Cant make decision between Surgery or Radiation
Posted , 19 users are following.
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
john47646 jerald1234
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j12080 jerald1234
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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 placed a portal on that site for anyone can 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. I uploaded him my MRI and he called us. He spent 3 hours in two different conversation 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. Urologists will not mention Focal Laser Ablation. It is FDA approved and it works vey well in these cases. It also improves dramtically BPH symptoms. Let me know and I will answer your PM> Good luck and God bless.
jerald1234 j12080
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aksns61 jerald1234
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My spouse ( at age 62) hadPCa with high gleason scores ( 8 and 9) but localized cancer plus a small prostate. He had the ADT + EBRT and the seed implants. Results were ( are) excellent. Cancer free. He had NO side effects from the radiation. Success rates with radiation at Sibley and Johns Hopkins in nearby Baltimore were very high and when we spoke to the men's groups who had similar therapy, each gave glowing reports of successes. While there are examples of bad results, I think these are not the norm. Check with patients! get first hand information. You will feel much better about any decision you make, because its based on solid evidence that YOU can see, hear and touch and fits your needs.
barry65984 jerald1234
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Hi Jerald,
If I were you I'd go for the radiotherapy. It is non invasive and these days they can target the cancer very precisely. I am almost through my radiotherapy treatment and have been assured that they can eradicate it. I had a gleason score of 9.5 in all the biopsy samples, so mine was very aggressive. My oncologist said that he would not operate as hormone treatment could keep it under control and even shrink it. Also with an operation there is a chance that some of the cancer cells could escape into the body and as you perhaps know, prostate cancer need not be confined to the prostrate. When my radiotherapy is completed I will remain on the hormone treatment for perhaps two years, or more if necessary. They will monitor it using the PSA test and only revisit it if the PSA rises for three times in succession. You need not "look over your shoulder" - have confidence that it can be cured or if not kept under control. I am suprised you were not offered hormone therapy - my PSA went from 6.5 tho 0.2 after only 2 treatments. Have you explored this route?
Good luck.
jerald1234 barry65984
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rocketman42 jerald1234
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Jerald - you don't mention if your Gleason 7 is a 3+4 or 4+3 - I'm sure you are aware that there is a difference.
This is by no means a comprehensive list but some obvious thoughts that come to mind.
Surgery:
Definitive and you find out what your true Gleason score is.
FInd out if there was extra capsular extension with path report
Easy to follow the PSA for recurrence
Peace of mind
Radiation still a possibility if needed in the future
Similar success rate as radiation therapy
Similar side effect profile with side effects manifested early and possibly resolving over time
Radiation:
Multiple visits without truly knowing if the cancer has been irradicated
May or may not still involve a surgical procedure to place markers etc.
More difficult to interpret future PSA's
Possibility of wondering where you stand / less peace of mind
Fewer options for treatment of recurrence - surgery more difficult and/or impossible
Similar success rate as surgery
Similar side effect profile with side effects showing up slowly over time including possible rectal and/or colon cancer
All comes down to the recommendations of your oncology "team" and your own expectations and personality type.
jerald1234 rocketman42
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Thanks for your nice pro con list. With seeds really no visits from what I understand however it's is considered surgery as anesthesia required. I am 3 + 4.
charles61038 jerald1234
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The seed implants requires a 'volume study' where they measure the size and shape of your prostate. It has to be within a certain size. This procedure is done in the office - no anesthesia required. A little more than a digital rectal exam. A device inserted in the rectum - it is an ultra sound probe that helps plan the seed implants. My prostate was slightly enlarged, so I was put on Tamsulosin (generic Avodart) to shrink it. It took only a couple of weeks. Then I was ready for the implants. You do have to go under anesthesia for it. It is done as an out patient procedure and it takes about 30 to 45 minutes. I liked the fact that it is a one time treatment... once and you're done. I went home after about an hour. They want you to pee a couple of times - then you are released. You are sore for a few days... another procedure I looked into was the Cyberknife. That requires 4 or 5 markers to be implanted in the prostate to guide the radiation beam. The procedure would require about 5 visits - about 45 minutes each. I think the implants was a better choice for me. Everyone is different, so you should investigate all your treatment options. Pick the one that is best for your situation. What ever it may be, my doctor told me to choose a doctor that has performed that procedure successfully many times. And that makes good sense.
barney34567 jerald1234
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lucky you're not a 4+3
stewarta rocketman42
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Of course there is the usual proton beam therapy with all its possible side effects that your radiologist can explain. But there is also photon beam therapy which is far less likely to have the side effects as it is so targeted. One issue with photon beam therapy is that there is no such centre yet in the UK or Australia. There are many in the US, Europe, China and South Korea. The major issue is that it costs so much to have it done. For example, an 8-week stay in Seoul with airfares would add appreciably to the about $50k for the treatment at the National Cancer Centre's Photon Beam Therapy Centre. I was accepted for photon beam therapy as the PCa was encapsulated and had not escaped the prostate.
I spoke with oncologists, radiologists, a cut-em-open urologist, and a robot-assisted specialist before choosing the later. That was 9 months ago.
rocketman42 stewarta
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I think you have it backward. Proton beam is the "new" much more costly surgery. There are several centers here in the U.S. From everything I've read it's no more effective then the other modalities.
stewarta rocketman42
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My apologies ... I do indeed, and have mixed up my i's and h's . Proton Beam Therapy is the newer radiation method.
stewarta rocketman42
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THIS IS HOW IT SHOULD HAVE READ:
Of course there is the usual photon beam therapy with all its possible side effects that your radiologist can explain. But there is also proton beam therapy which is far less likely to have the side effects as it is so targeted. One issue with proton beam therapy is that there is no such centre yet in the UK or Australia. There are many in the US, Europe, China and South Korea. The major issue is that it costs so much to have it done. For example, an 8-week stay in Seoul with airfares would add appreciably to the about $50k for the treatment at the National Cancer Centre's Proton Beam Therapy Centre. I was accepted for proton beam therapy as the PCa was encapsulated and had not escaped the prostate.
I spoke with oncologists, radiologists, a cut-em-open urologist, and a robot-assisted specialist before choosing the later. That was 9 months ago
aksns61 jerald1234
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Perhaps this information will help this discussion thread. The conclusion is quite astounding- all based on solid medical research (its at the bottom of this quote)
Results of the Much Awaited Randomized “ProtecT Trial”, … which has now “forth come.”
Published in the New England Journal of Medicine in September 2016, the study was prospectively randomized and designed to arbitrate the comparative effectiveness of prostatectomy, external beam radiotherapy, and active surveillance in PSA detected localized prostate cancer. The study ran from 1999 to 2009 and reported 10-year outcomes for freedom from metastases, prostate cancer-specific and overall survival. Participants were skewed to lower-risk disease: the median PSA was 4.6ng/mL; 77% had Gleason Score 6; 29% had disease spreading beyond the prostate (pT3), and 76% had non-palpable cancer. In all arms androgen suppression was initiated at PSA >20 and bone scans were performed at PSA >10 ng/mL.
The authors themselves pointed up the major limitations of the study: it was conceived 20 years ago; surgical techniques have changed; there was no use of multiparametric MRI; the less effective conformal 3D technique was used in the earlier period; brachytherapy was not included; and there was no sub-stratification between favorable and unfavorable Gleason 7 disease.
Findings:
1) At a median follow-up of 10 years there was no difference in overall survival among the groups.
2) Prostate cancer-specific mortality in the surgery arm ( 391 men) occurred at a rate of .9 men per 1000 person-years of observation compared to .7 for men in the radiotherapy arm (401 men) and 1.2 (482 men) in the surveillance arm. The prostate cancer-specific survival in all groups was 98.8%.
3) Metastases were diagnosed in the RP arm at a rate of 2.4 men per 1000 person/years; 3.0 in the radiotherapy arm, and at a rate of 6.3 per 1000 person years in the active surveillance arm.
Conclusion: “At a median of 10 years, prostate cancer-specific mortality was low [~1%] irrespective of treatment assigned, with no significant difference among treatments.”