Advice to a new member?: I'm a 67-year... - Prostate Cancer N...

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Advice to a new member?

Beast1952
Beast1952

I'm a 67-year-old otherwise healthy male. In November my PSA score had jumped tp 11.6 after a 2.3 score 3 years earlier. MRI and Biopsy tests in December confirmed widespread Gleason-9 aggressiveness throughout the prostate. PET-CT scan in January confirmed Stage II status with no cancer expansion beyond prostate. Family history includes 2 older brothers and father with varying degrees of prostate cancer, all 10 years ago or so. All had lower numbers than me. Father was not treated at all, given his 80+ age at he time. One brother stable with no surgery, medication-treatment only, and annual PSA scores still around 5.0 . Other brother had moderate PSA and Gleason scores and had partial removal of prostate. Doctor recommendation to me is total removal of prostate, given all the above information. Any differing thoughts from anyone?

14 Replies
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There is obviously a genetic link running in your family for prostate cancer. Which is not all bad you can be treated with targeted gene therapy.

There is no such thing as a partial removal of a prostate for prostate cancer, although there is a TURP for BPH. You have many options. You have to meet with different specialists to learn about them before deciding. You have to know your Gleason score. Here are a couple of patient guides that gives you some good basic info:

nccn.org/patients/guideline...

pcf.org/guide/prostate-canc...

Had very similar diagnosis and after heavy reading and months of weighting options I finally opted for prostate removal. If your personal case proves to be 100% contained, than you belong to a group of extremely lucky individuals. There are a couple of nomograms that, for Gleason 9 -off the top of my head- will not give a probability better than 15- 30%. To know for certain, there is only one way. Have your prostate and surrounding fat on the bench!

As I saw it, RP (prostatectomy) is an expensive and accurate biopsy. Expensive, not just in money, but mainly in quality of life tokens. Docs at the sound of such an unorthodox statement do whatever they can to persuade you, your wife, your children, that prostatectomy is cure. If you bump onto someone of this attitude, just pass. Head for the next one. I scrapped 4 of them until I found someone who plainly told me: "I can not promise anything". That phrase won me because it was the absolute unbiased truth.

Best of luck!

What Dr recommended surgery? You don’t need to answer!!! Pursue other options before hand!!! A lot to be said for radiation. With similar outcomes, Quality of your life and that of your love ones should be considered.

Not a Dr....just saying!!!

Jc

This will be a biased response.

I'm not into Vegas predictions but I have come to a few conclusions after my experience and Dx in May of 2017 .....

I have read of too many recurrences of PCa from survivors of RP - a few years after the fact - something got missed. I have no idea what the stats are but there's far too many for this guy to accept as 'normal' or acceptable.

ED and incontinence ?

ED comes with the territory for many, so I can't pick a favourite BUT the loss of precious penile length after RP might make some think twice. Some had enough to start with, some needed every inch to feel like it was good enough. That's a personal thing, of course.

The incontinence is more often linked to RP, not radiation or brachy. This alone might be enough to decide on radiation in the first place. I've had a TURP + radiation (EBRT@ 79 Gy), and radiation to the pelvic nodes + ADT(Casodex, Lupron, Apalutamide). Today, I'm on an ADT holiday, hoping it will last a very long time, but I know I'm very high risk (G9) and I canonly hope and pray that I'm done with this disease, at least in terms of looking at theoptics of long term treatment and probabilities of fatality.

Then they say after radiation, your options are limited. OK, fair enough - so what happens when the RP fails ? Maybe salvage radiation and the rest of the more advanced SOCs ?

In a perfect world, the front line treatment would work the first time out and that would be the end of it.

I have seen too many failed RPs !

I would consider brachy / radiation options first, given a choice.

That's a wrap ....

Hmm... Hey Beast. I'm guessing that you are 4 years my junior (1952).

Our cases seem to be similar, although, all cases are different.

Here is my first post,6/19. It might help with your decision.

healthunlocked.com/advanced...

Best

And this will also be a biased response...

I had Gleason 3, 4, and some 5 tissue throughout my prostate. I opted for RP about 8 months ago. I still have minor incontinence and am fully ED. I watched an uncle die of prostate cancer in his 70's following failed brachy treatment. My father in law died of prostate cancer at age 96 but he had 30 years of good, worry free health following RP. I would call that successful treatment.

I chose RP because of the extent of my cancer and the fact that more treatment options are available following surgery than radiation treatments. Radiation treatments are not without risks. Some side effects can take years to appear after treatment.

My PSA has been undetectable since surgery and I've had no other treatments other than PSA monitoring.

The bottom line is that none of the treatment options available to us are fool-proof and without side effects. Pick your poison and don't look back. Good luck!

westof
westof
in reply to jctaylor

Hmm... Just curious, how old are you and date of your dx?

Best

jctaylor
jctaylor
in reply to westof

I'm 68, diagnosed about a year ago.

westof
westof
in reply to jctaylor

Hmm... Yea, mine was 8/18 (G9, S3, high PSA 28 and no mets).

We have chosen different paths of treatment. Good Luck (to both of us)!

Best

AJ

jctaylor
jctaylor
in reply to westof

And best of luck to you, thanks!

I had a lesser PSA, but we watched it for 2-3 years when in my late 60s as it slowly but steadily grew. An insurance actuary insisted on another biopsy (a first had found a touch of cancer in one area) and it discovered three areas of cancer and two suspicious areas. I decided to do the RP and found the highest-rated Urologist in my region for the operation. Before it, we did an MRI and it saw no spread from the prostate. But the operation to remove it found that the cancer had, indeed, broken out. It now is nearly three years later.

There have been some life-style changes ("Depends" stock is up! ). Sex is no longer in the equation, but neither is any hint of cancer in my follow-up PSAs. Now mostly retired, I play golf 3X/week, sing in two choirs, enjoy more time with my wife, and believe I made the right decision, as I no longer worry about the cancer that killed an Uncle and more than a few friends. So I understand your dilemma and the range of other comments here, and simply thought this might provide a bit more perspective. Of course, Good Luck!: we all need that no matter how good the doctor and the analyses.

I chose RP over RT knowing that they offered statistically equivalent outcomes. RT and its 5 times a week for 8 weeks demand was too-great an interruption to my work schedule. It is a choice. Doing nothing is also a choice...tho' a bad one for someone as young as you. Perhaps ironically, yesterday I had surgery to repair an incisional hernia from my RP.

You might want to research HIFU. I chose that over radiation after being told I wasn't a good candidate for RP after prior TURP surgery.

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