Questions to Ask for Radiation vs Surgery?

NYguy

Hey everyone, I’m a new member. I’m 63 years old in NYC. My November PSA showed a sharp increase to 8.3, so I had an MRI, which showed RADS 5 and a legion in the left region. No seminal vesical or lymph node invasion. But it did state there was “overlying extraprostatic extension.” A subsequent Bone Scan showed nothing spread to bones.   Had a Biopsy last week and it showed cancer in left region, at Gleason 7 (4+3). Details below.

So I made appointments with 2 radiation oncologists and 2 surgeons over the next two weeks, as I am assuming (hoping) I will have a choice between surgery or radiation. This is all new to me and happening very quickly, and I’m learning a lot from these boards. Just looking for any comments as to questions I should be sure to ask either the surgeons or radiation oncologists to help me decide.  Any other comments welcome as well.

Thanks so much!

NY Guy

Biopsy details:

Left lateral base: Gleason score 4+3=7. PTI = 60%

Left mid: Gleason score 4+3=7. PTI = 55%

Left lateral appex: Gleason score 4+3=7. PTI = 35%

Left appex: Gleason score 4+3=7. PTI = 35%

Left lateral mid: Gleason score 4+3=7. PTI = 10%

Left base:  Gleason score 3+4=7. PTI = 95%

Mid right: Gleason score 3+4=7. PTI = 30%

Right base: Gleason score 3+3=6. PTI = 2%

Right lat appex: Gleason score 3+3=6. PTI = 1%

Right Apex: Prostatic glandular and fibromuscular tissue. Negative for tumor.

Right lat base: Seminal vesical/ejaculatory duct-type tissue. Negative for tumor.

Perineural invasion is identified.

Rob.Ski

My surgeon showed me a study of side effects and outcomes from his surgeries. Might be worth asking the docs if they have that vs. generic outcomes from their form of treatment.

VascodaGama

Hi,

From what you posted above, I think that you have an aggressive case in need of an aggressive attack. Probably a combination therapy involving RP plus RT with ADT would be also an option for you to add in your List of Questions.

Gleason sum 7 (4+3) with identified extraprostatic extensions and voluminous case of cancer (from base to apex in both lobes) is highly risky for failure of a solo intervention.

Surely we shouldn't compare cases but you may like to read the story of a survivor who had that combination treatment in this link:

https://csn.cancer.org/discussion/318066/prostatectomy-rt-adt/p1

You can inquire about the experience that those specialists (surgeon and radiologist) have in such combination therapy.

Welcome to the board.

VGama

https://www.cancercenter.com/community/blog/2020/10/questions-prostate-cancer-treatment

Old Salt

Yes, unfortunately, with the perineural invasion and the extensive (Gleason 7) cancer within the prostate, you are facing a more serious problem.

For cases such as yours, Androgen Deprivation Therapy (ADT; aka hormone therapy) is often recommended to start out. This would then be followed by one or two kinds of radiation.

I hope you can consult with a highly qualified radiation oncologist to see what (s)he recommends.

Clevelandguy

Hi,

Have to agree with the two survivors above. It’s your choice to either go surgery, radiation, or a combo of both. Make sure you get the best consulting doctors around to guide you. The 4+3 is on the aggressive side and in my non medical opinion need to be delt with aggressive treatment. Surgery with radiation to the Prostate bed does not sound like a bad idea as Vasco pointed out. Hormone therapy weakens the cancer while other therapies attack it. I have included a link to get you started. Unfortunately all treatment options have side effects, so pick and discuss with your medical team. I know its a big decision but I would not wait very long with your Perineurial invasion.

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

Dave 3+4