Best treatment for high risk cancer

During my recent participation in a prostate cancer review panel (see: Proton beam vs. x-ray therapy) I asked two professors, one a radiation oncologist and one a urological surgeon, what they thought should be done about high risk cancer, e.g., Gleason 9 or 10. Their answers surprised me.

The surgeon said that she didn't believe that high risk cancers are easily cured by a single treatment. She thought multiple treatments were needed. She recommended surgery to get rid of the whole prostate, and Lupron + radiation to treat the area around it.

I then turned to the radiation oncologist. He was present and heard what the surgeon said. I said that my radiation oncologist had told me that she thought that, if surgery didn't cure the cancer and radiation was needed to finish it off, then the patient would probably have been cured by radiation alone without having to go through surgery.

His answer surprised me too. He said that up to just a couple of years ago he would have said the same thing, but now he's not so sure. He thought it was possible that a very aggressive, high Gleason cancer might not be completely killed off by radiation. He therefore endorsed what the surgeon had said, thinking that surgery followed by radiation + Lupron offered the highest odds of a complete cure.

The answers weren't what I expected. I thought the surgeon and rad onc would disagree, as they traditionally do. Neither of the two people seemed to me to be shy about expressing their opinions forcefully, so I'm not ready to say that they were just being polite to each other, though it's possible that they were.

I guess that all I can do here is report what they said.

Alan

8 Replies

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  • Now I'm really confused.

  • Me too. I'm reminded of Richard Feynman's comment on the wave/particle theory of light. He said, "If this doesn't confuse you, you don't understand it."

    Alan

  • Or as Albert Einstein once said, " The only reason for time is so that everything doesn't happen at once".

  • It's not unreasonable. _If_ there's not extensive metastasis, removing the prostate gets rid of most of the tumor(s), therefore most of the cells that might survive (or mutate after) the radiation treatment. Hence, you have a greater chance of killing every _remaining_ cell with radiation.

    You'd need a careful clinical trial to find out whether _in practice_ the surgery reduces recurrence rates.

    . CHarles

  • Alan,

    My husband had a high Gleason score. The biopsy confirmed cancer in several areas. We too had consults with a radiation oncologist and a surgeon. My husband was relatively young for prostate cancer (46). The radiation oncologist, deferred, and said his best chance, was to have the prostate removed, and then follow up with radiation. Across the board, they did not recommend radiation treatment in place of surgery, but as an adjunct, following prostate removal. They also said that Lupron was a must. We are two years into this now, and without a prostate, my husbands psa started to rise again. This means that he still has microscopic disease, although his scans do not show any tumor activity. So even with BOTH prostate removal and a six week course of radiation, he still had reoccurance. He must have lupron treatment for the rest of his life, or until it stops working...which they say, will happen, it is just a matter of when. His psa remains undectable, for now, as long as the lupron is on board. Our hope, is that it keeps working for as long as possible.

  • I'm so sorry to hear that your husband's treatment did not succeed in destroying all the cancer. It sounds like the docs did the most that they could but, as you say, some microscopic bits of cancer survived.

    I know from personal experience that Lupron is not fun. However I believe that it can be managed if the two of you are determined to make the best of it that you can.

    Here is a good web page on how to combat the side effects of the drug:

    pcri.org/preventing-and-tre...

    One of the problems with Lupron and other Androgen Deprivation Therapies (ADT) is that most men lose their libido, their desire for sex. It's a physical thing. I could look at my lovely wife and feel no sexual urges at all. It may make a man feel like he is no longer a man and he may withdraw from his wife because he feels that he cannot perform sexually and is embarrassed about it. But I am convinced that running away from intimacy is NOT necessary and is NOT the right response to ADT. I resolved to support my wife physically and emotionally. I even tried, with good success, to perform the sexual acts (e.g., oral sex) that she most liked. I found, to my great surprise and delight, that when I forced myself to get started, after a while, I too became aroused and enjoyed every bit of the experience. Our marriage remained physically and emotionally strong and satisfying and we stayed, and still are, very much in love.

    I've known several men who have survived 20 years and counting on ADT. I'm hoping that your husband will be one of them. In addition, I think the very effective drugs that have appeared in the last five years (Zytiga and Xtandi) are just the beginning of a new set of drugs that will appear in the next five or ten years, some of which might even be a cure, and some of which have nothing to do with androgen deprivation.

    So I hope the two of you can hold on to your health and to each other and have fine and satisfying lives on into old age.

    Best of luck.

    Alan

  • Thank You for sharing.

  • Hi aquaeyes5

    I am now with this forum for 10 days. At the start I did not know how my condition is going to pend out. Please follow my post and my replies. You will be amazed at what I have accomplished. You be the judge.

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