Questions to Ask for Radiation vs Surgery?

NYguy
NYguy Member Posts: 1 *
edited December 2022 in Prostate Cancer #1

Hey everyone, I’m a new member. I’m 63 years old in NYC. My November PSA showed a sharp increase to 8.3, so I had an MRI, which showed RADS 5 and a legion in the left region. No seminal vesical or lymph node invasion. But it did state there was “overlying extraprostatic extension.” A subsequent Bone Scan showed nothing spread to bones.   Had a Biopsy last week and it showed cancer in left region, at Gleason 7 (4+3). Details below.

So I made appointments with 2 radiation oncologists and 2 surgeons over the next two weeks, as I am assuming (hoping) I will have a choice between surgery or radiation. This is all new to me and happening very quickly, and I’m learning a lot from these boards. Just looking for any comments as to questions I should be sure to ask either the surgeons or radiation oncologists to help me decide.  Any other comments welcome as well.

Thanks so much!

NY Guy



Biopsy details:

Left lateral base: Gleason score 4+3=7. PTI = 60%

Left mid: Gleason score 4+3=7. PTI = 55%

Left lateral appex: Gleason score 4+3=7. PTI = 35%

Left appex: Gleason score 4+3=7. PTI = 35%

Left lateral mid: Gleason score 4+3=7. PTI = 10%

Left base:  Gleason score 3+4=7. PTI = 95%

Mid right: Gleason score 3+4=7. PTI = 30%

Right base: Gleason score 3+3=6. PTI = 2%

Right lat appex: Gleason score 3+3=6. PTI = 1%

Right Apex: Prostatic glandular and fibromuscular tissue. Negative for tumor.

Right lat base: Seminal vesical/ejaculatory duct-type tissue. Negative for tumor.

Perineural invasion is identified.

Comments

  • Rob.Ski
    Rob.Ski Member Posts: 174 Member
    #2

    My surgeon showed me a study of side effects and outcomes from his surgeries. Might be worth asking the docs if they have that vs. generic outcomes from their form of treatment.

  • VascodaGama
    VascodaGama Member Posts: 3,707 Member
    #3

    Hi,

    From what you posted above, I think that you have an aggressive case in need of an aggressive attack. Probably a combination therapy involving RP plus RT with ADT would be also an option for you to add in your List of Questions.

    Gleason sum 7 (4+3) with identified extraprostatic extensions and voluminous case of cancer (from base to apex in both lobes) is highly risky for failure of a solo intervention.

    Surely we shouldn't compare cases but you may like to read the story of a survivor who had that combination treatment in this link:

    https://csn.cancer.org/discussion/318066/prostatectomy-rt-adt/p1

    You can inquire about the experience that those specialists (surgeon and radiologist) have in such combination therapy.

    Welcome to the board.

    VGama

    https://www.cancercenter.com/community/blog/2020/10/questions-prostate-cancer-treatment


  • Old Salt
    Old Salt Member Posts: 1,530 Member
    edited December 2022 #4

    Yes, unfortunately, with the perineural invasion and the extensive (Gleason 7) cancer within the prostate, you are facing a more serious problem.

    For cases such as yours, Androgen Deprivation Therapy (ADT; aka hormone therapy) is often recommended to start out. This would then be followed by one or two kinds of radiation.

    I hope you can consult with a highly qualified radiation oncologist to see what (s)he recommends.

  • Clevelandguy
    Clevelandguy Member Posts: 1,206 Member
    edited December 2022 #5

    Hi,

    Have to agree with the two survivors above. It’s your choice to either go surgery, radiation, or a combo of both. Make sure you get the best consulting doctors around to guide you. The 4+3 is on the aggressive side and in my non medical opinion need to be delt with aggressive treatment. Surgery with radiation to the Prostate bed does not sound like a bad idea as Vasco pointed out. Hormone therapy weakens the cancer while other therapies attack it. I have included a link to get you started. Unfortunately all treatment options have side effects, so pick and discuss with your medical team. I know its a big decision but I would not wait very long with your Perineurial invasion.

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

    Dave 3+4

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