Dartagnan

Hello, I am 48yrs old I was recently diagnosed with PC, 10 out of 12 cores, half are gleason 3+3 the other half 4+3 PSA 68, also have multiple iliac lymph nodes that showed up on PET PMSA (9) all are within the pelvic radiation field but 1 is just above by 2cm, which put me into stage 4. No other metasis found.

So I have high risk but very low volume PC, the amounts in my lymph nodes was very small, the prostate tumor not very large I think 3mm in total

I started Lupron immediately and have a had a good response PSA 1.8 after two months. Not really any side effects yet, pretty bad hot flashes at night waking me up from sleep and a some loss of endurance, can't run as far, ride as far or exercise as long as I should, but nothing that is unbearable

Here is my questions, My oncologist said if I am not having real severe side effects from the Lupron I probably won't, is this the case or do side effects get worse with time?

My second question is the main one. I was givin 3 options for treatment, the first was to stay on ADT as long as I can then whatever else if and when it quits working, so in other words meds the rest of my life.

My second option was radiate the prostate alone, then stay on ADT / medication the rest of my life (didn't make much sense to me)

The third option is to include the one lymph node that's outside of the radiation field with full prostate & pelvic radiation 2 years ADT and then they would take me off all meds and monitor the rest of my life hopefully no BC recurrence "the cure"

I am strongly leaning towards the 3rd option as I am young if I can go for the cure I think I should but I am very worried about long term SE from full pelvic radiation, would proton therapy be a better option? Should I get a second opinion? If so from who?

My oncologist in hematology said she sees no reason I shouldn't live a full life and do absolutely fine with the 3rd option , my oncologist in radiology not quite as reassuring.

[Tall_Allen]

The curative therapy is whole pelvic radiation (with boosts to the prostate and the known cancerous lymph nodes + 2 years of abiraterone + 3 years of Lupron.

[Hidden in reply to Tall_Allen]

Thanks for the response Thats what I have come up with doing the research as well I was just wondering if proton therapy is a better option being less invasive. I don't think they offer it in my state though

[Tall_Allen in reply to Hidden]

Probably no difference between proton and X-rays. They are both external beam=non-invasive.

[Justfor_]

Do not get a second opinion from any oncologist that includes "cure" or "curative intent" in their vocabulary. Get it from someone that will draw it up as: "long term management like a chronic disease".

[Tony666]

you might also take a look at immunotherapy (in addition to the other options, not instead of)

[Mike1971]

You are so young, why not go for the therapy where you have a curative chance?

[timotur]

I would recommend HDR-Brachytherapy/25xIMRT-full-pelvic/24-36 months ADT with intent to "cure" (see my profile for example of a tx-plan). The one concern is the distant node, which may indicate others that weren't found, which would suggest early chemo of four-six sessions.

[Survivor1965]

Just a side note, I was diagnosed at age 46 with gleason 9 in 2011. Still here with PSA undetectable and all mets dormant. You got this!

[Mbnm in reply to Survivor1965]

Magic ?

I had gleason 7 with several lymph nodes …immediatly on aberaterone and prednisone and lupron

PSA and T now .08

I am 84

Would like to survive for 5 years..how did u do it ?

[Survivor1965 in reply to Mbnm]

21 bags of chemo, cryoablasion, Zytiga then Xtandi. Lots of exercise. But I think its either luck or God, Im going with God. For some reason he has spared me and here I am.

[jfoesq]

What side effects from the radiation concern you? Perhaps finding someone at “the top of their class” might be the way to go in order to ease your concerns and get the best outcome? Just a thought.

[ron_bucher]

My side effects from external beam radiation have been next to nothing, especially in comparison to my side effects from ADT. My body also tolerated chemo (docetaxel at age 66) very well in case you consider that. Even if a "cure" is not completely successful, I think it's a curative treatment helps delay the need for lifetime ADT.

Adding another oncologist to your team might be worthwhile, especially if your current oncologists don't see your case as unique. Every case is unique.

[j-o-h-n]

Most members would probably agree that "a cure is unsure" ......

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 12/28/2023 5:38 PM EST