May 07, 2011 - 11:34 pm
This is thread number 2 which I started to make it easier for respondents. If you want to see the original thread from a few days ago, it is http://csn.cancer.org/node/217641
To recap my situation … I will be 73 in a couple of weeks and during a routine physical, my PSA was 5.2, which led to a visit to the urologist and a biopsy. I had 1 core out of 12 that had cancer with a Gleason 8 (4+4). It is a stage T1c. I had a consult with the surgeon, who thinks that RP is the best course of action, but they require that I also consult with a radiation oncologist. He also advised that I was not a candidate for brachytherapy, as it is only for low risk (Gleason 6) cancers but that external beam radiation was an available option for me. He advised RP, due to my excellent health and fitness at my age. He also advised that the hormone therapy usually given along with the radiation has unpleasant side effects.
I have been researching PCa utilizing the internet resources and talking to survivors about their experience. Some of the posters on this site like Mrs PJD, Kongo and others have been very forthcoming with helpful info about their experiences that could be related to my situation. It has been deeply appreciated. My wife has also read every post and is present at my appointments.
Yesterday, I had my consult with the radiation oncologist. Some of your posts, as well as my research had gotten me excited over the possibility of either HDR Brachy or Cyberknife. He dashed both of these hopes, saying that they were not appropriate for my Gleason 8 cancer, as there was not enough controlled study data to lift them out of the experimental category, at least in an academic teaching hospital like University of North Carolina. There is also some question of Medicare paying for these treatments, especially the CK. He made a pretty strong case for a combination of androgen deprivation therapy, which would be administered by an injection in the buttocks every 3 months for 2 1/2 years and about 10 minutes of external beam radiation 5 days a week for 8 weeks, starting a week after the first injection. They would also implant 3 marker seeds (he likened these to gps satellites) via the biopsy needle. These would provide very accurate placement of the radiation by compensating for any prostate movement due to air/gas in the rectum and/or rise and fall of the bladder. He said this is a feature that a lot of hospitals doing radiation do not have available yet.
He said that if I were younger, then RP would definitely be the recommended treatment, but due to my age, he believes that his way is the best. He did explain the side effects of the hormones, which are not nice, but I believe that I could live with them for 2 1/2 years. Some of the side effects are hot flashes, fatigue and libido shutdown.
There is a lot more info that I could tell you, but I have given you what I believe to be the salient points. What I would like is to hear from some that have had the radiation treatment that I have described and their results and impressions, especially the logic they used to choose this course of action. Most of the posters that have responded to me are younger than me. I believe that my age has to be considered along with any quality of life issues.
The bottom line is that I may still be confused, but I'm definitely less than I was 2 weeks ago! I guess that's progress!
Thanks so much,