Hello, lots of confusion deciding on treatment.
Diagnosed Apr 2019. Gleason 7,8,9. PSA 12.6
Bone scan negative. MRI T3 showed contained to prostate
Two urologist/surgeon advised RP. Radiation oncologist in his opinion said treatment by surgery or radiation about equal
Have surgery date late Aug by Dr V Patel in Orlando, Fl but feel unsettled that surgery is best treatment option
ANY SUGGESTIONS??
Badnews
Could you expand a little regarding the gleason score ? What exactly did the report say? How mare positive cores, one side or both etc.
I gather that you recently were diagnosed and made a treatment choice soon afterward. Is this is the case then I suggest you slow down some and learn more about the treatment choices other than that the results are about equal.
Were you made aware of side effects? Which type of radiation were you discussing? Where did you go for consultations ? Was it local or a nonprofit teaching hospital?
Please, if you can, provide more info as it greatly helps getting a better answer.
Mostly though, I would not rush into any treatment without fully educating yourself on side effects and outcomes. Take some time, learning is all important. If you have misgivings then cancel the surgery until such time as you do feel comfotable. You can always reschedule if that is your choice. There are no redos or going back so you need to be certain about your treatment decisions.
Good luck and all the best, and please keep us posted.
They are right that surgery and external beam outcomes have about the same oncological outcomes, but there is a clear advantage to brachy boost therapy over surgery or external beam monotherapy.
pcnrv.blogspot.com/2018/03/...
To learn about brachy boost therapy, you would have to talk to an expert practitioner. If you are in Orlando, you might want to talk to Dr. Matthew Biagioli.
I fully agree with 407ca about pause ,ponder,learn and then decide. One or two weeks delay in treatment will not matter in grand scheme of things. But, rushing to wrong treatment can cause more problems. Don,t let your fear dictate your decision...when we are too scared we tend to become vulnerable to be rushed into choices which might not be best for us. I m glad you are on this forum as here you will find highly knowledgeable and experienced prostate cancer survivors
Provide full data and i m sure you will receive great guidance..I made decision after opinions received on this forum.
Know that most Urologists are surgeons and they usually recommend surgery if they can..Also know that Gleason 9 is a whole different ball game then the less aggressive grades.. Much tougher to cure. You almost certainly will end up needing radiation on top of the surgery anyway, so why not just begin with radiation? On the bright side, Dr. Patel is one of the best surgeons which is important...I suspect his outcomes are better than average..Making this decision is troubling for all of us...
Thanks all for each response.
My wife and I have spent the 2 months doing research on treatments and side effects os each. We attend a prostate cancer group once a month that has been very supportive as is this web site. Hearing from others with the same issues has been a terrific comfort for us both.
407ca you asked for additional biopsy info. Twelve cores were taken with 7 showing cancer. Four at Gleason 7 (3+4), two 8 (4+4) and one 9 (4+5). Confined to left and center of prostate.
I am about to research branch “boost” therapy— Thank you Tall-Allen.
LearnAll I am in total agreement your position. The scheduled surgery is two months away allowing more time for research. If I find a different treatment that feels correct I won’t hesitate to proceed. As of this moment surgery doesn’t give me the confidence I’m looking for. If following surgery I’m faced with needing radiation and or hormone therapy then my feeling is why subject myself to surgery.
Thanks again for the feedback and best wishes for many good days ahead.
What is your age, weight and general health. These factors should determine your treatment. However, if the Pca is confined to the prostate, than ADT and radiation is your best choice.
Magnus, thanks for your reply.
My age is 75, weight 160 and in good health. I have successfully done all the preop testing required for surgery so health is good. All testing indicates cancer contained.
Looking into Boost Brachytherapy as suggested by another.
If your doctors say surgery is the way to go and they feel they can get it all then I would go for it. If your not comfortable with surgery then go for the ADT and radiation. You could get many years out of additional ADT drugs post radiation.
I see you're doing your research. Smart move. You have lots of time to make your decision. After "your treatment" do not second guess yourself. No coulda, wooda, shoulda just full speed ahead.
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 06/23/2019 1:50 AM DST
I wooda, if I coulda. Shoulda just left it alone.
i guess that wooda been gooda...
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 06/23/2019 6:50 PM DST
If I would a could a or should a gone to a urologist sooner than I did . Hindsight is 20/20 ..
All things being equal, I must admit a bias.
I am no fan of RP, although, for some, it is the best approach to take.
I'm a G9 - (Stg T3B) my Dx was 2 + years ago.
I did the radiation and ADT, with good response (reached undetectable) .
Today, I await my 'T' to come back after my self imposed ADT 'holiday'.
As I approach the lowest 'normal' level on the 'T' scale, my PSA has climbed to 0.03.
I'll see my RO this week and see what might be next.
As my withdrawal from ADT continues, I expect my PSA to rise as well.
The key will be what is my new 'normal' baseline going to look like.
I can say this - my energy levels are good and I'm active like I was years ago.
Even feeling some tingles in the groin area.
The brachy was not a choice offered to me, but it is something I would certainly consider because the stats indicate that it is effective in select groups.
In my case, I was too far gone (node positive).
The seeds would not have covered my immediate needs.
Good luck - we all wish you well ....
Dr Patel did my surgery also in 2008. One dirty margin, and now stage 3/4 and on Lupron.
My 2c says if I had my time again I would opt for open and not robotic surgery. Just have the idea that had I had an open surgery they might have identified and removed all the tumour.
Lymph node treatment 
A Year of Treatments.
Follow up treatment after radical prostectomy
fasting before radiation treatment
