Newly Diagnosed - How did you evaluate your treatment options?

DaveTX

I’m 68, active, and in good health. I just received my diagnosis yesterday and evaluating my options and making appointments. Clinical Stage=T1c; PSA=6.4; from the 13 biopsy samples taken, 2 are Gleason 7 (4+3) and 2 are Gleason 8 (4+4), all on the left side. All other samples are benign.

What did you find useful to help you select your treatment (surgery vs radiation)? I’m leaning toward surgery; but I’m still very early and do not meet with the oncologist radiologist until next week

Has anyone had the newer Retzius-sparing prostatectomy (newer robot-assisted) surgery? I live in Houston so will be getting an appt at MD Anderson. Several of their urologists do both the Retzius-sparing method; my urologist does not.

On_A_Journey

Welcome aboard, Dave.

Your question about which treatment to have is perfectly natural. I had the same question when I was diagnosed, and I reckon everyone else here is probably the same.

My cancer came early; I'm only 60 now. I initially considered radiation as a better option because of the perceived less risk of instant and permanent side effects such as ED and incontinence. To me it was 'safer' because it was less invasive, with a quicker physical recovery too. But, my urologist told me that since my cancer was detected on both sides, this wasn't the best option. I went ahead with a traditional prostatectomy in 2015 ; he did not perform the robotic type. I was happy to stick with him instead of going through the rigmarole of finding a different surgeon.

At the end of the day I'm still alive and kicking!

Rob.Ski

I had robotic surgery at Hopkins and my surgeon said he had done lots of surgeries both ways, Retzius sparing and not. He told me he typically determined this while he was in there doing the surgery. He also said his results for side effects were the same. I'm not sure if I asked which way he performed it. I faired well, was pretty much continent post surgery. Leaked a little if I drank too much the first year but, not at all now. ED is mild overcome with Vitamin V when I need it on occasion. If cancer is contained within the prostate, Surgery & Radiation have similar outcomes for success which means similar outcomes for recurrence. I was told by both radiologist and surgeons, surgery is a better option for someone my age and in good health (51 at the time). Mainly because, options are better with surgery if there is recurrence. They won't radiate you twice and surgery after radiation is much more difficult. If you are older, radiation is less invasive and chances are something else might get you before recurrence does. Radiation side effects tend to show up over time, surgery side effects are immediate. Not advocating one way or the other, just relaying the info I received along the way. It can be a hassle going to all the docs but, it is worth it to have as much info as you can to make informed decision. Talk to both radiologist and surgeons, make you best informed decision and don't look back. You can read on this site and see both positive and negative outcomes for both.

Best of luck.

Clevelandguy

Hi,

The choice between surgery or radiation is really up to you and your team of doctors once you know all the facts. Great doctors+great facilities =great results. The newer robotic technique sounds promising. Gleason scores of 4+3 and 4+4 are a little on the aggressive side so knowing where the cancer is at inside your Prostate in my humble non medical opinion is important. If the cancer is very close to the edge of the gland(ether on the bladder side or nerve bundles on the outside of the gland) then surgery might not be the best alternative. I had robotic surgery back in 2014 and do not regret it. I feel a PMSA PET scan is the best way of determining the location of the cancer which will help in your decision on surgery or radiation. The PET scan should give you a very clear picture as to the exact location of the cancer. If there are good clear margins and the cancer is deeper inside the Prostate then surgery might be a good option. A bone scan is another useful tool to make sure the cancer has not spread outside of your Prostate. Make sure your surgical team has done several hundred operations using this new technique so they are proficient. From what other survivors have said, MD Anderson is a good place for Prostate cancer treatment. I have included a link for you to study, good luck.

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

Dave 3+4

DaveTX

https://csn.cancer.org/discussion/comment/1709450#Comment_1709450

Thanks for the feedback, it will help ask the right question for me to make the correct and informed decision for me. You are spot on with “perceived less risks” comment, that is what I am wrestling with.

Dave

DaveTX

https://csn.cancer.org/discussion/comment/1709452#Comment_1709452

Thanks for the info. I am very active (skiing, cycling, backpacking, etc) and want to able to continue. Your response gives me comfort that this is possible post surgery. Not too concerned with having surgery since I did have a serious bike accident that required surgery to repair my arm. While not looking forward to the discomforts, I know that I can deal with it.

Dave

DaveTX

An update in case others read this thread as they start their journey. I did go to MD Anderson in Houston for their opinion and decided to have them perform the surgery. My learnings, If you can, go to one of the large cancer centers. They have departments that only focus on genitourinary cancers (Genitourinary Medical Oncology, Genitourinary Radiation Oncology, Surgery). If you can't go to one of the larger cancer centers, make sure that whatever treatment you decide on, the MO, RO, and surgeon have lots of experience treating PCa. I'm getting the impression from this site as well as other sites I belong to, this is very important. The greater focus/experience they have on PCa means increased probability of better results for us.

Once I decided on surgery, important questions to ask the surgeon are: 1) how many robotic prostatectomies have you done 2) How do you determine if you can/cannot spare the nerves. 3) If you need to remove one of the nerve bundles can you perform a partial or incremental nerve sparing procedure 4) for your patients, what is the mid-point for both urinary recovery and sexual function 5)How do you define urinary recovery and sexual function recovery 6) What are the best arguments for surgery. I've done a lot of research to help me decide surgery vs radiation as we all have and we all know the pros and cons of each. His response was new to me and was not something I had previously read.

So how am I doing? It was 3 weeks ago today I had my surgery. Pathology indicated that the tumors were contained within the prostrate. Biopsy indicated left side only; in actuality there were 2 tumors; one was a 18mm x 15mm tumor (Gleason 8 (5+3)) in the left transition zone and the other a 2mm x 1mm tumor (Gleason 7 (3+4)) in the right transition zone. 15 lymph nodes from the left side and 11 lymph node from the right were removed and all were clear, no tumor. Everything else was also negative, no tumor. In my case, PMSA PET was spot on. I was very fortunate with a Gleason 8; it appears that we got it before it escaped the prostrate. The next hurdle is mid January when I get my first PSA.

Physical recovery has been going rather well and I almost feel like I did pre-surgery other then some slight discomfort if I move in a certain way. I walk several miles every day and cannot wait for the clearance to get back to exercising. I have been very very blessed, no incontinence issues at all. As far as ED, before this week I would have said "yes". Over the last several days it started to wake up! I'd say it is at 40% - 50% today. I realize that I am in the minority with my side effects; but, wanted to share to others that are at the beginning of their journey so that they realize we are all very different; the surgeon's skills are different for each of their surgeries (forget about differences among surgeons); etc. On the down side, my bladder does not feel like it can hold the same amount that it used to. It feels like I needs to pee more frequently.

Everything seems to be a spectrum with PCa and each one of us is somewhere different on the spectrum. Best way I can state it is don't complain about the cards you have been delt; play the hell out of the ones you have.

VascodaGama

DaveTX,

Congratulations. It seems that you got it all. Surely the wait for the PSA will give you some anxiety. Let's cross our fingers for the good news on the results and full recovery in the new year.

Best,

VG

Old Salt

Wow; that's a great report; couldn't be better regarding the situation you faced.

I hope that your recovery will continue to go well in the new year.