Which treatment

rjg66

Recently was diagnosted with prostate cancer Gleason score of 7 3+4. Trying to decided radiation or surgery. Very concerned about side affects. Doctors say it's a personal choice.

Can anyone help from past expieriences or knowledge.

Old Salt

Need more info

For instance

Age

PSA history

Complete biopsy report

DRE  result

Scan results

rjg66

66 years old

66 years old

psa bouneced around then kept climing from 4 to 7 in a year

gleason 7 3+4

I dont understand dre results or scan

Clevelandguy

More tests

Hi,

If it was me I would want to find out if the cancer has spread outside your Prostate or is totally contained within your Prostate.  Bone scans, MRI, PET scans are good to check for the location of the cancer.  Once you know that you can determine whether you want to do radiation therapy or surgery.  3+4 is slighty agressive but not as bad as 4+3 so it's up to you to determine what you want to do. You should see both a Urologist and a Oncologist to discuss your scan results and treatment plans.  i have included a link to get you going on the different types of treatments.

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

Dave 3+4

 

VascodaGama

Clinical Stage

Treatment for PCa is chosen by the patient with consideration to his clinical stage. Did your doctor give you one?

In fact, no one can tell for sure which treatment is the best choice but most commonly, T2 ( contained cases) are recommended for surgery or radiation, T3 (not contained cases) are recommended for radiotherapy or multimodal therapy and T4 (metastatic cases) are recommended for chemotherapy or hormonal treatment.

Before deciding you should be aware of the risks and side-effects involving each treatment as your quality of life will change forever. 

Treat but do it coordinately and wisely. Get copies of all pertaining data and get a second opinion from another independent specialist (s).

Welcome to the board. 

VG 

rjg66

I have a urologist and a

I have a urologist and a radiation oncologist and am waiting for a discussion with a surgeon. The cancer is contained within the prostate as I have had ct, mri and bone scan.

I am worried about the side affects so my problem is which has the least percentage of chance for incontinence especial bowel incontinence.

VascodaGama

Incontinence worries

I am not sure if your bowel incontinence worries regards fecal incontinence. In any case, both, surgery and radiation, are linked to cases of incontinence. Cutting of nerves in surgery can lead to fecal incontinence as much it causes urinary incontinence if the tiny muscles of bladder and urethra sphincter are dissected.

Radiation therapy would cause the same if it destroys identically those nerve bundles but it doesn’t involve dissecting which may become a better choice. 

Typically, surgery is linked to urinary incontinence and erection dysfunction where Radiation is linked to cystitis and proctitis. Many guys manage recovery from such side effects (RP and RT) 3 to 6 months post intervention.

Recovery from ED hardly is achievable. Sex never returns to the same levels as it was before dissecting the nerve bundles and the pudendal artery which is the main source of blood supply to the penis.

One needs to accept our newer we.

Best,

VG 

lighterwood67

Your choice

Your doctor is right; it is a personal choice.  Please do your homework.  It is very difficult to decide on a path to cure when it comes to surgery or radiation.  This to me is like comparing apples to oranges.  Both have positives and negatives.  Personally, I went the RP route.  At this time my PSA is undetectable;  I am continent; I am intimate with my wife.  So, best of luck on your journey.  No two are alike.

rjg66

Does any one know which has

Does any one know which has less side affects, proton therapy or radiation IMRT using Spaceoar?

 

ASAdvocate

Your choices are overwhelming

I maintain a list of prostate cancer treatments that I occcaisonally post on various sites, to troll for new additions or discontinuances. There are 33 at last count, 31 of which are available in the USA.  My point in mentioning this is that almost all are curative (or say they are) for low intermediate (G3+4=7) cases like yours.

While that statement is encouraging, it can also be confusing due to numbers. Right now, according to the government's 400,000 man SEER database, men are choosing equally between active surveillance, surgery, and radiation. AS is for low risk men, but that still leaves a couple of surgery choices, and a half dozen radiation treatments. My research informs me that SBRT/Cyberknife has very impressive non-recurrence results, as shown by peer-reviewed,  multi-institutional studies. But, that's just another lead for you to check out.

Having a team of a urologist/surgeon. a radiation oncologist, and a medical oncologist is about the optimum position of knowledge. Other nations do this as a matter of course, and it is gaining in usage here.

Listen, ask, and learn. Your future is yours to manage and protect.

Clevelandguy

Proton vs IMRT

Hi,

From what I understand Proton radiation has a fixed focal or beam length where IMRT goes completely through your Prostate and Bladder/Rectum, that why they use the Spaceoar gel to protect those organs.  If it was me I would use the gel if I was choosing IMRT. You might not need it with Proton because the beam does not go through your body but stops after the Prostate.  You would need to check with your doctor team to make sure.

Dave 3-4

rjg66

Thank you all for the good

Thank you all for the good info.

 Ar least foer me it is going to boil down to which procedure has the least chance of fecal and or bowel incontinence.

RonJT

Which treatment

It is a difficult decision.  My case is similar so maybe this link will help.  Let me know if you have any questions.  FYI I have no incontinence issues. 

https://csn.cancer.org/node/302161

VascodaGama

Preparedness exams

I would like to add that radiotherapy is not recommended to guys that had or have (without knowing) ulcerative colitis. In your shoes I would have a colonoscopy before deciding. You can raise this matter in your next consultations for second opinion. 

Best,

VG 

rjg66

proton therapy

I am leaning towards proton therapy due to the reports that it has less side affects and has a success rate equal to other treatments from what I read.

I would have to go to Jacksonville< and stay for 2 months but may be well worth the stay as I am close enough to go home on weekends.

Does anyone have knowledge of proton therapy?

lighterwood67

Nuclear or Surgical

I can't speak from the nuclear side as I did not experience it.  However, on the surgical side here you go:  FINDINGS AND TECHNIQUE:The patient was taken to the operating room where he was placed under general anesthesia in the supine position. He was then placed in low lithotomy position,prepped and draped in the usual manner for a robotically-assisted radicalprostatectomy. The abdomen was entered through a periumbilical incision and adouble balloon 12 mm port was placed here. The abdomen was insufflated. The other five port sites were marked off and placed under direct laparoscopic vision. The robot was docked and the procedure was begun from the console.We began the procedure by releasing large bowel adhesions on the left side of the abdomen. This was done with cold sharp dissection. The space of Retzius was then developed by dividing the median umbilical ligaments bilaterally as well as the urachus. Both vas were divided as they entered through the internal ring. Once the space of Retzius was fully developed, the endopelvic fascia was opened close to the prostate. The dorsal vein complex was suture ligated with 0 Vicryl over the baseof the gland and then divided with the bipolar cautery over the bladder neck.A bilateral pelvic lymph node dissection was then done (obturator and hypogastric)including deep pelvic nodes on the left side. All longitudinal lymphatics were clipped or sealed.Bladder neck was dissected out anatomically and divided. We went wide anteriorly and obtained a negative frozen section here.Seminal vesicles and vas deferens were then identified, mobilized, dissected up and elevated. Denonvilliers fascia was then opened posteriorly and I dissected between the layers of Denonvilliers fascia all the way to the apex. The vascular pedicles to the prostate were taken with the ENSEAL device and large clips as we got close tthe neurovascular bundles. The bundles were well preserved bilaterally. Small metal clips were used as we worked under the posterior aspect of the prostate. An element of high lateral release was done, but I was not aggressive about getting too close to this capsule. I specifically went wide at the left apex to avoid capsularincision. As I dissected along to the apex I noted excellent neurovascular bundle sparing bilaterally.The dorsal vein complex was then isolated and taken with the ENSEAL device. The DVC was oversewn with a V-lock suture. The urethra was divided with cold sharp dissection. The prostate was put into a specimen bag.The anastomosis was then done in a two layer fashion using a Rocco suture toapproximate the urethra posteriorly. This was a single horizontal mattress.Continuous 3-0 Monocryl was then used employing a Quill suture to achieve awatertight anastomosis. The bladder neck was tapered with 2-0 Vicryl. Theanastomosis was sealed with Eviseal and stented with an 18-French Foley catheter. A Blake drain was placed in the abdomen through the fourth arm port. This was secured with silk.Marcaine was used to block all port sites.The right-sided 15 mm port was closed at the fascial level with 2-0 Vicryl. The prostate was removed in its bag through the umbilical port. The umbilical port sitwas closed with continuous #1 PDS in the fascia. All skin incisions were closed with Monocryl and Dermabond. The patient was awakened and taken to the recovery room in good condition. Estimated blood loss for the case was 100 mL. Sponge and needle counts were correct x 2. 

So there you have it.  If all things were equal, I would think most folks would opt for the nuclear side.  Less invasive, no body parts removed.  All things are not equal.  So good luck on your journey.

TJWA103

New to the group

Was diagnosed with prostate cancer and have a 4+3 gleasons rating but has not spread outside of prostate...Do you know of anyone that had treatment with Cyber Knife ? Trying to decide the best treatment, Thanks TJ

 

Fleet Foot

rjg66, my PCa was somewhat similar to yours. I was Gleason 7 (4+3 though), T3a and positive margins on right side. Had the DaVinci three and a half years ago, semi annual PSA blood work shows no recurrence. In my case, not everyone experiences the same stuff, I did Kegel exercises a lot both pre and post surgery anticipating urine leakage, but ultimately they did no good. I have to wear absorbent "pads" continually and sexual function is a thing of the past. No problems with the bowels though. One other thought though is every time you see something posted by VascodaGama, pay attention. He really knows his stuff and has great advice.

Clevelandguy

Hi,

I had surgery with 3+4 and perinueral invasion, tests showed no cancer outside of the Prostate. It’s been 7 yrs. since my Robotic surgery with no PSA detectable cancer. It took me about two years to reach a healing plateau. I still have slight leakage(just a drip or two) during heavy lifting or straining for which I wear a light pad daily. Irrections very usable but not as rock hard as I was several years ago, could be due to the surgery or just aging. No bowel problems or other urinary issues. So far I am very happy with my choice, I pray future PSA tests will remain undetectable. I do feel both Proton and Cyberknife radiation treatments are very good but they too can have either very good or sometimes bad results as can surgery. The best doctors +best facilities = great results so its up to you and your doctors. Don’t be afraid of secondary opinions from different doctors or hospital networks. It’s you who will live with the results, not your doctors.

Dave 3+4