Surgery vs SBRT Cyberknife

[Pride123]

Hubs diagnosed 11/15/23. 2 of 12 positive. Gleason 6 and 7. PSA 3.7-4.2. Met with Surgeon first, "slow growing, non aggressive" he believes is contained by looking at margins and pathology. Met with Radiology Oncologist, "favorable intermediate risk, non aggressive" he believes it is contained. Both said surgery or radiation are good options, but RO recommended surgery based on Hubs age, 59 and otherwise healthy, and also said if he has recurrence or develops a secondary cancer, radiation would be off the table in the future after SBRT. Hubs had hoped to go SBRT route, so when RO recommended surgery it was a blow. The decision is really a toss up! Take the chance of not developing cancer in the future and go with SBRT Cyberknife, or surgery, with the knows side effects? How is he supposed to make this decision? Trust the Professional? Then I read success stories here from SBRT! It's agonizing! Can anyone give their experience if faced with same scenario? Thank you!

[pd63]

What is the cancer volume have you considered AS, you have plenty time to decide, get second/third opinions.Take a deep breath and don't panic, prognosis is very good in your case

[Pride123 in reply to pd63]

What is AS? Sorry, newbie here

[pd63 in reply to Pride123]

Active surveillance

[Pride123 in reply to pd63]

Ahh yes. I knew that 🙄 I am a worrier! The thought of cancer inside my man, and the possibility of spreading, is terrifying. Both the Surgeon and RO said they do not recommend it. I think if Hubs had his way that would be his choice, because he does not want to believe he has cancer 😊

[Tall_Allen]

I was 57 when I had SBRT 14 years ago. No lasting side effects of treatment.

The "age" thing is a non-starter. Younger men do better with any therapy - RP or RT. When we are younger, our tissues are more resilient. But 20% of men are left permanently incontinent by RP, and 65% of previously potent men are left impotent. Younger men suffer more from both of these side effects of RP.

"...also said if he has recurrence or develops a secondary cancer, radiation would be off the table in the future after SBRT. " This is just incorrect. See this:

prostatecancer.news/2016/08...

More to the point, salvage is almost entirely unnecessary with the very high cure rates.

prostatecancer.news/2018/10...

Secondary cancers do not occur with SBRT:

thegreenjournal.com/article...

It is troubling to me that the RO you spoke to did not know any of this.

[babychi]

I’d want a second opinion. He might not need any treatment. Surgeons just want to do surgery in our experience.

[pakb]

You might want to also ask in the Prostate Cancer group here- more in that group might be in your boat with lower Gleason and no metastasis. But great guys in both group to help give their perspective!

[Pride123 in reply to pakb]

Newbie here, that's who I thought I was asking, ha! Help?

[HikerWife in reply to Pride123]

Hi - this is the Advanced PCa group, so many/most of the guys here have Stage IV cancer (distant metastases). It's a great group, with a lot of reliable info available. So don't leave yet! I did a quick look, and this *might* be the group for less advanced PCa: healthunlocked.com/prostate...

[Pride123 in reply to HikerWife]

Well. I feel bad. My sincere apologies for posting in this group, I would never want to make anyone feel worse with our "good" numbers. As soon as I have the time I will search the other group, thank you so much!

[pakb in reply to Pride123]

Absolutely no worries! This group will be more than happy to help. Never hurts to search in both groups. 💙

[bobdc6]

I had radiation (proton) for a small contained G 4+5 in 2017, so far no side effects other than no sex drive, PSA undetectable. I figured I'd skip the surgery part since it seems to always be followed by radiation. I'm 82.

[maley2711]

There are now some very well-done studies on the AS option for men with your hubby's diagnosis. It is late, and I am lazy, so please Google or this search option........

pubmed.ncbi.nlm.nih.gov/

Try something like " active surveillance results conclusion prostate cancer" .

IMHO, the fact that AS wasn't even offered is almost malpractice at this time> Consider a different medical team ?

There is LITTLE likelihood that this will be life-ending over the next 15 years....even with NO initial treatment. Did either Doc offer you any numbers? Check the Memorial Sloan prostate cancer pre RP nomogram and the the MSK prostate cancer life expectancy(without treatment) nomogram. Problem with our fee for service healthcare system.....no treatments, lower MD income ! Best of luck on a DIFFICULT decision..the C word is scary for sure.

[ron_bucher]

At his age, he is wise to think ahead about contingency plans if/when Plan A doesn't cure it. That "plan ahead" thinking has helped me keep my testosterone since being diagnosed at 54.

[Pride123 in reply to ron_bucher]

Agree! The RO said that there is a less than 1% chance of getting cancer DUE to the SBRT, but that if he develops unrelated cancer in the future, radiation would be off the table, so we are definitely considering the future with this important decision. I honestly don't know how he is supposed to make the right decision based on the information we've been given. Of course he doesn't WANT surgery, but wants it gone and cured. Realizing there are no guarantees, of course, with either option. I'm searching for someone to give a third opinion.

[pd63 in reply to Pride123]

If no surgery it's either RT or AS, there's no 100% guarantee of a cure

[ron_bucher in reply to Pride123]

As one of my friends says: "that's why all the docs turn to the guy in the room who knows the least about it to decide on the treatment(s)"

[j-o-h-n]

Like all of us, your dear husband's thinking is "I want the damn cancer out".....He has to make a choice on what to do .... so he's the only one who can make that choice... Like ron_bucher's friend said: "your dear husband is the one in the room who knows the least'....Remember God is on his (and your) side............

Good Luck, Good Health and Good Humor.

j-o-h-n