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For men in their 50s or 60s who chose brachytherapy or external beam
I'm 56 but one of my lesions is near a nerve and I don't think surgery is going to both preserve sexual function and get all the cancer, so I am leaning towards radiation. Yes yes, I know I might die sooner.
For those in their 50s and 60s who chose radiation, did you choose brachytherapy or external beam, and why? How recent was your choice and do you think the technology for either has changed significantly since then?
I'm getting down to the wire for when I have to choose, and these are the questions I'm asking.
Thanks all!
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When I met with my radiation oncologist at Dana Farber Cancer Institute as I research my options (65 yo, 3+3, 7/15 cores), he said I was not a good candidate for the seeds due to my long history of BPH and frequent urination. He will not do the 5-day high dose radiation (SBRT?) as he feels this technique is too new and he does not know long-term effects yet. He is pretty conservative in his approach, so not sure if others would be more open to it.
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I was diagnosed at 61. I am 65 now and have gotten back my erections to the point where it was pre cancer. I had a 31 PSA, 9 gleason and seminal vessel involvement…… I chose Brachytherapy and 25 sessions of external radiation. My Brachytherapy was done with an implant. I had it done at the University of Nebraska Medical Center in Omaha. My Radiation oncologist is a Dr by the name of Michael Baine. He is so awesome ! The difference for me was the 3 years of ADT hormone therapy. I think I would have been back in the saddle pretty quick after my treatment without the ADT. Just my thoughts. Good luck
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I did not have any side effects from any of my radiation treatments. That went as well as it possibly could have.
I am in total remission from the PC. The side effects from ADT can me difficult. I actually handled the physical side very well. Without the testosterone in my body, it turned out to be a fountain of youth. I have a full head of hair but it has really thinned. It came back big time on my head and I lost it everywhere else ! It was awesome ! lol ! I lost 50lbs and I look and feel great ! That being said….the mental part was way more challenging. I now understand how the females in our world tend to maybe think…the emotions of everyday life tend to be way more amplified and I found myself obsessing about my relationships with the people in my life. Not always a good thing. So to some it up…I am back to pre cancer form with 50 less lbs and feeling very blessed. Good luck
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well you may not want to hear this. I was 56 when I was diagnosed first of all is your cancer cribiform. If you don’t know it you better find out. Send it out for decifer testing. I will tell you why. Cancer I had was 3+4 of cribiform nature. Everything was contained at a prostrate and all that good stuff problem was I was scared to death of surgery. I chose external beam radiation with a breaking booster. After the second treatment, I could not urinate at all, I had to take Flomax from then on twice daily in order to urinate. It messed up my bowels something terrible in my bowels are still messed up to this day. After breakytherapy, I had extremely bloody hemorrhoids for about a week and then I had very loose stools, and I leaked out my rear end for about six months , then 6 years later, my PSA started to climb they did a biopsy and cancer was still there only the gleason 4 cribbiform . The tumor was right next to the marker two surgeons were convinced that it didn’t work because the cancer was Cribbiform. One surgeon told me studies as of late or showing that cribiform looks to be radiation resistant so next up surgery salvage surgery done at UCLA California I was on the table for less than two hours, catheter was no big deal. I do leak a little bit now only because it was salvage surgery, but I tell you what I did not lose any length and I can still get an interaction if I could go back I would not even think about doing radiation and barchytherapy I would remove it , if you look up the gold standard for prostate cancer, it is surgery and then God forbid it happens to come back you can do radiation and then you even have a third chance with hormone therapy. I am nine months out of salvage surgery and I am cancer free and I hope to stay that way. Just remember have it checked for cribiform the rest is up to you it’s not crib form you probably have a good shot at a cure, but it is cry form take my word for do not mess around
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I don’t understand the concern of the Dana Farber doc regarding SBRT. There are publications with 5 and 10 year outcomes. Maybe longer term as well but I can’t look that up from where I am. Dana F is among the best; I am disappointed in that specialist.
Please do note that I am not advocating that SBRT is the best for you. Maybe get a consult elsewhere.
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Thanks to @Old Salt and @Josephg for the questions and challenges. It is interesting to hear that another specialist at Dana Farber used SBRT. I am going to ask my radiation oncologist for more details on why he does not use SBRT. After reading @Steve1961’s bad experience with radiation, my head is spinning. I asked my doctor team if they saw any cribiform in my biopsy sample and they said no. I had a Decipher test and expect results tomorrow, which will help inform decision. Thank you!
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my in-laws is 70 he had PSA of 7.5 Gleason score 73+4 non agressive .. five weeks of SBRT no ATT no break therapy but yes a space oor going on about a year and his PSA is almost down to zero. He had no side effects whatsoever so here’s my opinion in law went to a private radiologist in San Francisco that all he did is radiation for men only specialized in it. I was referred to him. He told me to do surgery so I had another docto Tell me you can do radiation anywhere, but I would go to a place that specialize in it and I think they’re right, I went to major hospital UCSF San Francisco great day after day always waiting. They were always not on schedule having to see very sick people all the time had four or five different radiologist one patient breast cancer one patient stomach cancer one patient brain cancer next patient prostate if you have a private radiologist in your area I highly suggest you go and use them with a specialize in radiation for the prostate only , private practice valet parking not hospital always on time coffee tea, water light music waiting room had a pool table and a guy did a great job. Don’t know if a lot of places have private radiologist though this is San Francisco. Good luck with your choice ..i like I said if I could go back, I would do surgery in a heartbeat you go in surgery is done You’re out the next day catheter a week later 60 days later you know if you’re cancer free or not you don’t have to play the waiting game for 45 years always wondering if it worked, but thats just my opinion
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@Old Salt @Josephg as an update, I have been on AS since last post. My Decipher came back in Nov 25 as 0.54. So, with my dad’s history of PCa, my CHEK2 gene mutation, and 3+4 Gleason, my doc at Dana Farber says I should probably decide on treatment soon. I spoke with my radiologist there who originally was hesitant about SBRT and he now feels it would be the right treatment for me, which aligns with what both of you shared. I am leaning towards surgery to get the cancer out, learn my exact cancer score, and leave radiation as an option if I have recurrence. However, I have heard several cases lately from guys who had radiation and had good success for quite a while, but some had to do ADT later and were not so happy with that aspect. How are both of you doing?
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I don't understand the flip-flop of the rad oncologist regarding SBRT. In his defense, I will say that a lot goes into a decision about the best therapy for any prostate cancer case. People often say 'each case is different' and, to an extent, that is true. We do not know everything relevant for your case and our 'recommendations' should be taken with many grains of salt.
Since you asked, let me summarize my case; it's quite different from yours. I had Gleason scores of 4+5 and a PSA of 12 ng/mL (high risk). Fortunately, the available scans (no PSMA scans twelve years ago) indicated no spread outside of the prostate. Based on those findings, I was allowed to enter a trial for high-risk patients at Georgetown U Medical Center that combined SBRT (three sessions) with IMRT (25 sessions). I had two months of ADT (Lupron) before the radiation (this is common) and the Lupron was continued for a total of 18 months. I did not get a barrier gel inserted to protect my colon because that 'technology' didn't exist at the time. Nowadays it is often prescribed.
I had some side effects, the expected ones from the ADT and some damage to my colon that showed up about a year after the radiation therapy. Not unusual. The latter was resolved with Argon Plasma Coagulation during a colonoscopy procedure (not a big deal). Significantly, my PSA went down from about 12 before therapy. Quickly right after the radiation therapy, and then much more slowly. I did have one bounce in my PSA; not at all uncommon. An MRI showed that there was no reason to worry.
My latest test showed a PSA of 0.8 ng/mL. With respect to the ADT, my testosterone recovered to a normal level for my age. That is by no means always the case; I have been very fortunate.
It needs mentioning that the Georgetown group, headed by Dr Collins, had a lot of experience with SBRT and radiation in general. This is always an important consideration. If at all possible, you don't want to be treated by 'newbies'.
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@capecodder
Yes, it is one of the most difficult PCa therapy-related decisions ⇒ what to do first. Regardless of what folks may tell you, there are absolutely no guarantees with either therapy method. Period. Both therapies will have side effects, some earlier, some later on. Period. After either therapy, your life will be changed forever. Period. Those are the facts!
By now, you've done your own personal research, you have consulted in depth with medical professionals, presumably on both therapy options, and you've chatted with PCa survivors. You will be treated by one of the best PCa institutes on the planet for research and outcome deliveries. You've reached the proverbial S**T or get off the pot time.
If I had to do everything over again, I'd still choose surgery as my first therapy. The odds of recurrence are simply too high in general, and I want to have radiation available as a backup in that event. Yes, surgery can have a very significant impact on continence and ED. Those are simply the facts. I went into surgery with a 3+4 Gleason score, but I came out with a 4+3 Gleason score. If I had not selected surgery, I would not have known this detail on the true aggressiveness of my PCa.
You can stipulate a nerve sparing surgical procedure, but you risk not getting all of the PCa cells in the nerve area (if they exist). I left that decision up to my surgeon, telling him that I wanted all of the PCa out of my body. As a result, I lost 1 nerve cluster fully and the second nerve cluster partially. I was immediately fully incontinent and fully ED. My choice, my result, and I've lived with that result for 13+ years.
My first PSA post-surgery was 0.05, and my surgeon advised me that I probably still had some PCa cells in my body and referred me to a Medical Oncologist. My PSA rose steadily for a year, and when it hit 0.13, my Oncologist recommended that I undergo IMRT radiation on the prostate bed, along with a 6 month stint on the Lupron/Prednisone ADT cocktail. So, I had 38 sessions and 68 grays of IMRT radiation, along with the 6 month ADT cocktail. My PSA was <0.02 for 30+ months.
At the 36th month, my PSA rose to 0.05, and over the next 5 years, my PSA rose to 0.98. At that time, I had a PET scan, and a lesion was found in my left pubic bone. My Oncologist referred me to a Radiation Oncologist, and together they both recommended a 2 year stint on the Lupron/Prednisone/Zytiga ADT cocktail (totally new to the US at that time, but used for over 5 years in Europe) and 3 IMRT radiation sessions for a total of 30 grays delivered to the pubic bone lesion and the immediate surrounding area. So, I followed their recommendations. My PSA has been <0.02 for 3 1/2 years.
I can tell you that I've experienced just about every side effect that you can imagine, and then some more, over my PCa journey. But, I'm still here, and I still have a more than an acceptable quality of life, and at the end of the day, isn't that really the most important consideration?
I wish you the best of outcomes on your PCa journey, and always feel free to ask questions.
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Mark3plus4,
As others have stated it's an extremely difficult decision. It was the most stressful decision I ever made. At 68 with a 4+3 Gleason confirmed by two biopsies at different institutions and having very complete staging (genetic, MRIs, Bone scan, two PSMA pet scans, ect.) all indications were that Pca was contained within the gland. There was cribriform pathology noted. Low percentage of Gleason 4 and in only one side of the gland. Having been frightened of the likely side effects of the two prevailing treatments of radiation or prostatectomy, I chose a less traveled path of Focal Therapy which I was deemed a good candidate by the professionals I was seeing. Long story short. Procedure went well with exception of some temporary urinary retention. The only permanent side effect was dry orgasms. But all in all felt great. 6 months later my PSA rose to 9 which precipitated another PSMA PET scan which indicated metastasis to pelvic lymph nodes showing no recurrence in area originally treated. Doctors explanation was that very likely micro metastasis was likely already present in lymph nodes too small to be indicated by the PET scan. So the team quickly recommended 40 sessions pelvic IMRT and 24 months ADT. Now at about 8 months since IMRT concluded and still taking ADT with Abiraterone my PSA is undetectable. The ADT is annoying, but manageable. Other than some fatigue and occasional hot flashes, I feel pretty well. Exercise really helps!
In any event, I have no regrets for choosing the path I did. Even if I had a prostatectomy first, it's very likely the metastasis would still have occurred. Once I made my decision, the stress level reduced substantially. Opinions on here and elsewhere can be helpful, but they are only opinions. Whichever you decide after you've weighed all your options, and you feel the least uncomfortable with, will be the best choice for you. Hopefully your journey will be a good one. There are no guarantees! and like Josephg indicated "your life will be changed" hopefully to a lesser degree. Hang in there and good luck on you decision. Please let us know.
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