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Cancer: Prostate Message Board
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Old 01-22-2013, 04:34 PM   #1
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Torn between options...

66 yr old male, diagnosed with prostate cancer with a PSA of almost 40 and Gleason score of 8. Urologist pushing for surgery in 3 weeks. Open or robotic surgery? There's still the posibility of radiation, after. And hormones? Up to a year or so?
Anyone else out there that's been down a similar path? How has it gone for you?

 
Old 01-23-2013, 12:54 PM   #2
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Re: Torn between options...

I'm sorry to hear about your diagnosis. You must be in shock. It's hard to absorb all the facts and opinions about treatment when you're still reeling and feel time pressure to act.

Urologists always push for surgery -- it's what they do. It's up to you to get other opinions. I know it's hard to do when all you can think of is getting cured as quickly as possible. You are fortunate to live in a city that has arguably the best radiation oncology department for prostate cancer in the country at UCLA. Michael Steinberg, the chairman of the department, has brought in an array of "super stars" over the past few years, including Jeff Demanes, Pat Kupelian and Chris King. I think talking to any of them will be eye opening for you. They will most likely suggest a combination of external beam radiation to the local area combined with a brachytherapy boost to the prostate itself.

The problem with surgery for high risk PC like yours is that it may have already escaped the prostate. You can have an MRI to check for obvious extraprostatic extension, and your doctor can run a "nomogram" based on your biopsy results to show the probability it has escaped. If it has, surgery is not curative and may indeed spread the cancer if it is cut into. Radiation, on the other hand, treats a safety margin outside of the prostate and may be curative. If the cancer has already metastasized, neither will be curative.

Surgery after radiation is highly specialized but possible. More to the point, however, is that additional radiation or ablative salvage therapy is probably a better choice. Radiation after surgery causes more complications than either alone and should not be entered into lightly.

The principle advantage of surgery is that you will know with great certainty if you got it all. The pathology report will tell you exactly where the cancer was, and a sampling of lymph nodes will tell you if it has spread there. PSA will fall to undetectable levels and stay there.

I haven't seen any study demonstrating that hormone therapy is beneficial before surgery. It is even questionable whether it is beneficial with today's dose-escalated radiation. There's a clinical trial running now to determine that. Hormone therapy increases side effects. Many cancer centers add up to 2 years of hormone therapy after radiation although that is controversial.

- Allen

 
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Old 01-23-2013, 10:26 PM   #3
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Re: Torn between options...

Although my PSA was not as high as yours, I did have a Beacon Score of 8. After a CT Scan and Bone Scan, it was determined that it (the cancer) was localized. After looking at all the options, I opted for IMRT at Oregon Health and Sciences University, that has the Calypso System. (GPS for the body). It is a 4D real time system, that monitors three beacons during radiation treatment, that were implanted in the prostate, and therefore has much greater accuracy. The Beacon implant process was very similar to having a biopsy done. The biopsy was 12 samples, there are only 3 beacon implants. I then had 28 radiation sessions along with the hormone treatment. I am now done, and my test result as of last Friday was a PSA reading of 0.08.
Side effects? Mostly from the hormone therapy. Hot flashes, and some minor muscle pains. Minor burning sensation when urinating, but that's it. I worked 8plus hours a day. Traveled locally on sales calls. Slept through the entire night, every night. Hope this helps.

Ron

 
Old 01-24-2013, 09:12 AM   #4
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Re: Torn between options...

Ron-
Glad to read your side effects are minimal... How old are you? When did you have your treatments started? What did your radiation Dr. say about the possibility of new cancers in say, 5 years? How has any of your treatments affected your libido and erections?
Thanks,

 
Old 01-24-2013, 11:57 AM   #5
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Re: Torn between options...

I am 64. My treatment started on December 18th and completed Jan 18th. 28 sessions in total. As far as 5 years down stream, I looked at all the published data, that has been collected over the last 20 years by different hospitals that have done the studies. It is all available on line.
My focus was on the cancer. I jumped on it really quick, based on the information I received from the team of doctors. I did not want it to spread. I have seen and read too many horror stories about guys waiting or putting it off and making things a lot worse. So libido and ED were not even on my list of priorities, and still aren't. I am healing right now. I will tell you that I still "eye the ladies" so libido is intact. But I need some time to heal.

Ron

Last edited by ron380; 01-24-2013 at 11:58 AM.

 
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Old 01-24-2013, 12:30 PM   #6
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Re: Torn between options...

I'm 59 - was treated 2 years ago with SBRT. Testosterone dipped after treatment but has since come back to normal levels. Libido and erections are as strong as ever. I'm still getting used to the loss of ejaculation when I have an orgasm, however. That's the only lasting side effect of treatment for me -- no lasting urinary or rectal issues; in fact, urination is much improved (I never have to get up at night to pee).

In a recent study at Memorial Sloan-Kettering among men who'd had external beam radiation, brachytherapy or prostatectomy and were followed for ten years after treatment, they found that all 3 groups had the same secondary cancer rate for cancers in the pelvic area -- about 2-4% incidence whether they had radiation or not. Secondary cancers outside of the pelvic area only depended on their age and whether they smoked.

- Allen

 
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