Making a Treatment Decision

lshick said:

Making a Treatment Decision
I will second Wolf's comments. There are no doctors here, so we don't give out medical advice. You'll find that nearly all of us who have "been through the mill" will recommend whatever treatment modality each of us chose. Since you don't know my tradeoffs, my choice--even though it worked for me--might be utterly wrong for him.

Assuming (and this is the first thing you need to double check) that there's no metastasis, the various mainstream treatments (surgery, radiation, etc.) offer *roughly* the same survival rates. That means that he gets to choose from among them based upon quality-of-life issues, convenience, what his insurer will cover, and so on.

Major point: what the medical world calls "co-morbidities." Obesity, diabetes--to be blunt, is he dying of anything else? That will weigh in on choice of treatment. What is his life expectancy, prostate cancer aside? If he's not otherwise healthy, it may be that something else is likely to kill him first, in which case, the complications and downsides of any PCa treatment may not be warranted.

Major point: if you have access to a really skilled and experienced practitioner for technology X (say, surgery) but only mediocre practitioners for technology Y (say, radiation), go with skill and experience, which will trump technology (among the mainstream treatments) almost every time.

I went with robotic surgery (my story is at http://www.sv-moira.com and scroll down to "prostate cancer"). I'm happy with my choice (so far--call me after my next PSA test) but my choice could well be totally wrong for him.

Visit (my favorites):

http://www.yananow.net/
http://www.healingwell.com/community/default.aspx?f=35
http://www.guideline.gov/summary/summary.aspx?doc_id=12380&nbr=6409&ss=6&xl=999
http://prostatecancerinfolink.net/

and (in my opinion) the most powerful:
https://www.cancer.nexcura.com/Secure/InterfaceSecure.asp?CB=265

...which requires lots of data (some of which you won't have--don't let that bother you, come back and fill it in as you get it). But it gives you relatively easy access to the fine print and the assumptions and the uncertainties in each recommendation.

Take a deep breath, and reflect that you probably have plenty of time to make this decision deliberately. A Gleason 6 is far from the most aggressive. PCa is *usually* a slow-growing threat. Learn all you can before you pull the trigger.

Welcome to the club that nobody wants to be in. Lots of good people here to help.

wolf said:

Making a Treatment Decision
Hi Franklins,
From my experience as a PC survivor I would say that the first thing is to get educated about all the treatment options and what the side effects are. You have time so there is no hurry – PC is relatively slow growing and growth can be stopped and the tumors shrunk with hormone suppression therapy – reducing testosterone to near zero with drugs (PC cells need testosterone to grow). Hormone suppression is not curative but is effective for a number of years.

There are several options for ‘curative’ therapy (curative is in quotes since I have never heard a urologist or oncologist use the word cure – in remission is preferred). The first treatment everyone thinks of is surgery since for a long time it was the only curative modality available for PC and became the gold standard as it was successful with about 90% of patients treated. Read the posts here by patients who have had surgery and you will see that the likely side effects are impotence and incontinence. Most people who have surgery want to ‘get rid of the cancer’ and view surgery as the only way to do that. With ‘nerve sparing’ surgery a bundle of nerves in the prostate are ‘spared’ or not removed. Most patients with this kind of surgery do not become impotent but it is done only when the cancer in the very initial stages – otherwise it is likely to ‘spare’ cancer cells as well.

Many seem to believe that surgery is more successful than, for instance, radiation by several percentage points. Any good radiation oncologist will point out that they treat a lot of patients when surgery is not indicated because of the possibility that the cancer has spread beyond the gland and surgery is unlikely to ‘get it all.’ These marginal patients probably account for the difference in success rate. Then there is the fact that surgery is difficult and not likely to be successful if the cancer returns after radiation treatment; but if surgery is not successful it is still possible to get radiation treatments. I never understood this argument since radiation does kill the cancer and if radiation of a larger area than surgery can remove is unsuccessful I don’t see what later surgery could do to alleviate the disease.

Other than surgery there is radiation (x-ray and proton beam, radioactive seed implants), cryosurgery (freezing the cancer with probes that are inserted), ultrasound heating of the tumors (relatively new) and likely some other modalities that I am not aware of. All of these treatment options are successful to some degree and all have their side effects.
X-ray external beam radiation (even with the sophisticated beam shaping techniques now available) sometimes burn the colon and/or the urethra severely enough to cause problems that may require surgery to correct. Cryosurgery similarly sometimes destroys tissue other than the cancer. Don’t know much about radioactive seed implants and ultrasound is relatively new. The one modality that most patients say has no appreciable side effects is external proton beam radiation. Its success rate, like surgery and x-ray radiation is around 90%. The reason is that protons do not destroy the tissue it passes through – the energy is released when the proton stops. Techniques are available to precisely shape the proton beam and control the energy of the protons so that all the energy is released on the intended target.

I was diagnosed with PC in 1994 at the age of 63. My PSA was 102.6 and Gleason 6. I was treated at Loma Linda U. Med. Ctr. in California with external proton beam radiation. I had no side effects and my PSA promptly went to 0.5 and has been at 0.3 for over 10 years. Obviously I recommend this modality. If you want more information about proton beam radiation I suggest these sites:

http://www.protonbob.com/proton-treatment-homepage.asp (Check testimonials.)
http://www.protons.com/

In the USA proton beam therapy is also available in Sacramento, California at the University of California, Davis, the UC Davis Proton Facility. Since 2004, the Midwest Proton Radiotherapy Institute at Indiana University, and, in 2006, the University of Texas M. D. Anderson Cancer Center in Houston TX, and the University of Florida Proton Therapy Institute in Jacksonville, FL. Also I have heard that Massachusetts General Hospital in Boston has the capability.

Wolf