Need treatment options opinions

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paintednails1
paintednails1 Member Posts: 2
edited March 2014 in Prostate Cancer #1
I am new and would like some personal opinions regarding treatment options available to my husband. His medical history is as follows: slightly elevated PSA led to a biopsy a few weeks ago in December. Cat Scan and bone scan clear. Gleason 4+3. So we met with doctor at MD Anderson who says it's Stage 1, but still should be treated. (And believe me I understand from reading a few other posts how lucky we are.)

Doctor agrees with urologist that surgery would not be a good option because he's 71, a little overweight, with heart problems and diabetes. We assumed he would be having the Brachy therapy so he got a 3-month Lupron shot a month ago and is handling it well.

According to doctor at MD Anderson my husband's options are: (1) Brachy Therapy, (2) Brachy plus 5 weeks of IMRT, (3) 8 weeks of IMST, (4) 8 weeks of Proton Therapy. Fully insured; various degrees of travel inconvenieces, but all easily managable.

So, all being said, what experiences have y'all had and would you have done the same with these choices?

Thank you so much for your input.

Comments

  • JR1949
    JR1949 Member Posts: 230
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    Treatment options
    I know MD Anderson is one of the best hospitals for cancer and you are lucky to have caught this early. Yes, still should be treated. Early detection is the key to surviving any cancer.

    That being said, I can't give you advice on which option to choose because I had radical prostatectomy surgery (PSA 22, combined Gleason of 7 in March 09)and praise God a cancer survivor. Good news however because you have come to a good discussion board. There are many good men and women who can give you advice about your therapy options. This is truly a wonderful brotherhood and sisterhood.

    I wish your husband all the best.

    JR
  • VascodaGama
    VascodaGama Member Posts: 3,668 Member
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    All types of RT have different outcomes
    Hi Nails

    Stage 1 patients are not usually recommended for radiation therapy. I think that you are mistaken the diagnosis given to you. Can you describe the results of the biopsy (number of cores positive, etc), volume of prostate, PSA history before Lupron, DRE, etc., which are vital for some guys here to opinion on the treatment choices you pointed out.

    As your doctor recommended, surgery may not be the best solution to your husband because of his other health problems. But radiation is not a walk in the park too. There are side effects which you should be aware of before embarking on the treatment.

    All types of RT you listed have different particularities, which reflect better results in some cases than in others. Seeds implant (bracky) is the one with longer number of years of application and Proton therapy using particles (protons) hair-beams are the most accurate form of delivering radiation treatment in the present days, but it is expensive and it does not mean that it may be the best in your husband’s case. Whichever form of radiation you choose the important will be to have the treatment done at the best clinics with a reliable team of radiation oncology professionals.
    One could say that, in the hands of an excellent radiologist and modern IGRT-IMRT/IMPT machines, the success of the treatment is assured.

    Wishing your husband the best in this bumpy road.
    VGama
  • Kongo
    Kongo Member Posts: 1,166 Member
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    Welcome
    Paintednails,

    Welcome to the forum but I wish you didn't have to be here. You are fortunate to have detected the prostate cancer as early as you did and MD Anderson has a national reputation for being a world class cancer treatment institution.

    As your doctor suggested, most urologists are hesitant to pursue a surgical course for men over 70 but it's more of an overall fitness and well being issue rather than an arbitrary age cut off. Given the diabetes and the extra weight your husband has surgery may be inviting more problems than surgery would solve.

    There is no perfect prostate cancer treatment. Each individual cancer patient is unique with different grades of cancer and overall physiology. You should also be aware that every treatment course has its own set of adverse side effects that will impact your husband's quality of life following treatment. Radiation side effect generally impact continence and erectile function with sometimes some rectal toxicity. While complete incontinence is very rare, many men having radiation feel a sense of urgency for a few weeks after treatment like they have to visit the restroom quickly. These symptoms can be treated with Advil (for mild cases) or Flomax. In any event, the generally go away after a month if they occur at all. However, if your husband has difficulty urinating now (weak stream, start/stopping, having to go frequently) these problems can be exaserbated by radiation. Erectile issues, if they occur, tend to take place several months or years after treatment but luckily are easily treated by drugs like Viagra.

    Brachytherapy, IMRT, or a combination of both have been shown to be highly effective in treating prostate cancer with impressive long term success rates in the 90%+ range at the ten year point. Proton therapy (I consulted with Loma Linda in Southern California while researching my own treatment course) has also shown to be effective but no more so than other radiation treatments at much more cost and inconvienience.

    Your doctors probably explained to you the significance of the Gleason score and the 4+3 is potentially a serious condition (rather than say a 3+4). I strongly recommend that you seek a second opinion on the biopsy slides from another institution (your doctors can recommend one and tell you how to do it) to be confident that you're dealing with what you think you're dealing with. Second opinions frequently change the Gleason score (either up or down) and this could have a significant impact on which treatment course is best for your husband.

    Best wishes to you both,

    K
  • lewvino
    lewvino Member Posts: 1,010
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    First wishing you and your
    First wishing you and your husband the best in his treatment with this cancer.
    I'm 56 and also had a Gleason 4+3. The good news is they have caught his cancer early.
    I had the Davinci surgery and understand that this appears to be ruled out for your Husband. I'm at 17 months post treatment and doing great.

    My father had Proton treatments for his Prostate cancer and is doing great 13 years after treatment! However his cancer was graded 3+3.

    Please keep us posted on how your husband does. We are all cheering him on!

    Larry
  • Julietinthewoods
    Julietinthewoods Member Posts: 15
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    Our experience
    Paintednails1,

    Making the initial treatment decision can be difficult. I remember being so surprised to learn that this choice would be ours alone! My husband was also a stage 1, with a Gleason score of 7 (3+4 in his case). We were told that any treatment would be an option for him. His prostate gland size was small, his DRE normal and he had no symptoms at all. Both doctors with whom we consulted were very confident that radiation was a valid option for him.

    We quickly ruled out surgery for personal reasons relating to his work circumstances and our memories of my own past horrendous experience with a botched surgical procedure. That left us with the radiation choices. My husband elected to undergo 45 sessions of IMRT with gold markers. To him, it was the easiest and least invasive treatment. He was willing to spend the nine weeks of 15 minute appointments each morning before work. Luckily, the clinic was located very near to his office. He was able to miss no work other than those time slots and the appt. for the gold marker placement.

    He described the gold marker placement as 'much easier' than the two biopsies he endured. However, there is a thread on this forum concerning infection following the procedure, and I would discuss that with the doctor beforehand if you decide to go that route.

    My husband has had absolutely no side effects from radiation...yet. His last treatment is tomorrow. He has experienced no fatigue, no bladder issues, no irritated skin, nothing. Hopefully he will be as lucky with long term effects, and of course, cure. We are well aware that there is some chance of late-term side effects. Right now, he needs to be present and functional at work, and he is so relieved that right now all is well.

    I tell you this just because you asked for the personal experiences of others, and not to in any way influence you! Each man's circumstances are different, and I agree that you are in very good hands at MD Anderson. Wishing you an uneventful treatment course whatever you decide!

    Juliet
  • paintednails1
    paintednails1 Member Posts: 2
    Options

    Our experience
    Paintednails1,

    Making the initial treatment decision can be difficult. I remember being so surprised to learn that this choice would be ours alone! My husband was also a stage 1, with a Gleason score of 7 (3+4 in his case). We were told that any treatment would be an option for him. His prostate gland size was small, his DRE normal and he had no symptoms at all. Both doctors with whom we consulted were very confident that radiation was a valid option for him.

    We quickly ruled out surgery for personal reasons relating to his work circumstances and our memories of my own past horrendous experience with a botched surgical procedure. That left us with the radiation choices. My husband elected to undergo 45 sessions of IMRT with gold markers. To him, it was the easiest and least invasive treatment. He was willing to spend the nine weeks of 15 minute appointments each morning before work. Luckily, the clinic was located very near to his office. He was able to miss no work other than those time slots and the appt. for the gold marker placement.

    He described the gold marker placement as 'much easier' than the two biopsies he endured. However, there is a thread on this forum concerning infection following the procedure, and I would discuss that with the doctor beforehand if you decide to go that route.

    My husband has had absolutely no side effects from radiation...yet. His last treatment is tomorrow. He has experienced no fatigue, no bladder issues, no irritated skin, nothing. Hopefully he will be as lucky with long term effects, and of course, cure. We are well aware that there is some chance of late-term side effects. Right now, he needs to be present and functional at work, and he is so relieved that right now all is well.

    I tell you this just because you asked for the personal experiences of others, and not to in any way influence you! Each man's circumstances are different, and I agree that you are in very good hands at MD Anderson. Wishing you an uneventful treatment course whatever you decide!

    Juliet

    Thank you to all
    My husband was touched by all of the kind words and information written above. Juliet, my husband's circumstances seems very similar to yours. He is listening to everything and decide soon. There's a study at MDA which gives him brachy or brachy with 5 weeks IMRT. He feels either would be okay for him. I will keep everyone posted on his progress.
  • keithsr
    keithsr Member Posts: 1
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    Thank you to all
    My husband was touched by all of the kind words and information written above. Juliet, my husband's circumstances seems very similar to yours. He is listening to everything and decide soon. There's a study at MDA which gives him brachy or brachy with 5 weeks IMRT. He feels either would be okay for him. I will keep everyone posted on his progress.

    Proton Therapy
    i completed proton treatment at loma linda university medical center in california back in may 2003.....happy low psa's to you