Hello all. I noticed HealthUnlocked is headquartered in the UK but I hope a Yank is welcome. Just got my MRI fusion biopsy results last week: positive cancer in one core, Gleason 6. I believe that makes me low grade T1c. Last PSA was a little over 6. Sorry if I get the lingo wrong. My wife and I meet with Doc in a couple days to discuss treatment options. They gave me Dr. Patrick Walsh's book on Guide to Surviving Prostate Cancer. I've been reading, ad nauseum, about treatment options. At first, I was convinced I should go the prostatectomy route, but now, not so sure. I expected to live at least another 20 years (I'm 58) until I got this news but I'm hopeful that my treatment will let me die of something else. Since I have a long horizon, I want to be aggressive so I can put this behind me (as much as possible).
It seems that radiation treatments could be as effective as surgery but I read conflicting/confusing information on whether side effects (impotency, incontinence) are as forgone a conclusion as surgery, only delayed. My concern with radiation is that you still have a prostate and what's to keep that from getting cancer. I think I read one of you post that you can't get surgery after radiation, but you can go the other way around. Why is that?
I know I have a lot more thinking and learning to do before we make a decision (my wife will have a big say in this also) but I just wanted to get acquainted. TIA.
Based on your diagnosis, you sound like the poster child for active surveillance. Why are you even considering treatment at this point?
Benign prostate tissue never becomes cancerous after radiation - it mostly atrophies. Mine has gone from 55 cc to about 20 cc.
While it's true that salvage surgery is a poor idea after primary radiation, a MUCH better idea is salvage focal brachytherapy or focal ablation. Radiation changes the prostate tissue making it stickier. Consequently, attempts to remove it surgically require digging and scraping that can injure the bladder and rectum.
Take plenty of time - a year or more would not be a problem.
I'll know tomorrow the size and location of my tumor when we meet with the Dr. The problem I have with AS is my timeline. I find it very hard to believe that, left alone, in the next 20 years, my cancer won't progress to being serious or life-threatening. Sure, I could wait until it gets bigger or worse, but why? To delay the side effects of treatment? Seems to me that I have a better chance of non-recurrence if I treat it while it's small and localized. My PSA increased from 4 to 6 in less than a year. Even though my Gleason score is only a 6, do I take a chance with my life or live with cancer in my body to avoid side effects that will likely not be permanent or debilitating? While the one core they found cancer in shows low-risk cancer, pathology on removed prostates have shown more aggressive/extensive cancer than was apparent in the biopsy. I'll let you guys know what my doc says after tomorrow. Thanks for welcoming me to the forum.
i can only tell you what the facts are. The stories you make up in your own head may be creating unnecessary anxiety for you. The fact is, that in the longest running clinical trial of AS (at the University of Toronto), 55% of men have never been found to progress while on AS. MSK reported similar numbers. AS has been also found to be very safe - one is not "taking a chance with one's life."
It is true that about a third of Gleason scores are upgraded at prostatectomy (and about 10% are downgraded), but that does not matter. The outstanding results of AS are true based on what was found at BIOPSY.
Prostate cancer, unlike most other cancers, is very slow. In fact, in cadaver studies of men who have died from other causes, prostate cancer has been found in a very high percentage of them. Mostly, it is INDOLENT and INSIGNIFICANT. How do you know if yours is? Easy - you watch it very closely with PSAs (BTW - PSA kinetics have not been found to be a good indicator - you should consider using PHI instead), DREs, and targeted biopsies.
You may be interested in the only trial (in the UK) where patients were randomized to surgery, radiation, and AS. They found no difference in 10-year mortality among the 3, even though AS was done (what we would now consider to be) badly (without confirmatory and f/u biopsies).
pcnrv.blogspot.com/2016/09/...
I certainly agree that tucker man SEEMS to be an ideal case for AS. Are you sure that benign prostatic tissue never becomes cancerous? (I'm not speaking here of cancer that may have evaded RT). In my field there is a concept of multifocal carcinogenesis (sometimes referred to as "field cancerization"). The idea is that if there is exposure to a tumorigenic agent in a tissue, multiple areas may be predisposed to cancer. There seems to be far less in the literature for PC than for oral/oropharyngeal tumors, but it's not completely lacking.
Again, I agree that this patient should give serious consideration to AS.
Yes - I'm quite sure that benign prostate tissue never becomes cancerous after radiation. (As you say, this is different from radioresistant cancer). There has never been a documented case that I know of - have you seen any? One RO described the tissue as "fallow." The benign tissue shrinks over time and atrophies from disuse. Unlike most cancers, where just the tumor (plus a margin) is treated, the whole prostate is treated because 80-90% of the time, tumors are multifocal, even if too small to be detected.
I'm certainly not as familiar with the literature as you are, and wouldn't actually be aware of cases (although, if there has been biochemical recurrence after RT, how would you distinguish between an occult focus that was resistant, as opposed to a de novo tumor? I realize that to a certain extent, this may be a distinction without much clinical significance). That they are multifocal is similar to our usage of the term "field cancerization" in oral tumors. Mostly we see recurrence near a previously treated lesions. The analogy is not perfect, since most oral tumors are treated surgically. And you are right--in the mouth you are treating an area of a much wider field potentially exposed to a carcinogenic agent, as opposed to a circumscribed organ like the prostate. |
Thanks for the reply.