I'm a 68 year old married white male, smoker, active, and still working full time. I enjoy fishing, hiking, camping, playing guitar, and music from the 60s and 70s. I also take medication for an over active Thyroid and Rheumatoid Arthritis. In Aug 2023 I was diagnosed with stage 1 prostate cancer, my PSA was 10. 6 months later my PSA had jumped to 12. Last month it had risen again to 13. After discussing it with the doctor, I've decided to re test my PSA in 90 days. If it has not dropped below 13 at that time, I am planning on going through with surgery. The doctor said at my age, he would not do radiation therapy, as too much chance of the cancer coming back in my lifetime. I am 2 years from retirement, and want this dealt with before I retire and move to Idaho. I have not heard very good things about radiation therapy, and people I know did not have a very good success rate with radiation therapy, as a sole means of treatment.
2 years into stage 1 prostate cancer - Prostate Cancer N...
2 years into stage 1 prostate cancer
"The doctor said at my age, he would not do radiation therapy, as too much chance of the cancer coming back in my lifetime." Nonsense. There have been very low rates of recurrence and low toxicity with modern radiation. OTOH, surgery has relatively higher rates of recurrence (in the prostate bed).
prostatecancer.news/2018/10...
I am stage 4 and doing proton radiation. That is what the doctors told me and what i read it has better results. Get second option.
Please show me what you read.
This is just one article.
The cure rate after surgery is similar to the cure rate after radiation with either IMRT or protons. However, the risk of urinary incontinence and erectile dysfunction is higher after surgery than with proton therapy.
(Mendenhall et al. AJCO, epus, 2010)
Thanks. That does not say that proton has fewer side effects than IMRT. In fact, there has never been a randomized trial because proton advocates won't allow their imaginary claims to be disproved. But it seems from non-randomized trials that their claims are false.
The only issue that my doctor warned be about is rectal bleeding, well mot the only but his concern.
The risk of urinary difficulties is much higher.
On another thread, running concurrently, I used the same logical argument as your doc's in favour of RP to a 63 y.o. Those that believe in a "cure" dismiss it as "irrelevant", "nonsense", etc. Your life, your decision.
I think you're getting questionable advice from your doctor. Most of the studies I've seen as well as the numbers I've gotten from doctors at MD Anderson give a slight edge to radiation for cure rate and a significant edge to radiation in terms of lower sexual and urinary continence impact.
Dude, I would get a second opinion ASAP. Radiation Treatment is a viable treatment.
IMO, Prostate Cancer (PCa) is serious but not a death sentence. The most valuable thought you can take away from here is to get engaged with some of the best Doc's near Metro areas. Sorry let me be blunt, do not fook around with a second tier team, whether its a Urologists or a Radiation Oncologist and see both!
Don't become the underlying message of Smokey's Tears of a Clown.
show me be blunt 68 is what I’m gonna be in a few months and I’m looking at MRI Linic radiation….. To tell you that this age it’s gonna come back. Remember when they cut it out with robotic surgery there could be spread which is called seeding.. They got cut up into pieces to move it out of the port holes
we chose mr-g sbrt. elekta unity
Thanks for the reply. That’s the machine they have at Sloan-Kettering MRI Linac …. Where did you go??
Any side effects any issues? How far out of treatment are you? Sorry for the questions but this is hard for me.
utsw in dallas. dr. desai
just starting the 5 fractions. with barrigel spacer, no fiducials.
the first session took around 40 minutes.
interestingly, the doc worried about bph/urinary retention, so instead of EOD-every other day treatment, he suggested Qw-once a week. so 5 weeks instead of 2.5
we also did Prostox radiation tests which came back high risk for fast radiation, and low risk for slow radiation. that info used to justify Qw. this gives your urethra and bladder cells more time to recover between radiations.
we believe side effects result from stray radiation to non-target tissue OAR organs at risk. your only control is using a spacer to protect the bowel, the bladder fill procedure, and trying to be really still for 40 mins on the table. the MR-g linac uses smaller margins than CT. and get treated at a center of excellence.
we had a Decipher score of .40 which is used to decline ADT on top of apparent low volume cancer load to begin with.
there are clinical trials for urethra-sparing sbrt US-SBRT no data yet.
that is one of my concerns not being able to have a Prostox, for some reason, it’s not available or sanctioned in New York. Good I’ll mention to him doing it every 4th day or one a week..
my decipher is .29 low risk. I don’t think I have a lot of cancer either.
Yes the Linux uses 2 mm margins versus 4 mm for the CT that is a huge difference to spare the nerves.
I assume you have BPH?
I don’t have BPH, but I have had frequent urination some perineum pain that could be for my hips that could be for my knee who knows stream moderate urine streamI….IPSS around 12-15
MSKCC is a center of excellence actually rated number two in the country if not, number one
thanks for your reply more information the better
age 66 prostate vol 33 cc Flowmax helps
i think you could pay for Prostox out of pocket. used to be free early on.
your low Decipher--prob no need for ADT
Yes the first thing I was told when I got my decipher score 2 weeks ago no hormone treatment.
I tried ordering the Prostox online they will not ship to New York and it’s not available for testing here….. weird who’s blocking it
yes, weird. esp. if u pay out of pocket. why would the insurance lobby care.
fightcancer.org/releases/ne...
It's a game-changing part of cancer care, but, until now, a group of 27 insurance providers resisted mandating the coverage. cbsnews.com/newyork/news/go...
interesting but United Healthcare paid for my Decipher test which was not cheap around $6k……the Protox test is $500 which I can easily cover myself
It actually is due to very strict regulations from NY state. The Miradx lab has applied for a NY license, and they are waiting for the inspection. But they are not allowed to test NY residents until the lab has been approved, even though they are approved by every other state and by CAP which is national!
you know more about New York than I do and I was born here. I was recently in Texas to get the Watchman implant at Saint David’s Texas arrhythmia Austin, Dr Natale performed two of my heart ablations for AFIB , he is literally the best in the world.
Just went to see my barber his brother had a prostetomy three years ago, still in diapers and total ED. Brother went somewhere in Syracuse, at least needed a better chance with a center of excellence.
modern radiation is just as curative if not better than surgery most likely after surgery you will need radiation anyway remember what robotic surgery actually does. They have to cut the prostate into small pieces to get it out of the laparoscopic holes that can seed the cancer.
Also did you have a biopsy? What is your Gleason score? Did you get it decipher test
you can’t jump to assumptions because you have a high PSA, which is not a good thing to be honest and your velocity and time have increased
I did get a biopsy and came back positive, but have not gotten decipher test. I do not know what my Gleason score is, but will find out in a couple weeks when I go back in.
Wait on the biopsy results, get a PSAM scsn, that will show you where the cancer is located. Talk to multi doctors(urologist, radiologist, oncologist). Get a second option. Go on line snd read, read, read. There are a lot of people going thru this.
yes get that Gleason score then insistent of decipher test good luck to you
Decipher is done on the stored material left over from the biopsy.
I am 13 months post SBRT after Gleason 7 (4+3 unfavorable) and ADT for 6 months. I couldn't be happier. After 8 months of near 0 Testosterone it is now back to 600. PSA for the past 10 months has remained below .05. No incontinence and no ED. My Urologist advised against RP even though he is a highly respected and competent surgeon. I had my radiation treatments done at a top tier facility that compares equally with the City of Hope here in Southern California. Just as a side, both my best friend and my brother elected to have RP. They both have struggled with incontinence to this day and both have ED. Probably the main reason I chose radiation--I didn't want to wear diapers for the rest of my life. plus the fact that radiation therapy is fast becoming (if not already) the gold standard for prostate treatments. My brother chose RP (at the recommendation of his Urologist) because at the time (24 yrs ago) radiation definitely had too many severe side effects. He was 58 yrs old at the time. Good luck on your decision. As others have already commented, you owe it to yourself to get a 2nd or even 3rd opinion.
good to hear congrats
I’m trying to make the decision to have MRI guided SBRT on the Electa Linac which much tighter margins or brachy therapy….. I have moderate IPSS occasionally have some CPPS.
I’m following up this Wednesday top institution in Manhattan center of excellence surgery just terrifies me. Glad to hear your side effects of minimal. How’s your urinary function? My PSA has been steady at 2.17 for the last three years basically double that because I’m on dutasteride My decipher score just came back low risk at .29 my Gleason score 7 was downgraded to two cores 3+4 20 % 35% favorable and three cores 3+3
I struggled a little the first month post radiation with multiple trips to the bathroom at night but it quickly resolved. I have been on .8 mg FloMax the entire time and everything appears to be working fine to date. My initial diagnosis was 4 cores all at 4+3--45%, 35%, 20%, and 5%.
Have you had a biopsy? An MRI of the prostate? What exactly is stage 1 anyway?
Next week marks 6 years since my surgery. I chose surgery over radiation largely because of the experience of one man with radiation, then recurrence. I had a valid issue, but the decision was emotional.
I am not unhappy with my decision, but I recognize that it was emotional, and based on the experience of one person. The vast majority of evidence is that radiation is a perfectly valid way to go for localized prostate cancer.
i think emotionally, many men might want to cut that thing out asap. one and done. very natural reaction.
with PCa treatments, recurrence is a function of cancer load and aggressiveness-gleason score. with the higher gleasons, they will add 6-18 months of ADT for insurance to both surgery and radiation.
PSMA pet scans check for slightest metastases.
Yeah, that's part of it. But I'm a dentist (retired now) and a patient of mine had primary RT for prostate cancer, then had a recurrence, and had salvage surgery which, well, did not go well. While it's true (and we were always taught) that you did not want to do surgery in irradiated tissue, RT had become much more precise and damage to surrounding tissue much more minimal. So while it's not exactly a non-issue, it's certainly not the issue it used to be.
And then again, I'm always (as a psychologist once told me) "living in the negative prediction"--so not only am I thinking of recurrence, but also about how horrible things could be after salvage therapy. (and no recurrence so far--fingers crossed).
Before I was treated, I went to two of the top PC doctors in New York City, both at Memorial Sloan Kettering Cancer Center. One was a surgeon and the other one was a radiation oncologist. They both had their positions and their viable arguments. The argument that won out for me was with the oncologist said “if you knew that the outcomes were statistically the same why would you have an invasive procedure when you could have a non-invasive procedure. I leave you to ponder that… if you do your research, you will see that statistically. The two very different modalities have the same success rates. Good luck.
I would go the radiation route if I was you. It has advanced so much in the last decade. So precise. The cure rates are great. Surgery just seems archaic to me in comparison. But surgeons generally advocate for their bread and butter.
Did you have an MRI? What is your Gleason score? Any genomic testing? It's my understanding that gaining a profile of your cancer helps match treatment to it. If your tumor is only on one side, you may qualify for a less-than-radical treatment. As one doc described it, going after a small, low-risk tumor is like hunting a mouse with an elephant gun. Basically, you're currently on Active Surveillance (AS), but focal treatment (like HIFU, focal laser, TULSA) is a middle ground between AS and whole-gland treatment, with very low risks of side effects while gaining destruction of the cancer. If cancer comes back, you can still have surgery, radiation, or another focal treatment. It all depends on knowing exactly the size, location, stage, and aggression level of your disease. Best wishes for 100% success no matter what you decide!
With your diagnosis I would strongly consider RT over RP. If you were younger, perhaps. There's as much pro/cons out there on both treatments to float a boat. I would shoot for curative treatment and bypass cutting/bleeding edge treatments that are focal at this point. I had RP, completely successful from erections to continence and no recurrence as of 34months and counting. RP stats are much better with a younger patient, no comorbidities and of course, ZERO spread outside the prostate. This is my experience/research...take it with a grain of salt and good luck to you!!!
Now time to decide, based upon medical advice, flip a coin.......
Good Luck, Good Health and Good Humor.
j-o-h-n
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