Treatment advice

gtcrew66
gtcrew66 Member Posts: 5 *
in Prostate Cancer #1

I'm I 58 year old male healthy, non smoker no drugs in very good shape on active surveillance for 1 year. My PSA has been stable for last 9 months at 6.0. Original Biopsy (1year ago) I had 3 cores 3+3 and grade 1. Recent Biopsy I had 5 cores 3 at 3+3 and 2 at 3+4. I'm seeking treatment advice from anyone who would like to share their experience. Thank you

Comments

  • Wheel
    Wheel Member Posts: 99 Member
    #2

    Continuing on AS is an option, but before doing that I would have your urologist order the ExoDx urine marker test and have your biopsy tissue sent for genomic testing such as Decipher. Google these tests. They will help identify the aggressiveness level of your cancer and help you make a decision about going a treatment route now or being comfortable about continuing AS. I would also ask about getting a PSMA Pet to assess that it is definitely localized.

  • gtcrew66
    gtcrew66 Member Posts: 5 *
    #3

    Thank you so much for that advise

  • Steve1961
    Steve1961 Member Posts: 599 Member
    edited September 5 #4

    I was 57 when I was diagnosed I had three biopsies starting at age 50 didn’t know any better the third time at 57 they found cancer I freaked out I sent it out for testing. It came back as aggressive. What did I do? I made a huge mistake I did radiation well I was good for six years now I’m 63 and it came back or it didn’t kill at all and I had salvage surgery done now. I am cancer free. Hopefully I’ll stay that way. If I could do it all over again I would not mess around if I was you I would find a surgeon that’s done 3 4 5000 of them get it taken out and don’t look back. I personally have known five men now that had prostate cancer that had surgery. All them are 678 years cancer free with no side effects. Don’t overthink this. You want my opinion. It’s not that big deal even with salvage surgery. It was only two hours long for me in the hospital overnight catheter out in seven days and I do have some pretty bad incontinence only because I had radiation , that’s my opinion think about it you have cancer in your body. It’s not gonna go away. It’s only slowly going to get worse get rid of it.

  • Clevelandguy
    Clevelandguy Member Posts: 1,135 Member
    #5

    Hi,

    I had robotic surgery back in 2014, 3+4 and Perineurial invasion. Ten years later my psa has been running less than .1(undetectable) and the last few years with the sensitive test a steady .05. It took me about 1.5 yrs. to recover from the ED with gradual improvements along the way. I still drip a drop or two of urine during heavy lifting or awkward body twists so I wear a light pad every day. I have no regrets on my surgery decision. It’s really your choice based on your unique set of circumstances ie; amount of cancer, aggressiveness, location of cancer. Get the best doctors+best facilities to get the best results. A PMSA pet scan will tell you if you have any cancer outside the Prostate. Either surgery or radiation are very good treatment plans and yes each choice has side effects.

    Surgery: side effects after surgery but usually diminish over time, ED, urine leakage

    Radiation: very little side effects early but some develop over time, blade or bowel issues

    I have included a link for you to study:

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

    Dave 3+4

  • gtcrew66
    gtcrew66 Member Posts: 5 *
    #6

    Thank you so much for your comments, I'm just trying to gather as much info as I can to make my best decision so I appreciate you guys sharing. I'm leaning towards just getting rid of it with a robotic guided prostate removal. Dealing with the side effects are certainly downsides but the upside from the removal seem to greatly outweigh these.

  • Marlon
    Marlon Member Posts: 74 Member
    #7

    At 67,4+3, my urologist said I was on the borderline between preference for radiation vs surgery. I was likely to have good outcomes either way. I chose surgery because I wanted it out. I am glad I did, because the pathology report showed it was more aggressive than expected. The MRI and biopsy are just an informed guess until they get in there. Yes the side effects and recovery were harder than I expected and after 9 weeks, I am still slowly regaining continence. But I do not regret it. The standard radiation treatment would have just now been completed. If there is a recurrence somewhere in the future, radiation is still an option. And BPH issues are gone.

  • Wheel
    Wheel Member Posts: 99 Member
    #8

    i just want to recommend if you decide treatment and as you investigate the Surgery options that these are some consideration’s when you evaluate a Surgeon’s approach to the Robotic Laparoscopic Radical prostatectomy (RALP).
    My Surgeon did the following:

    1. Nerve sparing.

    2. Retzius sparing (It involves preserving the retzius space, a layer of tissue between bladder and prostate)

    3. Single port DaVinci entry ( 1 1/2 inch vertical incision above belly button)

    4. Puboprostatic ligament sparing.

    5. Interoperative Frozen Section Analysis ( sends tissue to Pathology while you remain on the operating table under anesthesia allowing him to go back in if positive margin is identified.

    Go ahead and google each of these above items. Numbers 2 and 4 increase you continence after surgery substantially. Within five days I no longer need pads and immediately after the catheter came out I was not sure I was leaking. I have a post about the pads questioning whether you know you are leaking a little.

    My Surgeon explained that during Surgery I am certainly not upside down but he will operate through the Davinci robotic system as if I were upside down during the surgery. He said many surgeons are not familiar in the use of this approach and this is how he is able to spare the ligament. He said it was developed by a European Surgeon.

  • gtcrew66
    gtcrew66 Member Posts: 5 *
    #9

    So much appreciated and I will do the research all you guys are helping me very much and know a lot about this I'm just starting to learn but with your help I will make the right decisions

  • Marlon
    Marlon Member Posts: 74 Member
    #10

    gtcrew66, i found the book "Guide to Surviving Prostate Cancer" by Dr Patrick Walsh to be a great reference for explaining a lot of things so I could ask informed questions. It helped me understand why surgery is recommended for younger patients instead of radiation, which is the opposite of what I thought going in. There are other books I'm sure that are as good. That was the one my survivor friend recommended.

  • bdhilton
    bdhilton Member Posts: 866 Member
    #11
    https://csn.cancer.org/discussion/328455/treatment-advice

    I'd get a second opinion from a recognized teaching hospital eg John Hopkins, UCSF, Anderson, UCLA, Northwester, etc… 2009 diagnosed with clinical Gleason 4+3 (same after surgery), Surgery (Northwestern) to remove prostate 2010, Salvage radiation/Lupron 6 months 2014, SBST/Lupron 6 months 2022 (UCSF); 2022 perforated colon-surgery and surgery to repair radiation damage to ureter and bladder wall, 2023 Hartmann reversal and now September 17 and 24, 2024 HDR brachytherapy for Cribriform cell cancer next to my bladder neck (no Perineurial invasion)….Probably have had a hard year in the almost 16 years dealing with this cancer and a possible divorce after all these years but life has been good, no leaking, remain in good shape…all luck of the draw in life

  • gtcrew66
    gtcrew66 Member Posts: 5 *
    #12

    Oh my you guys are so good to me, lots of you really been through a lot of challenges

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