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prstatectomy or radiation and hormones

greg from pa
Posts: 86
Joined: Jun 2010

I am a 51 year old survivor of oral cancer.I have been on remmission for 3 years.from this I know sometimes the best advice comes from those who have been there.  i have been recently diagnosed with prostate cancer.psa 42    biopsy shows 8 out of 12 cores positive. ( 3+4  3+3  3+3  3+4  4+3  3+4  4+3  3+3).i have a clear ct and bone scan.  urologist suggests prostatectomy  rad oncologit says she can cure it with radiation and hormones.  I hate the idea of "chemical castration and painfull radiation again. i am leaning towards robotic nerve sparing surgery at hopkins.  I go to hopkins for consultation next week.if you have had either one of these treatment regimens please share your experiences.It would be great to save the ability to have an erection. i know ther are no guarantees   thanks  Greg

yankeefan
Posts: 69
Joined: Mar 2013

My biopsey showed cancer in only one of 13 cores, gleason 7 (3+4), per hopkins pathology report. Because my prostate was large, my surgeon, who did both robotic and open prostatectomies, recommended doing it open vice robotic. He said it would make his job much easier and generally, he advised, you get a better result when the surgeon's job is easy. Because my dre was negative, the surgeon was planning to do a nerve sparing procedure. The one core that was positive was on the left side of the prostate. After the operation the surgeon said he spared the nerves on the right side and hopefuly some portion of the nerves on the left side...in other words, I understood him to say he probably didn't spare all the nerves on the left side. Obviously, I was hoping to hear him say he had saved all the nerves on both sides. The surgeon emphasized that he had probably added 15-20 years to my life...i'm currently 68...vice the only 5 or so years I would have had had I not had the surgery. In other words, his main focus was on saving/extending my life, not necessarily "sparing my nerves." I'm only 2 weeks out of the surgery so it is probably too soon to tell if I will get sexual functioning back or not. BTW, my highest psa was about 4.5. Hopkins is a great facility, probably the best in my area. The urologists there are considered experts in prostate cancer and in prostate cancer surgery. In your case, before jumping to surgery, I'd schedule a consult with an expert or two from hopkins and discuss all the options. My path report post surgery showed that the cancer was all contained within the prostate, which is good, and is what my local urologist, who referred me to hopkins, said he expected. In your case, that may or may not be the expected case. Prostate cancer is complicated and there appear to be a variety of options. The options may differ depending on whether they believe the cancer has already spread beyond the prostate, and if so, by how much. I certainly don't know enough to advise you, that's why I say go talk to the most expert doctors you can. If you do decide to have surgery, I can't imagine a better place than hopkins. The bottom line on surgery, though, is that where you have it isn't the critical factor, the critical factor is the expertise and skill of the surgeon, especially in the case of robotic surgery, but in open as well. If you go the surgery route, pick a surgeon who has done hundreds if not thousands of these operations. Truely, it is the skill of the surgeon that will make the difference between a good experience and a bad one.

I was also worried about incontinence. so far that doesn't appear to be a problem. I barely leak at all. In fact my urinary functioning is better now than prior to surgery. I had BPH and even with flomax I had issues with urinary functioning that impacted my life style. Now with out a prostate my urine flow is great, the frequency is much less and the urgency is diminished. 

talk to as many experts as you can, get all the pros and cons before you make your choice...and best of luck.....

 

Samsungtech1
Posts: 350
Joined: Jan 2011

As far as I know no one on this site has put a survey out there to see how everything works.  You get RP they tell you spared nerves or not.  No matter what they say beforehand.  If I had it to do over again I would choose Cyberknife.  RP will get rid of problems, but you do not know until you wake up what happened.  They might say nerve saving, etc, but when you wake up it might be a different story too late to say sorry about tha.

Moderate PCa should be treated with Cyberknife.  Once it has spread getting it out is a start.  The problems from pCa RP are, in my opinion, severe.  If you know it has spread then go with RP.  If not Cyberknife

VascodaGama's picture
VascodaGama
Posts: 1508
Joined: Nov 2010

Greg

You have not mentioned about the clinical stage attributed by the urologist but by the data you shared it is more likely that your stage is for risk of metastases.
8 out of 12 cores positive indicates large volume of cancer probably producing the majority of the serum PSA. The Gleason score of 4+3=7 is for a high risk case even if the prime pattern of 4 was found in only two cores. The negative scans are good but with the other data it raises a flag for micro-metastatic diagnosis. This is hard to treat.

I am sorry about my negative opinion. I think it is good for you to know about other survivors experiences. We are not doctors, however we can explain about our cases which may be of help to you.

I also confronted a case of micrometastases. My initial PSA was high (22.4) and the biopsy shown all cores positive (6x6) with negative image studies (MRI, CT, CD, Infra-X, Bone SS). I choose open RP knowing about the probability of extra capsular extensions. I wanted to get it out but later I confronted recurrence. This occurred in 2000 at the 50 years old. I pursued tests to locate the cancer and tried PET, but up to this date I never got a picture of the bandit (positive image study). My continuous increasing PSA is proving of existing micrometastases.

Latter I followed with salvage radiotherapy. This was done because it is the typical sequential way for treating recurrent cancer. It was done by guessing locations. There were no apparent targets to treat, so I could only hope to hit the bull’s eye. It was like throwing arrows in the dark.

At present times there are better equipments for image studies providing higher resolution which can detect smaller sizes of tumours. You could try to get a better picture to verify for any spread, out of the prostate gland, which would render not only the nerve spare technique but the whole surgery out of the spectrum of treatments to your case. Radiation is preferred in such diagnosis because it got higher rates of success, when the cancer is not contained but still localized.

I think you should get more advice from specialists. I would try to get better diagnosis before deciding.

I wonder about the other facts found by the pathologist in your biopsy cores. Is there any mention of benign prostatic hyperplasia (BPH)?
Was there any positive DRE?
What about the results of other test, such as PAP?

I recommend you to do more researches about diagnosis and treatments, in particular regarding the side effects. They all cause a variety of symptoms and got risks. The protocol suggested by your radiologist with the combi of RT+HT is typical. Studies have shown that the hormonal portion of the combi result in a 25% improvement of the main portion which the RT.

Erection dysfunction (ED) is most prevalent in surgery. RT is more likely to cause proctitis. HT is drudged induced hypogonadism which does not cause ED but it lets us libido less with hot-flashes and fatigue like symptoms during the period that the drug is effective. Once we stop taking the drugs, the libido returns and the symptoms disappear.
Surgery and radiotherapy may cause irreversible consequences.

Yankeefan is providing you with good information on Johns Hopkins. This is a reliable institution treating PCa. You could request for consultations with several specialist at the same time.
It is better that you are accompanied by a family member to take notes. You can also prepare in advance a list of question. Try reading books and participate in PCa forums to gather the most information before deciding.

http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

 

Diet and a change in live tactics become important to counter the treatment effects. Physical fitness programs and proper nutrition are important when dealing with prostate cancer. UCSF got a publication on Nutrition & Prostate Cancer, which copy I highly recommend you to get.

http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

 

Here is another good link;

Newly Diagnosed Prostate Cancer:  Understanding Your Risk
http://prostate-cancer.org/PDFs/INSIGHTS/Insights-Aug-2012-ROUNDY.pdf

 

Some books;
http://csn.cancer.org/node/213559#comment-1017931

 

Best wishes and luck in your journey.

VGama  Wink

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