Decision time on Surgery & Radiation, all test done

lasermarketing

Thanks again for all the help in these past few weeks, my PSMA Pet Scan Results have arrived. At this point (waiting on Decipher Test) I am done with testing.

At this point I am leaning towards SBRT & Hormones for 6 months. I meet with my urologist tomorrow and then Radiologist, Oncologist on Thursday and Friday to hear treatment options.

TEST RESULTS & INFO

56 years old. PSA 5.3

MRI - One PIRAD 5 Lesion, one slightly enlarged pelvic lymph node

Biopsy - Gleason 7 (4+3), 10 of 12 cells active

PSMA

1.  Radiotracer avid lesion in the prostate is consistent with primary prostatic malignancy.

2.  Radiotracer avid left obturator lymph node is consistent with nodal metastatic disease (Radiotracer avid left obturator node measures 1.7 x 1 cm with SUV max of 8.7.)

3.  No evidence for radiotracer avid osseous metastatic disease.

I believe this means I have Regional Prostate Cancer?

I am sure my Surgeon will still want to remove it, plus the one obturator node & others in the area. Radiologist would hit the prostate, and nodes all at once. Plus they are offering to put me in a clinical trial (50% chance) with SBRT, Hormone Therapy 6 months & darolutamide.

I would hate to do the surgery with radiation immediately, if the particles have moved into other nodes. On radiation, i could always come back with Focal Therapy, if it returns inside the prostate.

Thanks

Steve1961

I messaged you

ASAdvocate

No sense having surgery with its side effects if you are likely to need radiation later.

I have been reading about the SBRT and the proton trials for regional spread prostate cancer, and those therapies look promising.

Clevelandguy

Hi,

Sounds like your cancer has spread to at least one lymph node, radiation is probably a better option. If it was me I would investigate the various types of SBRT vs their side effects. From what I have read Darolutamide has some pretty nasty side effects. Talk with your doctors, the ADT and Darolutamide could make a rough time of it if your doctors plan on doing these two drugs at the same time. I have included a Mayo clinic website for info on Darolutamide. Make sure if your going into a Clinical trial that you will not be one of the group that does not get the full treatment for study comparison. I would not want to be the one that got the “placebo” treatment. Good luck…….

Dave 3+4

Old Salt

I concur that the radiation plus some ADT is the better option.

Steve1961

Dr Robert Reiter ucla They’re doing the surgery differently down there they inject dye in to you a day before and they use a scope any cancer glows and can remove it all confidently not just guess which lymph nodes may be infected they can actually see it it’s a breakthrough for detecting cancer in Lumph nodes ayou might wanna look it up on YouTube explains and shows the The way they do it the method and it will tell you exactly the name of it I forget now I posted a video on one of my treads

lasermarketing

Talked with first doctor, the urologist today. Not part of UTSW, but he seems pretty smart.

Due to my age, he would still do the surgery, remove the bad node and other nodes in the area. But he said the reality, is particles could be in the area.. He would immediately do radiation of the entire pelvic area in 3 months, regardless what PSA shows. He did say, we could wait and see if he got it all, before doing the radiation. He has had a few other people go 4-5 years, before they had to get the radiation. He says if the cancer comes back fast it's aggressive and if comes back slowly in 3-5 years, then the new cancer in me is not as aggressive.

Even though he is a surgeon, he did say the option with radiation with Hormone therapy, is another option. But not sure he would do it, based on my age first.

He threw a wild card option (not commonly used) doing Chemotherapy from day one (to kill any microscopic cancer) and then go back and do surgery or radiation on the prostate. Kind of interesting... I am more worried on the particles then the actual prostate and lymph node.

Far as the UTSW study, he thinks I may not qualify, since I now have advanced cancer, instead of the Intermediate Gleason 7 (or something).

Next up is Oncologist and Urologist at UTSW on Thursday, then Radiologist on Friday at UTSW.

No matter what, I will have to move quickly to treatment...

Old Salt

You are making good progress evaluating the options. I hope the upcoming consultations will be helpful as well.

lasermarketing

Final notes from doctors today...

All done with meetings...... I think this is the plan I will take next week....

Met with UTSW Oncologist today, and a UTSW Urologist (Surgeon). Surgeon agreed with the Oncology department. Says it is doubtful, surgery would yield any better results at this point, and for sure would give me twice the number of side effects.

I week of Casodex (then I start next 3 drugs)

24 month of Lupron

24 months of Zytiga

24 months of Prednisone.

We wait 1-2 months to begin Radiation. SBRT Radiation on Prostate, the one pelvic lymph node and the pelvic area (I think)

They did not recommend any Chemo, says it's not needed with me being Gleason 7 or something.

They did say there was still a very high chance they can cure me, since only one node was involved. (will see)

Also mentioned the combo of 3 drugs could possibly kill any particles flying around, on top of keeping them in check for the 2 years.

They are also sending me in for Genetic testing, due to my young age and no family history of prostate cancer.

lasermarketing

UTSW suggest this plan (oncology department and the urology Department (Surgeons)

1 week of Casodex, then

24 months of Lupon, Zytiga & Prednisone

We start SBRT in 30-60 days for prostate and my one lymph node. They mentioned there is still a very good chance they can cure me, but we will see...

Surgeon agreed at UTSW, that surgery would not yield better results, but would pile on twice the bad side effects and potential long term issues. This is probably the treatment plan, I will go with....

I am very healthy and already work out regularly in the gym. I will step it up, to help combat some of the Lupron side effects.

lasermarketing

All done with meetings...... I think this is the plan I will take next week....

Met with UTSW Oncologist today, and a UTSW Urologist (Surgeon). Surgeon agreed with the Oncology department. Says it is doubtful, surgery would yield any better results at this point, and for sure would give me twice the number of side effects.

I week of Casodex (then I start next 3 drugs)

24 month of Lupron

24 months of Zytiga

24 months of Prednisone.

We wait 1-2 months to begin Radiation. SBRT Radiation on Prostate, the one pelvic lymph node and the pelvic area (I think)

They did not recommend any Chemo, says it's not needed with me being Gleason 7 or something.

They did say there was still a very high chance they can cure me, since only one node was involved. (will see)

Also mentioned the combo of 3 drugs could possibly kill any particles flying around, on top of keeping them in check for the 2 years.

They are also sending me in for Genetic testing, due to my young age and no family history of prostate cancer.

Old Salt

A good plan; it will be tough though (but you already knew that).

Just my opinion, of course, but with the positive node, the chance of metastasis via the lymphatic system seems too high a risk for the surgery route.

Lymphatic metastasis - PubMed (nih.gov)

lasermarketing

Well...... I am 3 weeks into my treatment plan. Casodex has been no big deal, perhaps a little jittery during the day when hungry. Got my 6 month Lupron shot on Monday, nothing yet, but I am sure side effects are coming in about 3 weeks.

I was already in the gym and now weight training 3X a week, plus lots of cardio through out the week. I come off Casodex in 1 week and switch to Xytiga & Prednisone. Those plus Lupron will be my med path for the next 2 years.

SBRT Radiation is in late January. Plus after talking with the Chief of Radiology for UTSW, he thinks I should do a few short rounds of Chemo after radiation. He said it can not hurt, but could increase my survival rates even more. My oncologist thinks it's over kill, so we will figure it out in Feb. I have read other studies, where many doctors are experimenting with chemo as an early treatment with radiation/surgery, opposed to late salvage therapies.

Thanks again for all the previous help and input..

lasermarketing

Well...... I am 3 weeks into my treatment plan. Casodex has been no big deal, perhaps a little jittery during the day when hungry. Got my 6 month Lupron shot on Monday, nothing yet, but I am sure side effects are coming in about 3 weeks.

I was already in the gym and now weight training 3X a week, plus lots of cardio through out the week. I come off Casodex in 1 week and switch to Xytiga & Prednisone. Those plus Lupron will be my med path for the next 2 years.

SBRT Radiation is in late January. Plus after talking with the Chief of Radiology for UTSW, he thinks I should do a few short rounds of Chemo after radiation. He said it can not hurt, but could increase my survival rates even more. My oncologist thinks it's over kill, so we will figure it out in Feb. I have read other studies, where many doctors are experimenting with chemo as an early treatment with radiation/surgery, opposed to late salvage therapies.

Thanks again for all the previous help and input..

Old Salt

I do think that you are getting excellent guidance and doing all the right things (exercise).

There are some 'tricks' with respect to Zytiga. I have read that taking the pills slowly (over a period of 30 minutes, rather than all at once) makes for a better experience.

I assume the doctors are talking about Taxotere chemo. Is that right and if so, how many cycles? The side effects vary a lot among patients but I am pretty sure, you already know that.😁

lasermarketing

Sorry for duplicate I have not been able to post on this thread in about a week. I guess it's working again.... I am talking with pharmacy this afternoon on Zytiga, and will ask them. Not sure on chemo drug, but they said 3-4 short rounds right after radiation.

Thanks, Robin

centralPA

Sounds good, glad you are attacking it!

Ranger71

https://csn.cancer.org/discussion/comment/1710870#Comment_1710870

Hi LM. I sent you a message. We are in very similar situations and at the same provider (UTSW). Would like to chat and see how things are going for you. Makes me feel better talking with others in same situation. Thx

lasermarketing

Totally agree... Ranger71 will message you....

oldspice

https://csn.cancer.org/discussion/327233/decision-time-on-surgery-radiation-all-test-done

My results from PSMA scan are somewhat similar and my first oncology visit is on Dec 20th. I am trying to learn all I can to my particulars and found this site in the process. My cancer is located mid to lower right Apex area 4+3 in mid and 3+4 in lower. SUV if 3.4 in prostate but SUV9.1 in nearby internal lymph node. No distant spread per the scan. I believe because it spread outside the prostate to one lymph node I am considered stage 4A/Regional but no doctor has confirmed it yet. Your path at the moment is interesting so I plan to stay connected. Will let you know my plan when I get it. Any suggestions are appreciated. I am 73 years old but in decent shape and like to stay somewhat active in retirement. Best of luck on your journey stay in touch.

lasermarketing

Yes, you are 4A, similar to me. But 4A usually means a few spots, so only having one is borderline 4A.. My biopsy was Stage 2....

Have you had surgery or radiation.... if you are new, Radiation probably makes the most sense with one lymph node involved. A surgeon can try to remove the effected lymph node (and surrounding ones), but it is very likely you will need radiation anyway.

I am 4 days into Zytiga and 18 days into Lupron.. I did stop Casodex on Monday, which switched to Zytiga. So far all the same on side effect... Nothing too noticeable except being jittery/high, if I am hungry. My sleep patterns have changed, but so far no hot flashes or anything. I do find myself having power naps on most days, which seems to give me more energy. I am still in the gym 3 times a week, weight training.

I have my surgery Jan 8 for the Space OAR and will have my SBRT around mid January.