New to the forum, my dad was diagnosed with prostate cancer and he is struggling with whether to do the radiation or surgery, his levels are different in different spots from 4-9,said his psa is 30. My dad will be 67 this aug., he is in excellent health eats right, excersises can outwork all his younger co workers put together, Any help would be greatly appreciated.
Maybe you can supply some more info; e.g., how many positive cores, and where, what % cancer, stage, PSA history. Was his biopsy read by a lab that specializes in prostates?
They may check for bone metastases with a bone scan or other PET scan.
It is controversial to have surgery with a Gleason score of 9 because there is a high probability the disease has escaped the prostate and he will probably need radiation anyway -- so why have radiation+surgery when he can just have radiation? Treatment for Gleason 9s usually begins with hormone therapy followed by a boost to the prostate with brachytherapy (HDR or LDR) followed by external beam radiation to the pelvic area.
New to the forum, my dad was diagnosed with prostate cancer and he is struggling with whether to do the radiation or surgery, his levels are different in different spots from 4-9,said his psa is 30. My dad will be 67 this aug., he is in excellent health eats right, excersises can outwork all his younger co workers put together, Any help would be greatly appreciated.
The Gleason scores (aggressiveness of cancer), results from Digital Rectum Examination (DRE) and from image studies, are elements essential to get proper advices. His age of 67 and fitness are also important and could suggest that all treatments would do well in his case.
A matter of concern will be the risks and side effects that can be nasty. With surgery he may risk incontinence and ED. With radiation he may risk damage to the urethra, bladder sphincter and radiation colitis/proctitis. Past history of ulcerative colitis is prohibitive to undergo radiation.
Proper diagnoses lead to better decisions and better treatment.
Prostate cancer got many ways of treatment. Your father will do fine like the many of us. He should consider getting the treatment done by specialists and at modern facilities with proper staff and equipment. The outcomes vary a lot depending on the physician.
Ok went with my dad to his last appt, he is going to opt for the surgery, because he was told if the radiation does not take care of it he cannot have surgery afterwards, asked about gleason count his doctor said since one area tested at 9 they treat it like it was all 9.
Whoever told him that is mistaken, although it is a common enough wive's tale. I've heard that from several friends whose urologists didn't know how to do the surgery. It is challenging, but there are surgeons expert in salvage surgery after radiation. And the salvage surgery can even be done robotically. Here are a couple of references your father might want to look at:
"feasibility and safety of salvage robot-assisted radical prostatectomy after radiation failure" http://www.ncbi.nlm.nih.gov/pubmed/21568696
He is correct, however, that the disease is characterized by the highest Gleason score, even if it is only a small amount of one core. The reason is because it doesn't take much for higher Gleason score cancer cells to escape the organ, whereas lower Gleason score cells very seldom escape. Hopefully, it is well-contained within the prostate and hasn't yet migrated out. You didn't mention his PSA history, which can give a clue as to whether it escaped. Also, cancer found near the base is often a more adverse feature, as is lumpiness felt on the DRE. If the cancer is large enough, they can sometimes see if it is extending outside of the capsule with a 3T MRI.
If he goes ahead with surgery, hopefully by a surgeon who has done more than a thousand of that kind of surgery, they will be able to check the margins, the seminal vesicles and sample some lymph nodes for evidence that it has escaped. If it has, but it seems to be contained in the local area, they will then probably follow up with external radiation and hormone therapy. If it hasn't escaped, then there is every hope that it was surgically contained. I trust that his urologist ran a nomogram that shows the odds of this occurring, given the results of his biopsy.
This is a common reason given by urologists recommending surgery, but one that doesn't hold water. There are many options to failed radiation including both low and high dose Brachytherapy and more commonly cryosurgery as well as radical surgery. Given your father's psa of 30 along with a G9 ( Higher Gleason grades give off less psa) it is a very high probability that surgery will fail. You can plug his numbers into the Partin tables or many of the nomograms available and calculate his probability of success; you can do it on line through the John Hopkin's website. Your doctor should do this and discuss the results with your dad. Before you make a final decision you should get a 2nd opinion from an oncologist specializing in prostate cancer. This is an important life changing decision and to make it with only one doctor's recommendation is not prudent. Also a PAP test is highly recommended with his psa of 30 as it is the primary indicator of primary treatment failure. Any high gleason with a psa over 20 should have bone and CT scans; if your doctor hasn't recommended your dad getting these and a PAP test before recommending a treatment I would certaintly be searching for another doctor.
