Looking at options

[TexasAg125]

Hello all. I was diagnosed last year after biopsy showed Gleason of 3+3 in three of 12 samples. PSA at the time was 3.7. Decided at the time to take active surveillance option. Went back to dr may and PSA was down to 2.8. Again went back earlier this month, had biopsy, and results were as follows. PSA 2.8, 3 of 18 samples had cancer (two were 3+3, one 3+4). Having ct and bone scans next week. I have several questions currently researching. 1- is proton beam radiation a good option for someone in their early 50’s. My dr doesn’t believe so and ruled it out at our first meeting. 2- can you have surgery to remove the prostate after radiation? Have been told no by one source. 3- have read that orgasm after removal is sometimes painful. Has anyone experienced that?

[Tall_Allen]

(1) Proton beam is good, regardless of age, but it is no better, as far as we know, than other radiation options that are much less expensive and much more convenient - like SBRT, hypofractionated IMRT, or either kind of brachytherapy. For your kind of prostate cancer, all those therapies and surgery have equivalent success.

(2) If you need salvage after radiation, which is unlikely, there are several better options than salvage surgery.

(3) Dysorgasmia (pain at orgasm) is a known side effect of prostatectomy, but incidence is very low. Often, it is temporary as damage to the pudendal nerve heals. Much more common side effects include lmpotence, incontinence, climacturia, and size loss. Here are the most common side effects of surgery and radiation:

prostatecancerinfolink.net/...

pcnrv.blogspot.com/2016/08/...

pcnrv.blogspot.com/2016/09/...

A single core with GS 3+4 doesn't necessarily preclude you from staying on active surveillance. I suggest you have your biopsies slides sent to Epstein's pathology lab at Johns Hopkins for a second opinion (cost= $275). They will also tell you what percent of the core is pattern 4, which is important to know.

I also suggest you talk to experts in each of the therapies I mentioned above. Your urologist just would not know- it's not his field.

[timotur]

There's several non-surgical focal treatments out there... take your time and research them-- FLA, Tulsa Pro, SBRT, Proton, HDR-Brachy-mono, HIFU, etc.

[ron_bucher]

I was diagnosed with Gleason 3+4 at age 54 in 2006, and am very glad that I've used every tool in the toolkit since then. Currently in remission. Happy to chat via phone if you email me at [e-mail]