Treatment Decision

Hi,

If it was me I would be asking your doctor team why they can’t do nerve sparing surgery. Do you have Perineurial invasion or positive margins? A second opinion might be in order with different doctors/hospital network. If the cancer has invaded the nerve bundles a PMSA PET scan might be in order to check for spread outside of the Prostate. Both surgery and radiation have side effects, you have to determine based on your set of circumstances which is best for you.

Dave 3+4

I went back and forth between Radiation and Surgery. I am 70 and decided Surgery next month. All in prostate , no lymph no involvement. 13 core Biopsy showed 5 cores Gleason 6, one core Gleason 7 (3+4), and one Gleason 8 (4+4) 10 % involvement. Decipher intermediate . My staging is IIC , cT1c NOMO. I am upstaged because of just the one core of Gleason 8. I personally don’t feel just because you have one Gleason 8 you should go up with Gleason 9 and 10’s high grade. I feel even just one Gleason 8 is not like having 8 cores of Gleason 8 heavy percentage in the cores. I again personally feel they are not making enough allowance for that in treatment protocols. Remember it wasn’t that long ago their was no active surveillance and they aggressively even went after Gleason 6, not understanding and having all the access ro genomic testing that mught show its likely to grow slowly. It definitely is about quality of life and treatment protocols have evolved to not necessarily go immediately after the cancer depending on its grade and continue to look more at quality of life. My initial direction was radiation thinking it would give me a better quality of life but then learned about the hormone treatments for 2 years and their side effects and reevaluated my thought process. The surgery recovery is basically healed in three weeks and you are up and around before then but clearly have the side effects which clearly improve over the next months except ED for maybe quite awhile even with nerve sparring. I don’t feel needing to wear or change pads while I get better is going to be as much detrimental to everything about doing things being active and getting around in daily life as Radiation because you are on the hormone treatment likely for at least two years. In addition although they are saying after healing from surgery will likely need adjuvant radiation and hormone treatment due to my having one Gleason 8, I feel it seems you could defer on that until it actually returns then do salvage treatment. Many articles discuss lack of enough studies to truly show substantial long term survival benefits over immediate adjuvant treatment and waiting for salvage treatment that the difference in outcomes might not be as significant for quality of life in waiting. Finally for me was no one knows how Radiation and hormone treatment might affect your overall health in years to come and then you might not be eligible for Surgery. The consensus is still salvage Surgery after Radiation is much more complicated if able too although possible, but no issues if Surgery first and Salvage Radiation later.
I had non Hodgkin’s lymphoma 20 years ago and upon relapse my ONC wanted me to go on two year maintenance of Rituxan every 6 months, which was being pushed and the big thing. Then there were different opinions on whether receiving 4 weekly doses, 6 or even 8 doses. However one ONC from UCLA believed overusing Rituxan although it showed good response rates, it was too soon to know long term benefit outcomes versus continuous suppression of your immune system and maybe loss of effectiveness of an outstanding drug for lymphoma. His recommendation was just one 4 week course, no maintenance and if returns can then retreat if necessary. Have had no further treatment for 16 years, but who knows if I had gone on to receive so much. That’s why I am inclined after surgery to just wait and if it returns then go with the Salvage Radiation. It clearly is a difficult decision which direction and what one person decides could very well be different under the same circumstances what another person decides. Good luck.

No, I’m referring to focal therapy, like cryosurgery or TULSA. I edited my post to correct above. But after more reading, it is not recommended for Gleason 8 and higher at this time.