Prostate cancer diagnosis
Newly diagnosed prostate cancer. 54yr old healthy male
3+4 and 13.5 PSA. Prefer radiation due to side effects of surgery .Thoughts
Comments
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Yes, radiotherapy should be studied
Based on the data provided, radiotherapy does appear to be an option. But it would be good to have more info regarding the biopsy and other relevant health issues. I am sure that others will chime in once we have those data.
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In spite of the pressure not all roads lead to surgery
Hi Pawpabg,
Surgery may be the right treatment for you, but not necessarily. Laser ablation worked well for me but admittedly it is not a silver bullet treatment for all cases of prostate cancer. Still, you should check it out - google Prostate Laser Center in Houston (Dr. Ara Karamanian). Admittedly, I drank the Koolaid, but I am now a cancer survivor. I just honestly believe you owe it to yourself to turn over as many stones as you can prior to committing to surgery ...
Peace and blessings to you and yours!
Doug
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All treatments have side effects
Pawpaw (MI?) - Do not dismiss surgery. It does have advantages over radiation, which by the way does have side effects also. Generally - and I repeat generally, surgery is the quickest and most thorough way to address the cancer for younger men, those under 70. Generally. I do have to repeat that because any statement regarding "historically conventional thinking" on the matter is always subject to refute. This is the internet after all.
Your grade 4 component and elevated PSA would indicate that you should preceed with treatment in the near future. Often a biopsy will miss higher grade tumors, so there may be more in there than is apparent. In surgery your prostate will be removed and the gland and surrounding tissues will be carefully examined by your surgeon and pathologist(s). The true nature of your cancer will be identified and further treatment may be required. Pathologic upstaging is not uncommon. Most side effects are immediate and recovery proceeds over the following months and typically are fully resolved within the first year. ED is the most lasting SE and may last years. There is also a 5% possibility of urinary incontinence. The objectives are 1) cure the cancer 2) regain urinary continence and 3) redevelop sexual function - in that order.
Numerous forms of radiation therapy exist, and more are being developed constantly. The most common is IMRT and generally requires two months of daily treatment. Side effects are cumulative and become worse with time. Some late radiation toxicity may not become apparent until more than a decade later. Radiation is administered based upon external scans. The treated tissue remains in your body. It does affect sexual and urinary function to some extent, so for example if you tend to have frequent prostatitis the radiation will not make that any better. Your PSA will gradually decline until it reaches a nadir over the years following radiation.
Adjuvant or salvage radiation may be required even after surgery if your pathology reveals higher grade or more extensive cancer. Options for salvage following radiation are generally very limited. Radiation is often chosen by older men who may have other health conditions that might preclude surgery. The cutoff is generally age 70, though there are exceptions. You are a very young man, and understandably loss of sexual prowess may be a major concern. However you should also give thought to the strong likelihood that you will live an another thirty years or so with your pelvic organs having been radiated.
All forms of treatment have side effects.
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PleaseMagicsparkes said:In spite of the pressure not all roads lead to surgery
Hi Pawpabg,
Surgery may be the right treatment for you, but not necessarily. Laser ablation worked well for me but admittedly it is not a silver bullet treatment for all cases of prostate cancer. Still, you should check it out - google Prostate Laser Center in Houston (Dr. Ara Karamanian). Admittedly, I drank the Koolaid, but I am now a cancer survivor. I just honestly believe you owe it to yourself to turn over as many stones as you can prior to committing to surgery ...
Peace and blessings to you and yours!
Doug
Provide evidence that the procedure worked well. Feeling good right after the procedure is great, but doesn't prove that the cancer was totally eradicated.
I hate to put a damper on your enthusiasm, but success needs to be ascertained at one-year intervals for at least five years.
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SnoreOld Salt said:Please
Provide evidence that the procedure worked well. Feeling good right after the procedure is great, but doesn't prove that the cancer was totally eradicated.
I hate to put a damper on your enthusiasm, but success needs to be ascertained at one-year intervals for at least five years.
Well, the ablation destroyed the tissue. I saw both the pre and post MRI. I guess you and I have nothing to talk about for another five years. I'm sorry, what insurance company do you represent again?
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.Magicsparkes said:Snore
Well, the ablation destroyed the tissue. I saw both the pre and post MRI. I guess you and I have nothing to talk about for another five years. I'm sorry, what insurance company do you represent again?
I hope that the targete procedure that you had will be successful for you, however since prostate cancer can be mutifocal, the cancer can be elsewhere in the prostate, , since the T3 MRI image is not able to detect micro cancers.
If any more cancer is found during future review, will the facility re-laser the prostate, without additional cost?
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Exact
RobLee just accurately described my experience with DaVinvi robotic prostatectomy. I was struggling with frequent prostatitis caused by an apparent recurring Staph infection. Even after antibiotic treatments, at my biopsy the prostate was still enlarged to 250cc compared to normal 25cc. I could have done active surveillance at Gleason 6 3+3, but opted for surgerry because of the triple threat of BPH, Prostatitis, and cancer.
Radical nerve sparing prostatectomy in June 2016. Incontinence recovery after 6 months or so, 98% recovery now. Erectile dysfunction recovery after one year, still recovering, about 90% with only minor issues, hopefully full recovery by two year mark.
My experience was exactly in the order RobLee described. One more SE should be mentioned... when the prostate is removed surgically, the urethra section goes with it, and the urethra is pulled up and reattached... leading to about 1-2 inches of penile shortening.
Whatever treatment you choose Pawpawbg, make sure you have skilled, experienced professionals administering the treatments. I invite you to read far into the archives of this forum and discover the commonality among all successful forms of treatment... skill and experience of the professional administering the treatment.
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Hey
check out my blog ...almost 5 months on and no decision yet...I have been lucky enough to have met the supposedly the best of the best at Stanford and UCSF number 4 and 8 supposedly in the country ..lcyberknife expert 2 brachytherapy experts and 3 top notch surgeons who r nit pushing fir surgery ...but to tell u the truth I may end up doing surgery and be done with it ...cybrtknife sounds and seems great just not sold on it ..brachytherapy I just can’t see it nit messin* up my poor urinary problems 5 times more ..I mean do I want urgency 4 times a day instead of 2 do I want to get up 5 times a night instead of 2 and sit on the toilet fir 6 minutes each times while pee dribbles out like a bad faucet ....every single night fir the rest of my life going to be a huge tough decision ...This whole drama has been exhausting bone scans mri sonograms ....but thank GOD so far all is good but I really just want this over with ........it’s hard to bielieve all this far 3 little tumors the biggest one probably smaller than a pee and it Gould and would eventually kill u...wow cancer sure does suck......I went fir an hour long mri t3 kidney liver and prostrate. All was good ...guess how much 27000 dollar omg anyway my friend get many opinions hopefully u won’t have to hurry like I don’t have to at least that’s what they say April 20i will have narrowed down my choice hopefully it will help u .....old salt hopeful and helpful and a few other have helped me a lot ..listen to their advice like I have
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Wow here u go again scaring peopleRobLee said:All treatments have side effects
Pawpaw (MI?) - Do not dismiss surgery. It does have advantages over radiation, which by the way does have side effects also. Generally - and I repeat generally, surgery is the quickest and most thorough way to address the cancer for younger men, those under 70. Generally. I do have to repeat that because any statement regarding "historically conventional thinking" on the matter is always subject to refute. This is the internet after all.
Your grade 4 component and elevated PSA would indicate that you should preceed with treatment in the near future. Often a biopsy will miss higher grade tumors, so there may be more in there than is apparent. In surgery your prostate will be removed and the gland and surrounding tissues will be carefully examined by your surgeon and pathologist(s). The true nature of your cancer will be identified and further treatment may be required. Pathologic upstaging is not uncommon. Most side effects are immediate and recovery proceeds over the following months and typically are fully resolved within the first year. ED is the most lasting SE and may last years. There is also a 5% possibility of urinary incontinence. The objectives are 1) cure the cancer 2) regain urinary continence and 3) redevelop sexual function - in that order.
Numerous forms of radiation therapy exist, and more are being developed constantly. The most common is IMRT and generally requires two months of daily treatment. Side effects are cumulative and become worse with time. Some late radiation toxicity may not become apparent until more than a decade later. Radiation is administered based upon external scans. The treated tissue remains in your body. It does affect sexual and urinary function to some extent, so for example if you tend to have frequent prostatitis the radiation will not make that any better. Your PSA will gradually decline until it reaches a nadir over the years following radiation.
Adjuvant or salvage radiation may be required even after surgery if your pathology reveals higher grade or more extensive cancer. Options for salvage following radiation are generally very limited. Radiation is often chosen by older men who may have other health conditions that might preclude surgery. The cutoff is generally age 70, though there are exceptions. You are a very young man, and understandably loss of sexual prowess may be a major concern. However you should also give thought to the strong likelihood that you will live an another thirty years or so with your pelvic organs having been radiated.
All forms of treatment have side effects.
how do u know that that often they miss higher grade tumors in biopsies ..reallly says who you...quit scaring people like you scared me a while back ...u don’t know what the hell you are talking about
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Treatments?
Hi Pawpa,
Got to agree alot of what Grinder and Roblee said. I too had surgery and I am glad I did. Hopefully it got rid of the tumor once and for all, done, gone out of there. Surgery can leave you with very little ED and urine leakage, it takes a year or two to heal completely. Radiation will work also but can have some residual complications later on 5-10 years down the road. Colon lesion problems,scar tissue in the uretha & bladder, other cancers caused by the radiation because it can change your DNA where the radiation hits other tissue or organs. You notice I said "can" as the side effects vary from case to case based on the amount of cancer you have and its location to other organs.
All treaments have side effects so study them carefully. Even at 3+4 you have some time to study what you want to do. AS in my opinion does nothing more than push the decision down the road but is a good decision for an older man in his 70-80s, your cancer will not go away on it's own.
Dave 3+4
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SteveSteve1961 said:Wow here u go again scaring people
how do u know that that often they miss higher grade tumors in biopsies ..reallly says who you...quit scaring people like you scared me a while back ...u don’t know what the hell you are talking about
You are wrong.
A biopsy is like a needle in a haystack (usually only twelve samples). It's not uncommon to miss a cancerous spot which may be a higher grade one.
And it's against forum policy, and plain impolite, to state that a member doesn't know what he is talking about.
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Again inaccurate statements
Again inaccurate statement: Surgery can leave you with very little ED........
Surgical SE are way heavier and way harder to recover and they hit you upfront. Chances to recover ED are not higher then 50% at the best. According to one reaserch, only 23% of post RP patients are able to have erections at 2 year post surgery.
Whoever is happy with that, then RP might be good choice.
RT side effecto are milder, developing slower and they are consistent with aging, not much harsher. PDE5 inhibitors work perfectly same as for aging men.
MK
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Beat the odds
Hi all,
Well I guess me and a lot of other folks here beat the odds. No Ed after about 1.5 years. As I said earlier RT can produce problems not consistent with old age like DNA changes and colon problems and possibly radiation induced cancers. See my other posts.
Dave 3+4
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Steve, I'm sorry if I scared youSteve1961 said:Wow here u go again scaring people
how do u know that that often they miss higher grade tumors in biopsies ..reallly says who you...quit scaring people like you scared me a while back ...u don’t know what the hell you are talking about
Honestly, I don't remember what I might have said that scared you. I tried to read your blog here that you mentioned below, but it is empty.
I believe that patients should be well informed. My doctor told me very little. He never mentioned cancer. I only know what I am talking about because I have lived it... four years so far. More actually. It is hard to not feel resentful when I think back on it. And I don't want others to end up that way, so I try to tell them what I have learned, the hard way.
Again, I am sorry and I hope your experience is much better than mine has been.
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Nerve sparing vs. other RPs
"Prostate-cancer treatment causes ED because the nerves involved in erection border the gland. Surgery often cuts these; radiation frequently damages them.
A special surgical approach called nerve-sparing prostatectomy can push your ED risk below that of radiation. Studies report "functional" erections in 60 to 80 percent of men who have nerve-sparing surgery. "
https://www.aarp.org/home-family/sex-intimacy/info-01-2014/sex-after-prostate-cancer-castleman.html
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Some Actual Research Results in the Surgery vs. Radiation Wars.
Radiation appears to win out.
https://pcnrv.blogspot.ca/2016/09/patient-reported-outcomes-from-protect.html
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Unproven statement by PCNRV
"RP was open and nerve sparing. While most men now have robotic surgery rather than open surgery, it seems to make little difference, except for some higher incidents of issues arising during the operation"...PCNRVThis is a disingenuous example of lumping together all results of open, laparoscopic, and robot assisted laparoscopic nerve sparing prostatectomy.
They should have separated nerve sparing robotic data from other types of RP if they wanted an accurate comparison. Since they do not, open surgery, et al, will drag down the data of nerve sparing RP. If nerve sparing RP data had been presented without the open surgery data mixed in, the outcomes for nerve sparing would have been much better.
And that is EXACTLY what happened in the studies quoted by the American Association of Retired Persons (AARP). When nerve sparing RP surgery was compared to other types of RP surgery, instead of lumping them together like PCNRV did, nerve sparing pushes "ED risk below that of radiation".
But as far as proctitis and potential loss of bowel function side effects, radiation is the clear culprit. There are plenty of horror stories I have listed of proctitis and worse side effects, some permanent, in this forum. There are currently victims posting right now if you noticed.
But any fair review of research would also distinguish between diffetent types of radiation treatment. Some may have better results than others, and lumping them all together gives an inaccurate view of the better treatments as well in regard to proctitis and/or loss of bowel control.
I have yet to see comprehensive research done which dileneates between ALL different types of radiation, radical prostatectomies, HIFU, laser ablation, etc.
So no, Radiation does not appear to "win out" against nerve sparing RP once you investigate their research methods and procedures, it only "wins out" against protestectomies in general of all types.
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Stats
Where I used to work our Stats guy said what do you want the numbers to say? Really need a true comparison of open vs robotic and the various radiation methods. Grinder's has some valid points.
Dave 3+4
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Again, variables.
The following lists the variables that can affect research outcomes for radiation . For some reason everyone is ignoring my statements on the importance of variables, and continue to quote research that is skewed by those variables not taken into account....
"The incidence of radiation proctitis is not clear due to the lack of consensus on its definition and reporting methodologies. There is a general agreement that the incidence is likely related to the dose of radiation, area of exposure, method of delivery, and the use of cytoprotective agents. "
Listed above are four variables that will affect the incidence of radiation proctitis, and the data collected that apoears to support the conclusions of the research.
"External beam radiation studies have seen incidence rates of radiation proctitis range from 2% to 39% [7–10] depending upon the severity/grade of proctitis, whereas IMRT studies have seen incidence rates from 1% to 9% [11–13] and particle radiation therapy in the range of 1% [14]. Although particle radiation therapy seems to have a lower incidence of proctitis, it is limited by cost and only available at specialized facilities. The incidence of proctitis in patients treated with brachytherapy alone is 8% to 13% and up to 21% when used in combination with other modalities [15]."
Incidence of radiation proctitis ranges anywhere from 2% to 39%!!! Why is that range so widely variant? Because of VARIABLES.
Again, as I have said before, the most significant variable in successful nerve sparing surgery is the skill and experience of the surgeons. I am getting blue in the face trying to get this across... is there a better way to explain this? Are we going to keep playing dueling data without regard to the variables that are essential in any meaningful discussion about research?
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