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Laser Ablation or Radiation?

sammym65
Posts: 6
Joined: Jan 2017

I have stage 1 prostate cancer, very early and the radiologist wants to do 8 weeks of 5 days a week for 20 minutes, treatments for a couple of lesions that are 3 mm, and 1 is 5mm......pl?us he wants to start out with Lupron Harmone injection then do the radiation. The sound of that much radiation on such small lesions scares me to death! why so much, on a couple of small places.

Have looked at Laser Ablation which sounds very safe and easy to do, without radiation! can anybody make a suggestion?

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

Sam,

Radiation in prostate cancer (PCa) treatment is typical and has been arround for many years, with certified results. Laser ablation is not that old as a treatment for PCa. You need to investigate further to be more assured on the options.

In any case, both treatments may be effective if the cancer is whole contained in the gland, however, that is difficult to certify. Can you share details of your status?

What is your age?

What is the Gleason score and PSA histology?

How did they find the (two) tumours and how did they diagnose them as cancerous?

Proper diagnosis lead to proper treatments and successes. The risks and side effects of therapies may prejudice your quality of life. You need more assurances that you are deciding in the best.

Welcome to the board.

VG 

sammym65
Posts: 6
Joined: Jan 2017

Hi VG, thanks for the response!

I'm 65, and was not given the gleason score, just a print out of a sectional view of the prostate showing the location of the lesions, which are both on the right lateral, near the outer radius of the wall was determined by Gleason standards. I had a PSA score of 2.7 in Nov. 2015, this past Nov of 2016 I got my yearly check up, and the PSA had risen to 3.72. Urologist then wanted to do investigate and it revealed that my prostate was 2-1/2 times larger than normal, or about 90 grams. A biopsy was taken and it turned out that there are 2 lesions that are about 4 to 5mm, so we did a bone scan and CT scan, as well as a chest X-ray, and cancer has not spread anywhere else.

I was told that I needed Lupron harmone therapy to be followed by radiation using either IMRT or IGRT, but the scary part is that he said that I would need 8 weeks of 5 days a week treatments!!!!!  I'm having a hard time believing that I need this much bombardment of radiation for these two small places! I am not totally against doing the treatments, but this sounds like an overkill to me! I'm a very wholistic approach person, and want to learn about alternatives like laser ablation, but the oncologist was very negative about that procedure, but I realize that these new inventions scare the most doctors because of the threat of losing business to a concept that is growing and proving itself to be very effective without the threat of healthy tissue damage that radiation can bring, and usually does create to some degree....

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

Sam

The information you provide is limited to judge on what would be best to treat your case. However, radiation treatment is usually well accepted in terms of administration and outcomes. You have a long life expectancy so that treating with intent of cure is logical. Holistic therapies are mostly palliative and some are also linked to side effects.

Radiation has several forms of administration and these are chosen according to the patient status. The type suggested by your doctor, IMRT, is the most typical. It is administered for a specified total dose (approximately 80Gy) which is distributed in a number of sections (about 2Gy each) that takes about two months of administration. Each section takes just 3 minutes (about 30 minutes daily in the clinic) so that one can continue their normal daily life.

There are other forms of radiotherapy that take lesser number of days for administration. They are more convenient but they are recommended to cases where cancer is thought to be contained (whole cancer inside the gland). I do not know why your doctor has suggested IMRT however you should inquire if other types are proper for you. For instance, Brachytherapy is done in one day and Cyberknife is done in 5 days.

I would recommend you to read the details of each type and decide in some you feel comfortable with. Here is a link;

https://www.cancer.org/cancer/prostate-cancer/treating/radiation-therapy.html

You should keep copies of the tests and reports and exams in a file. The report of the biopsy will describe the type of cancer and Gleason found by the pathologist. Aggressive types need to be treated aggressively. The PSA was elevated but big glands produce higher levels of the stuff. Yours at 90 cc is very big which makes it difficult to treat. The neoadjuvant (previous) hormonal treatment may have been suggested to try decreasing the gland's size (?).

Surely you can choose alternatives to the traditional but all therapies have risks attached and should be administered to accomplish the best in one time. One must be careful in his choice. In the end it all depends in one's status. Is your case aggressive?

Best wishes,

VG

sammym65
Posts: 6
Joined: Jan 2017

The radiology oncologist told me the cancer is NOT aggressive, and I as I mentioned to you already the two places are 3mm and 5mm located along the outer edge on the right lateral, and it has not metastized to any organs or to bone.....There is no way that I will buy into needing 40 treatments for this very early detection! Yes the harmone therapy is meant to decrease the prostate size, but I haven't read any reviews that are favorable to Lupron, or any other harmone therapies and have actually read about the many NEGATIVE side effects of these harmones!!!!!  Yes Brachytherapy sounds more reasonable and seems to be more tailored to my condition, but that has NOT been mentioned as an option, in fact, no other options have been offered to me, other than radical prostectomy, which really makes me skeptical of these doctors!

Your statement about Hollistic therapies being "palliative" but the side effects of radiation are far more lingering from what I'm reading, and what bothers me the most is that you can't screen out your other nearby parts from being radiated, regardless of how "focal" they claim the beam is going, I just don't buy it! However, I believe that Laser Ablation therapy is far safer, with hardly no side effects, and is not a threat to healthy tissue, and seems to be gaining credibility every day.

I feel that I have a lot to research, and not getting all the info from my doctors, and this alarms me!!! I won't be a statistic or a lab experiment for anybody!!

I appreciate your input, and I will read the link that you've sent!

Sam

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

I think you should do what you prefer and feel most comfortable with. Laser therapy for low risk cases of prostate cancer became popular in England. However there are no published long cohort results to verify its success. Your outcome from laser therapy most probably would became part of those statistics.
In any case, treatments are decided with basis on proper diagnosis with evident retrieved data. When judging the status of a patient Doctors also depend on several reports from other specialists. A simple misinterpretation by one of them would affect the whole diagnosis process and prejudice the final decision. The pathologist is the one that specified the characteristics of the cancer he found in biopsy cores, and surely he did not report it with words like "cancer is NOT aggressive". He used a grade, namely, the Gleason score. His report also relates to a tiny portion of the gland (approximately 1/50th of your large prostate in a 12 needles biopsy). Image studies are the ones that provide a clue on the location and extent of cancer but these have limits in detection when cancer is small in size. In particular the exams you describe above are typically linked to false negatives.

My recommendation is for you to get second opinions from various specialists before deciding, including those specialized in laser treatment. You should bring along copies of the pathologist report, tests and image studies results. I wonder how much you trust your doctors when, in your words, you say "...I feel that I................not getting all the info from my doctors....".

In the end it is you that will decide on a therapy recommended by the doctors. They will inform you and you need to find about the details. Before treatment they will request you to sign an agreement relieving the hospital and physicians from any responsibility in wrong outcomes.

Best wishes and luck in this journey.

VG 

Clevelandguy
Posts: 441
Joined: Jun 2015

Hi,

Will the laser only hit the turmor and leave the rest of the prostate?  If so what are the chances of the healthy prostate tissue going cancerous in the future?  Would you have to undergo the laser maybe several times over a period of a few years it the cancer re-appears?  If it was me I would like to know what the gleason score is before I commit to any kind of treatment.  If you have an aggressive type of cancer maybe radiation would be a better option.  

Proton beam radiation has a limited focal length so it hits just the tumor and the radiation does not go completely through and possoibly damage other tissue after it has hit the prostate.  I guess the beam would hit tissue on the way in but stops at the prostate.

Dave 3+4

sammym65
Posts: 6
Joined: Jan 2017

Thanks for your reply! I'll learn more about Laser Ablation this Thursday as I have an appointment with their doctors for initial consultation. My cancer is not aggressive according to my doctors, I just need more options at this point, and I will find out the Gleason score.

I've heard good and bad about Proton Therapy!

MEtoAZ
Posts: 37
Joined: Feb 2016

Welcome to the forum, As you've seen from the responses, there are numerous treatment options and ultimately, the onus is on you to make the decision you are most comfortable with.  Doctors tend to rely on their experience (don't we all).  With low-grade, non-aggressive cancer, you certainly have time on your side to make a decision. 

I did research Laser ablation, and outside the US, it seems to be used fairly routinely but in the US, it is very limited and therefore access to care and follow-up treatment is expensve (not covered by insurance) and limited locattions within the US.  In my case, I chose Cyberknife over surgery (I was 52) and other options due to the relatively short treatment period (4-5 days) and the lack of any immediate side effects after the procedure.  My doctor wanted me to take Lupron as well and even prescribed it (after I said no).  I still declined as in my case, I went from 93% likely cure to 94% likely cure so I did not want to deal with side effects of Lupron for one percent, but every case is different. 

Good luck with your treatment choice, this is a very beatable cancer, especially when detected early.  You also have the active surveillance route as another non-treatment choice so at your stage/age, doing nothing but monitoring and lifestyle improvements is also a viable option.  Many have gone down that path as well.

sammym65
Posts: 6
Joined: Jan 2017

I will check into Cyberknife, as I am interested in a short treatment period and fewer side effects afterwards! How long ago did you have the procedure? I haven't found anything positive about taking Lupron, other than prostate shrinkage, and my doctor also wants to do that therapy for me, and I have refused it! I truly believe that I will take advantage of "Watchful Surveillance"  for the next 6 months or so, and see where I am then. In the meantime there are many things that I can do such as a better diet and exercise, with some proven supplements and alternative therapies.....

MEtoAZ
Posts: 37
Joined: Feb 2016

I had 2 of 12 cores positive, one 3+3 and one 3+4, initial found by a slightly elevated PSA of 5.1.  My PSA progression since treatment has been 1.6, .9 and latest was .72 so doctor is very pleased with the progression and feels that I am ahead of schedule in that regard, so far, so good.  There are lots of good posts here around those pursuing the Active Surveillance route and lifestyle changes that were adopted during this period.  You have time, remember that the first word of AS-"Active", continue to monitor your PSA and get checked out regularly to make sure you are able to quicklly detect a change in status/progression. 

Old Salt
Posts: 720
Joined: Aug 2014

I recommend that you look if you are a candidate for Active Surveillance. This approach, usually only for Gleason 6 cancers, requires careful evaluations of your prostate at predetermined intervals. No treatment if your situation doesn't get worse.

I also recommend that you continue to increase your knowledge about treatments. No immediate decisions are necessary, unless you have a high Gleason score (you should really inquire; it's of the utmost importance!). With regard to further study, I notice a number of misconceptions in your posts:

1. Two lesions were found; this doesn't mean that there aren't others. A biopsy samples a tiny part of the prostate. I don't want to scare you, but it's possible that other lesions are present and conceivably (!) more aggressive.

2. The two lesions that were identified are close to the margin. This is a warning that cancerous cells may have escaped. I emphasize 'may', because we don't know and can't find out at this point with the usual scans.

3. Although hormone therapy has side effects, all of us writing on this forum have survived. I personally didn't like it, but the side effects usually go away after the testosterone has recovered. Mine did. One can find lots of horror stories on the internet, but that's not representative of studies done with larger groups of patients.

Finally, I want to point out that the reason your radiologist recommends 40 sessions of IMRT could be that he has access to that equipment. It is the classical form of therapy for cases such as yours, but there are other methods (see Vasco's post earlier). Personally, I think that five SBRT sessions are just as good for organ confined prostate cancer. And there are numerous published studies to back up that statement.

sammym65
Posts: 6
Joined: Jan 2017

I believe the Active Surveillance is my best option at this point, and there is no need to jump up to radiation treatments at this point. My doctor did the 12 point biopsy to determine his result, and if there are other lesions, they didn't show up, so I can't see any reason to think that I may have others.....

When you received the harmone therapy (I assume it was Lupron) did it shrink your prostate permanently, and are you having to still fight an enlarged prostate, and if you are, what are you doing for it? drugs?

I'm not sold on harmone therapy, and I read more stories about lingering side effects than success stories, this bothers me!....

I will look into the SBRT sessions, thanks for your input!

Swingshiftworker
Posts: 1013
Joined: Mar 2010

OP: I too was treated successfully w/CK back in Sept 2010.  Have been cancer free since with absolutely NO side effects.

If it's not clear to you, when being treated w/radiation for prostate cancer, the ENTIRE prostate is treated, not just suspected sites of cancer.  This kills ALL of the cells in the prostate and eliminates any doubt about the possibility of a spread.  This is the same for IMRT, CK, BT (brachytherapy) or any other method of radiation used.

CK is by far the most precise method of radiation delivery currently available and I would dare say as good (and perhaps even better) than the precision available via laser ablation.  CK now has a 10 year track record with an excellent record of success.  Only 3-4 treatments over a week are required and CK can deliver radiaiton at the sub-mm level in 3D and can be adjusted for organ and body movement.  During one of my treatment sessions, the session was paused by the radiation tech to allow gas to pass through my intestine in order to avoid any error in radiation delivery.  That's how accurate CK can be.

You are an excellent candidate for CK.   You should take the time to find a CK site near you and discuss the specifics of your case w/the attending RO there.

Good luck!

PS:  No problem w/going w/AS t this point in time but the question is whether you can live w/the knowledge that the cancer may advance at some unknown point in the future.  I couldn't live w/that myself but perhaps you can.  As for HT medication, I would avoid it at all costs.  Quite a few current threads here relating to this topic, including some where men have chosen to opt for physical castration over HT, if it became necessary.  Fortunately, I have not had to make this decision yet but, if I do, I am in the latter camp.

 

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