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Radiation or Surgery

mrdcb
Posts: 2
Joined: Nov 2016

I am 62 recently diagnosed with prostate cancer. My Gleeson score is 7 with 8/12 cores positive for cancer. Doctor recommends radiation or prostatectomy. After some research and visits with radiology and surgeons I’m strongly leaning toward prostatectomy. I want to have normal bladder, bowel and sexual function and it seems surgery offers the best chance for a this. Anyone care to share an opinion or their own experiences with either procedure?

Will Doran
Posts: 207
Joined: Sep 2015

mrdcb,

I'm very sorry to hear of your diagnosis, and pray and hope for the best for you.

All of our cases are different, and thus what one of us has as treatment might not be what's right for others.  I was diagnosed in August of 2013 purely by accident.  I had an internal bleed and they found my PSA was at 69, and a Gleason of 3 + 4 --7.  I had had no symptoms that there was a problem.  I was 67 at the time.  I had a biopsy and it came back positive.  I was a road cyclist, out on the road two - three hours per day.  The doctors said because of "my youth" and Physical Condition, that they recommended surgery.  However they made me go to Radiation Oncology and talk to them first.  After that visit I was leaning towards Radiation.  However I decided to go with the surgery, and wanted the cancer removed. Robotic assisted Surgery was done in December of 2013.   Post surgery pathology showed 40% involvement of the prostate, with one very small spot in one lymph node.  Other margins were OK and there was no spread to the bones.  I was listed as a Stage pT3bN1.  So, my doctors said it was aggresive and we were going to be very aggresive with treatment.  I was put on Lupron for a period before Radiation.  Then had Radiation for 8 weeks, 5 days per week to the prostate cavity area..  I remained on Lupron for two full years.  They kept my testosterone knocked down to 17 for two years.  Normal is between 250 and 1,100.  My PSA was down to <0.010 in a few months and had remained at that level until three months ago.  I've been off the Lupron for almost 6 months at this point and two months ago my Testosterone was back up to 320 with in the normal range.  My PSA has come up a small amount which they told me would probably happen.  My PSA is now a 0.035. That is still considered undetectable.  We are watching that very closely.  If my PSA starts to climb then I will have to go back on some sort of ADT treatment. Be that some chemical or surgical form -- we will decide.  My doctors and I are hopeful that my PSA will level out and hold, but we are prepared to do what ever we have to to keep this "beast" under control.  I am now dealing with bone density problems.  After doing bone density scans they found that I was gaining bone density in all areas except for my femurs were the raqdiation had hit.  I had lost density there and thus they put me on Prolia for that.  The side effects of the Porlia are in some ways worse than the Lupron.  Muscle and bone aches being the main problem.  Not sure whether Chemo Oncology will take me off of the Prolia or not.  I'll no that in another two months.   

So, that is my story .  I will be a three year survivor in Dec.  What has worked for me to this point is what was recommended for my situation.  Make sure and study every possible treatment and decided what you feel is best for you.  As I said, all of our cases are different.  Make sure that you understand ALL of the side effects of all the forms of treatment.  This changes your life completely.  I am still able to ride my indoor trainer / spinner bike for 100 - 120 minutes per day but I don't feel secure out on the roads on a bike.  I do my weight lifting, etc, and am trying to keep myself in shape.  I had a good bit of muscle mass loss while on the Lupron, but kept working out and that helped a good bit.  Now that my Testosterone is back up in the normal range, I am starting to regain my lost muscle mass.  All my shirts are starting fit tighter in the shoulders and arms.  My wife has been commenting on that for the last couple months.  You must keep youself in shape and fight like "H".  You can't let this run you down.  My doctors let me get back on a treadmill two day after surgery, for short periods of time.  In a couple of weeks I was up to an hour per day.  Then I was told not to try my spinner bike for 8 weeks, but they left me back on the bike at 6 weeks because I was bugging the devil out of them.  They told me to try it and told me I'd know if I was doing to much.  All went well.

You will hear from others on this site and they will also tell you what they have had as treatment.  Again, learn all you can from us and from other places on the internet.  Study hard and decide what is best for you.  We all feel what has worked for us is the way to go, and thus you will hear that loud and clear.  However keep an open mind and study, study, study.  Listen to your doctors.  We are not doctors  on this site, and thus we can't and won't tell you what to do. 

Best of luck.  Fight like "H".

Know that you are in my thoughts and prayers.

Love, Peace, and God Bless

Will

desperate for hope
Posts: 44
Joined: Oct 2016

Will, do you have a special seat for your bike? My husband and I were biking an hour a day and many more on the weekends until the biopsy came back. Now, we're concerned the bike seat might aggravate the cancer. 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3050
Joined: May 2012

mrdcb,

Your question is the most popular discussion item at this site, and the one that engenders the most debate. Men wanting to know what to do for newly-discovered, first-line treatment.

You have not really provided enough info for commentary to be given.  What is your PSA ? What is the history of your PSA changes ? Do you have other urinary issues ? (BPH, gland size, etc?)  Your overall health, especially heart and weight ? (These can recommend for or against surgery, for instance)

The most-common views or assumptions regarding all of this (but even these are argued about) is that surgery is usually a good choice for a younger man (like yourself) in overall good health, who wants to end worrying about cancer immediately, since PSA results following surgery will within a few weeks go to zero if there was no metastesis (spread outside the gland).  Also, the gland is studied by a pathologist immedately upon removal in the operating room, and you will know exactly what was where regarding tumors.

Negatives regarding surgery is that if there is metastasis, surgery often will miss it.   But, the area can be radiated following surgery to kill metastatic cells, if they are still in the immediate area.  Erectile disfuntion (ED) is universal following, at least for several months, but more commonly than not, sexual function will return.  Some degree of ED is common after surgery for approximately a year, but his varies tremendously.  Urinary control will take a few weeks to months to return.  In rarer, problematic cases, ED and incontenince are forever.  There is some pain and recovery time post-surgery; you will hurt several days to a week or so, and lifting is restricted for a month to a few months.

Radiation can be delivered in three primary manners:  "Fractionated" is the most traditional form, and treatment with low individual doses taken each weekday for a month or little longer. Treatment time each day is short, and weekends and holidays are off. Fractionalted radiation is also a primary tool against metastatic diseaes, both first-line and second-line.  SBRT radiation is given in stronger bursts, and is done over a week or less.  SBRT is usually referred to by manufacturer names: Cyberknife and Varian being the most common.  SBRT is not ordinarily used against metastatic PCa. 

Radiation has advanced dramatically in the last decade or so, and is extremely precise in delivery, both SBRT and fractionated technology.  A third type of radiation, "seeding" implants radioactive seeds directly into the gland, via a minimally invasive needle.

Radiation is good for a variety of prostate cancer (PCa) patients: Men older than recommended for surgery; men with disease that is likely metastatic, men for whom avoidance of side-effects is paramount.  Radiation side-effects are usually delayed, if they occur at all: They ordinarily are not known the first week or month following application, but can occur many months later, if at all.  Incontinence, rectal burn, and other issues can happen, but are rare.

Radiation may not be the best choice for men wanting to instantaneously know their status following treatment.  PSA levels will oscillate following treatment, sometimes for a year or more, even when the treatment hasa killed all of the disease.  Some forms of radiation are not recommended for men with extremely large glands or with urinary stricture (inablitily to begin or maintain urine flow, for differing reasons).

These are GENERALITIES. Guys DIFFER, sometimes STRONGLY, about treatments.  There are better choices, and less good choices, but there are a LOT of choices. Everyone suggests speaking to at least one surgeon (who ordinarily will be your uriologist), as well as at least one or more radiation oncologsits.

I received DaVinci surgical removal two years ago, and have normal bladder control and sexual funtion today, but mine is just one case.

You need to read, listen, ponder. And then wait a little while, and just meditate on the direction you choose. Treatment for PCa is usually not an emergency, and allows time to decide.

max

 

hopeful and opt...
Posts: 2218
Joined: Apr 2009

I'm sorry for your diagnosis and that you need to post this question.

You mentioned that you were diagnosed with a Gleason of 7. I wonder if that was a 3+4=7 or a more aggressive case of 4+3=7. You also mentioned that 8 of 12 cores were positive, which is extensive. I also wonder what the percent of each core that was positive is cancerous. Your biopsy report will show this information. PLease post.

What were the results of your digital rectal exam (finger wave)?

Did you have any other diagnostic tests, ie image test such as an T3MRI that can indicate if there is extracapsular extenstion, that is outside the prostate, will stage the disease.

The side effects of surgery are age related, that is, a surgeon can do a perfect surgery, but an older man say, 70 can have side effects of ED or incontinence while a younger many of say 50 will show no side effects.

In your case, looking at the limited information that you posted,  it is very possible with what appears to be extensive amount of cancer, that the cancer has left the prostate, so you need to have an imaging diagnostic test.

Radiation can be done outside the prostate as well as the prostate itself; the radiation oncologist can adjust the radiation to extend  beyond the prostate when it is of intermediate aggressiveness as yours appears to be, thus there is a greater likelihood of erradicating all of the cancer.

In the case of surgery, the prostate is removed and this treatment does not extend outside the prostate as radiation does, so cancer can be left which will require addtional treatment of which salvage radiation is one. The side of effects of multiple treatments are cummulative, so you can have side effects from surgery as well as from radiation.

Please provide additional information that you have about your situation so a more informed answer may be provided.

PS As far a radiation, you may wish to do research about SBRT. There are various platforms that deliver this treatment of which Cybeknife is one and Novalis is another.

Old Salt
Posts: 718
Joined: Aug 2014

There are some on this (and other) prostate cancer forums with very strong views about the surgery vs. radiation dilemma. But the above comments give excellent perspectives.

With respect to mrdcb's original post, I am puzzled by one sentence:

I want to have normal bladder, bowel and sexual function and it seems surgery offers the best chance for a this. 

How did you arrive at that statement?

Clevelandguy
Posts: 372
Joined: Jun 2015

Hi,

I feel that you need to know if the PCa is confined to the Prostate or not.  The MRI and Biopsy should tell you that, 4+3 is a more agressive cancer than 3+4. If the PCa is totally contained inside the Prostate then you can make the choice on radiation or surgery.  Study both cafefully and talk to both your Urologist & and Oncologist to get both sides.  Get the best doctors/hospitals you can afford to give you the best chance of a sucessful recovery.

I chose surgery and don't regret it, other people have chosen radiation and don't regret it.  I had an overnight stay in the hospital and a catheter for two weeks(the worst part). I had very little pain but a fair amount of bloating in my adomen from the gas used to blow up the area where the surgery took place.  That went away after a couple of days.  After two years I have no Ed and just a slight leakage(one light Depends pad per day) when I do heavy physical labor.  I have no detectable PSA(below .01) and I love that, hope it continues. My doctor put me on Cialis for around six months after surgery to aid in the blood flow and healing.  I wanted to know the cancer was gone from my body, I think a positive mental state helps you recover quicker and keeps down the stress of not knowing if all the cancer is gone.  So the choice is yours, good luck on your decsion.

Dave

3+4 

Swingshiftworker
Posts: 1013
Joined: Mar 2010

The OP said: "After some research and visits with radiology and surgeons I’m strongly leaning toward prostatectomy. I want to have normal bladder, bowel and sexual function and it seems surgery offers the best chance for a this."

OP: How did you reach this conclusion?

I think it is undisputed that surgery presents the greatest risk of side effects, mainly ED and incontinence (but also the risk of collateral organ damage and infection) than any method of radiation.

At Gleason 7, you should still be eligible for SBRT (aka Cyberknife) radiation treatment which is the more precise method of radiation delivery for prostate (and other forms of) cancer, which can be calibrated to the sub-mm level and adjust for both organ and body movement during treatment.  No other method of radation treatment can do this and this ability greatly limits the potential for damage to the urethra, bladder, seminal vesicles and rectum (all of which if injured can cause problems).  Treatment is completed in only 3-4 sessions over a week's time compared w/25-40 treatments for IMRT (which is much better than it use to be but is still liable to greater risk of side effects than CK).  CK is also better than low dose BT (brachytherapy) which involves the manual placement of radioactive seeds in your prostate; improper placement and movement of the seeds is the primary problem w/this method.  CK was developed based on high dose BT, which involves the temporary placement of radioactive seeds in the prostate but improper placement (in terms of location and dosage) is still a problem w/this method.

If you have not researched any of these other methods of radiation treatment, I suggest you take the time to do so before submitting yourself to surgery.  Personally, I was treated w/CK 6 years ago without any side effects whatsoever and have been cancer free ever since.  Other men have reported similar success.  If CK is not available, you can problem do about as well w/IMRT which is more widely available; you'll just have to endure treatment for a much longer period of time. 

Good luck w/whatever treatment you choose.

 

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3050
Joined: May 2012

On the subject of radiation therapy, the next county over from where I live had an article in my local paper today regarding a device called SpaceOAR, which it says stands for "Space, Organ at Risk," now in use at their Oncology Center.

It is a gel-filled device that is inserted between the rectum and prostate gland in men receiving RT for PCa.  It stated that it replaces "baloons," which had been used to separate the rectum and prostate to avoid radiation burns for many years now.

The SpaceOAR has to be insterted only once, not prior to each radiation application.  This cancer center uses it with a (Varian) Novalis Truebeam STx machine for IGRT and SBRT, but I suppose it can be used with any RT machine.   I had not heard of it before; sorry if it is "old news."

I will add that IMRT technology has been replaced with IGRT technology at most up-to-date oncology facilities.  Of the three county hospital systems in my region, none any longer uses IMRT; all have combined IGRT/SBRT availability.

max

Swingshiftworker
Posts: 1013
Joined: Mar 2010

mrdcb:  If you haven't seen it already, I strongly suggest that you read MK1965's story about his recent experience w/surgery.  It's at the top of the list of current threads (along w/yours) and you can find it here: http://csn.cancer.org/node/306274.

Long story short, his surgery has not gone well and is experiencing significant post operative pain.  He regrets his decision and would have opted for radiation (the only other option) if he had it to do over again.  Of course, not all surgeries go bad but, just as I decided when I chose CK for my treatment 6 years ago and as mrdcb has discovered, if you don't have to subject yourself to the risks of surgery to achieve the same result ("a cure"), why do so?  Short answer: there really is no good reason to do that.

 

 

mdo53
Posts: 5
Joined: Oct 2016

Mrdcb,

I'm 63 and my Gleason was also 7.  My choice worked for me.   I remember my surgeon telling me "I sell surgery and the radiation oncologist that I am sending you to, sells radiation".  Both doctors told me that there is no one correct choice and most patients are fortunate to have several choices availble.  I chose Da Vinci robotic surgery thinking radiation as a follow up or future option if necessary. Do your research and make your choice. 

I woke up in pain as most everyone does and checked out of the hospital 24 hours after surgery.  I walked on my own carrying my "bag" approximately 100 yards to my car. On the evening of my first day at home, I took one pain pill.  Nine weeks have passed and I have zero pain, normal bowel and bladder functions. My first PSA check after surgery was 0.04.  I no longer wear a pad.  Doctor says normal sexual functions may take several more months or up to a year. 

My experiences were much different than MK1965's.  I didn't experience that level of pain and the small scars do not bother me at all.  I've met patients that chose open surgery, robotic and radiation with positive results.  It's a tough choice.

 

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