I’m new here, and have been reading posts for the past few weeks. It has been very helpful. I’m 54, and was diagnosed with prostate cancer this summer.
Exodex Intelliscore 79.34
MRI: prostate 25cc, "15 x 10 mm right posteromedial apex peripheral zone lesion. PI-RADS 5, very high. Overlying capsular bulging and irregularity, likely representing EPE." No perineural or seminal vesicle invasion.
My MRI guided biopsy results were:
Gleason 3+4, 7/12 cores positive, plus 5/5 cores of lesion positive.
Classified as "Unfavorable Intermediate Risk"
I’ve had a clean bone scan and I am scheduled for a PET scan tomorrow to check lymph nodes for some abnormalities on the MRI.
I’ve met with two reputable surgeons at NYU and Memorial Sloan Kettering (MSK) in New York. They’re both very positive and on the same page that I’m a good candidate for robotic surgery and would tolerate it well with a good long term prognosis .
The two radiation oncology opinions I’ve received, however, could not be further apart. One, from NYU, suggests a 5 dose round of SBRT and nothing more. He says I’m not a good candidate for brachy because of the possible extra-prostatic extension (EPE). He thinks ADT is "controversial" and not necessary.
The other radiation opinion, from MSK, suggests a combination therapy: 6 months of ADT, high dose brachy, and 5 doses of SBRT. The doctor cites the improved long term outcomes for as the reason for combination therapy, and in his words, he “wouldn’t have it any other way” for someone my age.
One of my greatest concerns is potency and sexual side effects.
My sexual function is fine, and I’m not encouraged by either treatment plan in terms of sexual side effects. The 6 months of ADT concerns me as much as surgery does. I've consulted with a sexual health doctor at MSK who warned 6-9 months of ADT can have irreparable effects in terms of atrophy of erectile tissue and nerves. Is there a chance I would fare better with surgery?
I would love to hear from others who have been through this… I want to beat the cancer, obviously (and I have an extensive family history of prostate cancer), but I’m also very concerned about quality of life and sexual function. I’m especially interested in hearing from those who’ve been through combination therapy (ADT/Brachy/SBRT) and what the experience and side effects were like. (I'd also love to hear from others who went the path of surgery with a similar profile and what the long term sexual side effects were.)
Thanks for reading, and for any advice.