I had brachytherapy 10 years ago and have been happy with it. I had a Gleason score of 3+3 and it was confined to the prostate. In last couple years my PSA has started climbing again. I had a bone scan and an ultrasound and no cancer was found other than my prostate. I had another biopsy and have a Gleason score of 3+3 again with no cancer outside the prostate. The surgeon I met with said I have two options. One being the robotic surgery to remove my prostate which is tricky at best. The second is to start hormones when my PSA reaches 10, it was 3.4 three months ago. I’m goin to get another test next week. So far I am headed for the surgery. I realize this ends my sex life except maybe by artificial means and I will leak and have to wear pads. I’ve talked to a few guys who say they can still bike, hike, and kayak, so I can live with it. My regular urologist said it may take a long time for my PSA to climb to 10, but after 2-3 years of hormones I am on my own and the cancer will spread. I saw two uncles die when theirs spread. It wasn’t pretty. She did say that if I have surgery and my PSA does climb again in the future, hormones are still an option. It seems like not having the surgery is a death sentence in a number of years.
Are there guys out there who have experienced my situation and can to tell me what you have done and are ok with it. Thanks. I have about three weeks until the surgery is scheduled.
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gegan01
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These are possible treatments for radio-recurrent cancer. You could discuss this option with an urologist and a radiation oncologist. Radical prostatectomy is not the only treatment available.
If I were in your situation I would try to get a Ga 68 PSMA or a 18 F DCFPyl PET/CT to be sure there are not lesions outside the prostate. CT scan and bone scans have low detections rates.
No, don't do it! You are seeing the wrong kind of doctor - (To a hammer everything looks like a nail). Results of salvage surgery are almost always horrible.
If not having the surgery is a death sentence in a number of years, according to the surgeon, I would ask how that verdict applies to men with Gleason 3+3 as compared to men with higher grade PC.
From all I have read, if your two biopsies are accurate and truly reflect 3+3 cancer, you might be waiting a pretty long time for that cancer to kill you. So I would certainly get a second and even third opinion on the risk/benefit of doing RP for a man with your history.
It is certainly possible that your biopsies have missed some higher grade cancer, too, and that it is actually worse than indicated. But do a little research on Gleason 3+3 and on the history of how docs approach it now versus how they might have approached it a few decades ago. Don't get stuck with a doc who is stuck in the past.
3+3, you have lots of time to research and get second opinion...With 4+5 and 5+4, I got in a hurry and if doing it all over would have done a few things differently.
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I send in my application to the second opinion yesterday and hope to have them review my case soon. I am going to postpone surgery at least for now to hear what they have to say. Thanks everyone
It's a tough decision, I know, but having it "chopped out" is no more effective than just going with hormone treatment. Do you know that around 30% of those who have what so many Urologists call "the gold standard" still have recurrence later? I also had brachy in 2006, seemed cured, but in 2004 discovered an elevated PSA and at the beginning of 2016 it had risen to 45 and a scan showed a tumor in a lymph gland in my groin. I reluctantly started ADT with both Lupron and Casodex for 6 months by which time my PSA and become .003 and the tumor had disappeared. From then onward, I refused the treatment until my PSA climbed to 7+, used Casodex alone off and on for 2 years at which time it stopped working, then 2 years ago switched back to Lupron only and my PSA is now only 2 with no sign of tumors in my scans.
I strongly encourage you to do your own research--as I have done from the beginning--on the effectiveness of various treatments before you consider the life-destroying prostatectomy.
I had brachytherapy in 2011 for Gleason 3 + 3 prostate cancer. I reached PSA nadir of 0.1 by 2014. But in 2016 my PSA started rising rapidly reaching 1.8 in about six months. A second biopsy and MRI found extra capsular recurrence, which we treated with cyberknife and ADT and my PSA remained < 0.1 for about a year. In 2018, I was lucky to get into a study at NIH and got a 18 F DCFPyl PET/CT scan, which found metastasis in multiple pelvic and abdominal lymph nodes even though MRI showed nothing. Since your PSA is 3.4, you should get a PET/CT scan and see both RO and MO.
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