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