRI. Mine was 2.4 rising to 3.5 over a decade, yet the MRI showed an anomaly in the prostate.

      2) a MRI guided Biopsy is safe from infection-causing, yet the Gleason score of 8 detected was in fact a nastier 9 from post-op pathology tests.

      3) your comments about a Robot-Assisted assisted Prostatectomy being better than radiation are correct. It can be followed by radiation, but after radiation, cell destruction is the thing that stops surgery. Reconnecting the urethra to the bladder is the issue.

      4) if my Gleason score had been 7, I would probably have rolled the dice three times until I got the watch and wait answer. I am 70 yo, and reckon the real issue is do I want the extra (say) 15 years. Having just spent a month travelling to car racing events and museums in Germany (I live in Oz) my answer is a resounding yes. I am 9 months post surgery with a zero PSA result.

      Hope there is some help in my answer.

    • barney34567
      barney34567 romneyj

      Posted

      I wish to add that your point on on robotic surgery in regards to continence is spot on. I had such surgery mid August and am close to 90% of my former continenence. I wear one light pad all day, just in case I leak but don't wear it in bed.

      Surgery, robotic or not, is suitable if it is be sliced the PCa

      is localised and the patient is considered 'young'.

    • barney34567
      barney34567

      Posted

      sorry, my iPad spell checker is playing up.

      I meant to say ' surgery, robotic or not, is suitsble it is believed that the PCa is localised and the patient is "young" 

       

    • barney34567
      barney34567 stewarta

      Posted

      I am 50 and had surgery 2 months ago for a Gleason 9. I fully agree with romneyj and Stewarta's contributions on this issue. Spot on!

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