Wife seeking input regarding RT

[Mtnhigh]

I've been reading posts for several months and have learned a great deal. Thank you all! This is my first post so forgive me if I ramble a bit.

Hubby is 78 and healthy (had stroke 4 years ago, fully recovered). He was diagnosed with Pca a year ago. PSA 10.2, TRUS biopsy showed three 3+4 lesions (2 had 5% 4, 1 had 10% 4). Also showed several 3+3s. Volume was over 50% Had Plarify pet scan last week. No spread and showed only 1 avid lesion.

We have charted our own course...haven't always followed Dr. recommendations. ADT (4 mo) recommended. Husband declined due to prior stroke and QOL issues. Turp was recommended for BPH, declined, and did PAE instead. SpaceOAR recommended, declined due to possible risks. Has had fiducials inserted.

Questions/issues

1) Treatment after 75

Thank you Tall_Allen for posting a link to research discussing treating after age 75. None of the Dr's discussed this research or the debate on treating or not. They just said you need to treat because you are healthy. Now I'm wondering if he should do any treatment. Husband is very worried about SE's and QOL after RT.

2) Plarify scan (one week ago)

Do 3+3s show on a psma pet scan? Only 1 lesion showed up...assume that is a 3+4? The RO wants to treat whole prostate.

3) Cribiform

Biopsy showed cribiform in all lesions. Is this more aggressive? Should this push more in favor of definitely treat?

Thank you all in advance for any information you can provide. I seem to be more confused, not less, at this point.

[MyDad76]

My father was diagnosed when he was 74, following a TURP with 4 +3. In Slovenia there seems to be unwritten rule among urologists that once you hit certain age (not sure if it is 74 or less), you will not die of prostate cancer, but with it. So they do not treat with radiation or surgery. I have been to 4 urologist, 3 claiming that low dose old fashion hormone treatment will do. The head of urology department at local hospital never even mentioned to him that anything else should be done, just put him on bicalutamide. When I directly asked him about the need for additional treatment he simply cut me off by saying: No!

Guess what, my dad is 81, castrate resistant and with metastasis. He has no comorbidities. His quality of life is getting worse and worse and yes, he will die of prostate cancer unless something unexpected takes him before.

So while others have more knowledge on this site, I wanted to share our experience. My dad did eventually have SBRT but it was 5 years after diagnosis and it was (way) too late.

Getting treatment to get it fixed while you can cure it in my eyes always bits the miserable attempts to slow down disease progression. ADT is much more debilitating for my dad than SBRT. And if you miss a chance to cure it, you are on ADT for life. And still likely to die because of cancer. And whoever has seen dying someone due to cancer would not wish it upon his worst enemy.

[Mtnhigh in reply to MyDad76]

Thank you MyDad for your input. I am very sorry to hear about what you and your Dad are going through.

[Tall_Allen]

He may want to fill this out:

webcore.mskcc.org/survey/su...

If his expected all-cause survival is less than 10 years, it is a reasonable choice to undergo Watchful Waiting. Watchful Waiting means deciding to have no treatment until metastatic pain or other symptoms begin. At that point, he would start hormone therapy for palliative purposes.

[Mtnhigh in reply to Tall_Allen]

Thanks Tall_Allen. We will fill out the survey. Drs say he could cure it now. But we worry about QOL issues related to SEs of RT. Maybe we are worrying too much?Does cribiform raise risks or signal more aggressiveness?

[Tall_Allen in reply to Mtnhigh]

Yes, it raises risk slightly, but RT will still work.

[Mtnhigh in reply to Tall_Allen]

Thank you again Tall_Allen. We are weighing the risks of treat/no treat. He is scheduled for RT in two wks, 20 sessions IMRT. Two sides of the coin, no treat, and a risk what MyDad describes or RT and risk of long term SE. I guess it all boils down the mental side.

[Tall_Allen in reply to Mtnhigh]

What did the nomogram show?

What long-term SEs do you imagine? I have none, and,according to available data, I am typical.

[Mtnhigh in reply to Tall_Allen]

The nomogram showed that 18 of 100 would be alive at 10 yrs and 3 of 100 alive at 15 years. If I am reading it correctly. My husband is mostly worried about long-term urinary SEs, leakage, etc. I saw that you mentioned low-dose Cialis during treatment. He will ask Dr. for that. Just talked to RO, thought maybe could do more focal as psma scan lit up only one lesion. She explained that since biopsy and MRI showed three she still wants to do whole prostate. Glad you didn't have long-term SE's. And we see many other mention no SEs. Thanks again for you input...it's very helpful.

[Teacherdude72]

My only comment is if you focus on side effects you will get those side effects.

[Mtnhigh in reply to Teacherdude72]

Teacher, I think you are so right. I've been encouraging my husband to make sure he stays in his gym routine. And stays focused on his "projects." The latest one is installing a paver extension on the patio. He's an engineer, so pretty good with staying focused on projects. Thanks for your response!

[Teacherdude72 in reply to Mtnhigh]

You are Welcome. Projects are good for mental health.

[Djangler in reply to Mtnhigh]

I'm a retired engineer and my wife says my projects are all fixing things she didn't know were problems.

For us, getting away whenever we can has been good for mental health. We get to share new experiences and it's great to stop talking/thinking about medical crap. We call them our vacations from Cancerland.

[Mtnhigh in reply to Djangler]

Taking breaks from medical talk is important. My husband can only take so much and doesn't like to do research re Pca. A new project was started yesterday...small retaining wall near garage. So now there are multiple projects...all unfinished. I think the planning must be the exciting stage. I definitely agree with your wife!

[Rick_]

Hi, my progression is near the same as your husband's. I'd be interested to read the paper Tall Allen directed you to  - 'discussing treating after age 75'. Could you please post the link. Thank you.

[Mtnhigh in reply to Rick_]

Hi Rick,Sorry for not replying quicker. I followed the link Tall_Allen provided in his first post above. We did the nomogram a 2nd time with better medical info. Showed for my 78 year old hubby after 10 years 26 of 100 alive, 4 died of Pca and rest died of other causes. It would be a reasonable decision for him to choose watchful waiting.

However, hubby chose to go with RT. He had 2nd session today. It was tough decision for us.

Best of luck to you!