Surgery vs Radiation: another question

Marlon

I am 67, Gleason 7, unfavorable, and PSA 4.2. Both surgeon and oncologist say I am on the borderline age-wise and that either treatment would give good results. I am more concerned about long-term continence than longevity. I am changing my mind ten times a day. Any input appreciated.

swl1956

Me too! 67 Gleason 7, unfavorable, PSA 5.7

Incontinence also being my biggest worry! With surgery it being a more likely occurrence. At our age, the longer term side effects of radiation are scary as well. I was offered a third choice of Focal therapy. Have you looked into it? Not everyone is a candidate, but if you are, side effects are minimal to none. Many major cancer institutions are offering it even though it is still considered investigational.

Take time to way out your options. I've been vacillating since my diagnosis last November and have only recently pulled the trigger.

Clevelandguy

Hi,

On your Gleason score it matters if you are a 4+3(more aggressive)or a 3+4. The best radiation in my humble non medical opinion is Proton. Proton had a fixed beam length and does not go beyond it’s intended target, so less damage past the target. You can get the same effect with Cyberknife but they have to inject a gel to protect tissue and organs past the target. Best surgery is of course robotic assisted which is probably the only type being done today. Both surgery and radiation have side effects. I have included a link to get you started.

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

Dave 3+4

icanbeatthis

I went with radiation for a better quality of life no diapers needed

Marlon

Thanks for input guys. I have researched the heck out of it and my decision revolves around these two choices:

Surgery: advantage - problem most likely solved (including BPH); disadvantage - low risk but high consequence of permanent incontinence.

Radiation (IMRT/IGRT) with ADT: advantage - minor temporary incontinence; disadvantage - side effects of ADT, and risk of longer term side effects, no surgical option for plan B.

\The surgeon agrees that radiation would be as effective as surgery in my case, with my numbers. and the radiologist agrees that surgery would work equally as well as IGRT in my case and with my numbers. I trust both, but their focus is on eliminating the cancer, not on quality of life.

I'm not afraid of long-term radiation risks or the potency issues. I have friends who have done one or the other, and they're all satisfied with their decisions. I guess its that leap of faith either way that I'm struggling with.

fjubier

https://csn.cancer.org/discussion/comment/1715064#Comment_1715064

fjubier

I agree that focal therapy could be a third choice for selected patients only if you meet the criterias. I am also ready to pull the trigger on focal after a year of indecision. I am getting out the active surveillance since my repeat biopsy shows the % of cancer has grown. For focal treatment you need to make sure that the Dr selects the right source of energy (cold, heat, electricity…) based on your case. My issue that I got different opinions on the right source of energy to do the job. I am making the final decision on the type of treatment this month and I hope to have the treatment done early summer.

Steve1961

you best get decifer testing done .at 57 i was in the same boat ..they sent the biopsy out for testing and it came back as Cribiform, aggressive and out of just fear i chose radiation instead of surgery …..very bad decision cribiform is radiation resistant they are now finding out ..so 6 years later still have some cancer and I just got done with salvage surgery …even with salvage surgery. I’m not doing that bad. If i could do it all over again. I wouldn’t think twice about surgery .the gold standard for prostate cancer contained to the prostrate is surgery. Look it up …You keep the radiation for back up. I don’t have any back up now. You cant do radiation twice If surgery didn’t do the trick my onky choice is hormone treatments.l it’s simple… surgery plan a radiation Plan B hormone treatment plan c I personally know five men over the age of 67 that had surgery. They’re all fine. None of them even leak and they’re all cancer free ….that’s just my opinion . Plus cancer does not belong in your body period ..

RonB

https://csn.cancer.org/discussion/comment/1715085#Comment_1715085

Thanks for sharing that Steve. You very eloquently described why I settled on having surgery…currently scheduled for July.

lighterwood67

I can't speak to the radiation side as I had surgery (prostate, seminal vesicles, internal bladder sphincter, 8 lymph nodes all removed or dissected) in March 2018. I was 67 years old; Gleason 4+3=7. Post surgery, incontinent until around the 4th month post surgery; dry by the 6th month. Erectile dysfunction was really not a problem. PSA at this time .03ng/ml (pretty much undetectable). Post biopsy clean as a whistle. Prior surgery most memorable moments: cystoscopy (camera (so to speak) inserted in your penis and eventually gets to the bladder); Probes inserted in my rectum and required to flex (kegel). I had been doing a lot of kegels prior to this. Scored a 4 out of 5. Anyway, good luck on your journey.

Marlon

Thanks everyone for your input. Still undecided but better informed.

bdhilton

Marlon…Options are good place to be but damned if you do, damned if you don’t…Your decision will be the right one for you and never, never, second guess your choice. The guys that are blessed with choices have the thought process to go through…If you’re not being seen by a medical school, at least get a second option from one. I'm big on Medical school hospitals and their faculty doing the treatments (which doesn’t make me right or wrong)…I personally travelled to Northwestern for my initial surgery and have been treated at UCSF since…Good luck in the process and again, your choice will be the best one…

All the best in your journey-BD

Tico14

https://csn.cancer.org/discussion/327978/surgery-vs-radiation-another-question

The ONLY reason I chose RALP over radiation was should I have chosen Radiation over RALP and there was a recurrence it would be difficult if not impossible for a RALP to be effective in treating the recurrence. Six years later and zillions of Depends later, I think - no, I know - I made the wrong decision. And I was five years older than you are now when I had the surgery.

ZeekDPG

Also in the same boat in re the choices. I have been told by both the surgeon and the radiation oncologist that I am a good candidate for both, with the surgeon saying surgery is the best option and radiation the second best option. I am leaning toward the radiation therapy (having met the radiation doc today) because of how comprehensive the doctor was, having spent over an hour with me walking through the process and answering my questions. The surgeon, whilst not unpleasant, took 10/15 minutes to let me know what his option was like.

The incontinence issue is a big one for me: catheter, incontinence pads……. Slightly less risk of PED with radiation as well is a benefit. So that’s where I am at. They want to start treatment soonish, as 14 of the 16 core samples showed cancerous, with a Gleason of 7 and a PSA of 15 at last test. They did another PSA today so I’ll know if it has elevated since the last PSA.

Thanks to all of you, and best wishes to you for good health and on your journey.

RonB

These are not easy decisions. My best wishes for a long and happy life.

knowayout1

I just got my biopsy results today, two areas 4+3, a couple of 3+4. My age at 65 and a PSA that has steadily been rising to almost 8 the last time. I have yet to discuss the options but think I will probably opt for radiation.

Marlon

https://csn.cancer.org/discussion/comment/1715517#Comment_1715517

knowayout1, I was sure going in to that first discussion that radiation was the way to go based on my research. After talking to both surgeon and the radiation oncologist, I was overwhelmed by the pros and cons of both options, and am now scheduled for surgery next month. I was told I could have a good outcome either way. What swayed me, was learning that if the cancer returned after surgery, radiation could be used. But if it came back after radiation, there were fewer options for treatment. If I was older, I'd make a different decision.

RonB

https://csn.cancer.org/discussion/comment/1715518#Comment_1715518

Thanks for the post @Marlon. Your story and experience pretty well match mine. Same reasoning on surgery (I’m scheduled for July 9). Like @knowayout1 , I was leaning hard towards radiation. In addition to the concerns about treatment options should the cancer return, I just don’t think I could safely deal with the side effects of the ADT treatment with the radiation. I do recommend discussing your case with both surgeon and radiation oncologist. There’s a lot to consider.

knowayout1

Thanks for your input, man what a difficult decision!