Surgery vs SBRT Cyberknife

[Pride123]

I posted this in the Advanced PC group and shouldn't have, as my Hubs is not in an advanced stage. Posting here in hopes of more input! I apologize if you are in the other group and have already seen this!

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!

[Aodh]

I can’t give medical advice. When I was diagnosed with locally advanced prostate cancer I could have had surgery although I would still have had to have radiation and androgen deprivation therapy (ADT). So the choice in some ways was made for me to go with radiation and ADT. SBRT wasn’t an option, I had to have 39 sessions of external beam radiation.

I can understand why even an RO might recommend surgery over radiation. I too was in my late 50s but have heart complications.

Given that none of us know what’s in our future or even if we have a future, I personally wouldn’t be swayed by what might happen in 20 years time. I suggest visiting a different radiation oncologist for a consult and laying out your preferences for SBRT and getting another perspective.

Remember the doctors don’t have to live with the consequences of your family decisions, you do!

I wish you the very best, whatever you decide.

Hugh

[Murk]

I would get a second set of opinions from a highly rated institution and Urologist & RO. Either path you choose requires that you have an expert that has treated thousands.

What general area are you located? People here will make some recommendations on both treatment centers and Docs..

Ask your original and second opinion Docs to map out their recommended going forward plan and timeline. Once you can visualize what they are recommending, you will feel more knowledgeable & comfortable.

Keep asking questions, investigate, you will come to a decision that is most comfortable and give you confidence on the best possible outcome.

[Pride123 in reply to Murk]

We are in Wabash, IN. Close to Ft Wayne. We saw the Surgeon and RO at Parkview, and they have the Cyberknife machine. Researching now another RO. Thank you for your response!

[conbio]

When diagnosed was 65, G 4/5, limited to local, clean PSMA. Given the choice of RP or the triad of ADT (18 months), EBRT (24 sessions), and Brachy. After talking about side effects and researching outcomes I went with the triad.

Finished in March 2023. All good and on monitoring. Urologist was straight-up and said one of my lesions was close to nerve so risk of permanent ED was high. Friend had RP and had some incontence issues.

The decision is all very personal. Talk to health care team, get second opinions (or 3) and read up. I found the videos lectures here very useful.

pcri.org/

[Pride123 in reply to conbio]

We were given AS, RP and Radiation as choices of recommended treatment (the RO did not recommend AS, just Surgeon) and the RO only discussed traditional radiation (did I say that right?) vs SBRT cyberknife, 5 sessions. This triad you spoke of wasn't discussed. Thank you for this information! We are researching and looking for RO's to give other opinions as I type!

[janebob99 in reply to conbio]

Conbio,

What sort of brachytherapy did you have, LDR or HDR? Thanks.

[conbio in reply to janebob99]

I had LDR. Went like this - started Lupron in Sept 2022, 24 sessions of beam radiation starting in January 2023, 2 week rest, then 68 seeds implanted in prostate - with a half life of 6 weeks. Followed protocols in the Canadian ASCENDE study. pubmed.ncbi.nlm.nih.gov/284...

[janebob99]

Thanks!

I'm likely going to do SBRT (5 fractions) of X-ray. I'm also considering adding a brachytherapy boost, either LDR or HDR (leaning towards HDR). Hoping to do estrogen patch therapy in place of Lupron ADT.

Do you have any side effects of your combined RT?

[mijona]

What is the estrogen patch therapy and how does it replace ADT ? Thanks