Gleason 8 and Proton Therapy vs Surgery

MC1979

Hi there. I was diagnosed with Prostate Cancer on the right side. This was following an MRI on 23 Feb and a Biopsy on 28 March. Had bone scan and PET PSMA scans on 18 and 24 April 2024. Met with a Urologist and two different Radiation Oncologists since then.

Biopsy result was 6 of 13 samples were positive for adenocarcinoma with one being 3+ 3, one being 4+4 (<5% involvement). The others were 4+3 and 3+4 ( 2 were 4+3 and 2 were 3+4). My PSA that led to all this was 4.5.

I am being given the choice of Radiation or Surgery; no one is pushing me one way or another, but since 2 samples had perineural invasions present, the Urologist thinks he won't be able to spare the nerves on the right side but should be able to spare the ones on the left. I get the sense he is hedging his bets as to whether it is fully contained or there may have been some microsopic particles in the Lymph nodes.

Radiation Oncologist says no matter what ( Proton or Photon) radiation I will need 24 months of ADT. Surgery scares me a lot. So does ADT. Radiation does not scare me so much, and I have heard good things about Proton therapy. But is that for lower-grade cancers only?

Appreciate any thoughts. Have to make a decision soon.

MC1979

I'm 67 years old. Forgot to add that. PET PSMA and Bone Scans showed no spread beyond the prostate.

Steve1961

here is my two cents and I tell everybody this send it out for decipher testing. You have to make sure there is no cribi form involved with the Gleeson 4 I had Cribiform and I did radiation Cribiform is radiation resistant ..I was OK for six years and then it started going up my PSA, so I had it removed salvage surgery ….with a TV PSA that low and the only negative was perennial invasion I don’t understand why they want to do 24 months of ADT that’s pretty rough. I might get a second opinion if I was you or I would just do surgery and have it taken out unfortunately they saw perennial invasion after , my surgery but what can I do? There’s a few guys here that had perennial invasion and they are 15 years cancer free

MC1979

The Gleason 8 is what is driving it. They are saying that puts me in a high risk category. From everything I have read it jives with treatment guidelines for high risk prostate cancer.

Surgery scares the crap out of me. I’ve resigned myself to being impotent, but being incontinent bothers me. Plus it concerns me, what is the point of doing surgery if you just end up doing radiation and ADT later. The Sloan Kettering nomo grams say for my numbers there is a 40 percent chance of recurrence.

MC1979

They have ordered a decipher test, but the results won’t be back for two more weeks.

Clevelandguy

Hi,

Proton radiation is a great way to go if you do not want surgery. The beam has a fixed length so it does not have the potential to damage other tissue past the tumor site. From what the surgeon said he did not think he could save the PNI nerve bundle, I don’t know the effect of radiation on those same nerve bundles. Might want to talk to you Oncologist about that. I had PNI with my cancer when my Prostate was removed in 2014. I am still undetectable today with no ADT. ADT can be a rough ordeal but they have some new medications out taken by oral pill with lesser side effects. ADT is normally given before radiation to weaken the cancer so the radiation is more effective. I have to wear a light pad every day to catch a few drops here and there but if my cancer stays undetectable it is worth it. ED is somewhat age and surgery dependent. Radiation can have similar bladder effects plus possibly colon irritation issues. My point is both surgery or radiation can produce side effects from almost none to severe, there are no guarantees. Get the best doctors+best facilities to get the best results, good luck.

Dave 3+4

Clevelandguy

https://csn.cancer.org/discussion/comment/1715343#Comment_1715343

Hi,
If your cancer is contained within the Prostate ADT is not normally used with surgery. A PSMA PET scan can be used to determine if its contained to your Prostate. Followup radiation(ie; Cyberknife ect) and ADT after surgery failed is another tool to kill the cancer. If you do radiation 1st(ie; Cyberknife)and the cancer returns to the same area it could be possible that no more radiation can be done in that area due to healthy tissue being damaged. Proton therapy from what I understand can be used after other radiations because it is a different type of radiation, proton based vs X-ray based.

Dave 3+4

donslay

Gleason 4+3, I had 42 days of Proton Radiation in Seattle six years ago when my PSA was 4.1. Dr. Didn’t want to do biopsy but my family had lots of prostate cancer on my father’s side.now PSA has doubled to 3.1 and am considering Orchiectomy. Would have preferred freeze-thaw but Doc says too much risk of fistula. Would like any advice re Orchiectomy patients and would you do it again. I’m 84 and very active, ie pickleball, MC riding, wood cutting etc.

Thank you

donslay