Stats. 39, 3+4 Gleason, PSA 6.28, diagnosed 1 May. Duke didn't want to do radiation. Flat out told me they wouldn't radiate a 39 year old prostate. Thank you for wasting 7 months of my time and billing my insurance thousands of dollars and the 2nd unnecessary biopsy. Got referred from Duke to a regional cancer center in NC. Doctor ordered updated PSA and MRI since those were last done in July/August respectively. I'll have gold markers placed on the gland or in the gland. Not too sure, and gel placed between the prostate and rectum to keep some space between them.
My question is, should I also ask for brachytherapy or ADT coupled with the SBRT? Will it help? Also, a hypothetical here, if I get a 2nd malignancy from radiation, can I then have RALP for whole gland removal?
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wally198562
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For "favorable intermediate risk" there is no benefit adding brachytherapy or ADT. Unfortunately, at 39 you are an outlier for any therapy, so they would rather just be rid of you than take a chance.
So, it won't help anything for an added therapy? Probably why the doctor didn't even mention it. I've read that coupled together, SBRT with ADT or brachytherapy can help overall success rates.
My understanding is that a prostate can be removed after radiation treatment but it’s not an easy surgery. There’s maybe only a handful of surgeons that can do it. But doable. Whether/when recommended, I don’t know.
If it comes to that, I have care established already with Dr. Polascik at Duke and he's one of the best. I am confident he could do it, if it comes to that. It is a concern but I've let it go. God is in control.
Look to holistic therapies. There are many out there now being revealed that are capable of eradicating or even slowing the growth of tumour cells. If you research you will find. 🙌 blessings to your healing journey.
Cures are never lucrative. Bridge the gap with integrative oncology and functional medicine.
Even naturopathy. The samplings out there are vast, and can be expensive but you only live once.
Chris Wark outlines some very guiding principles for working through this journey.
Let food be thy medicine to a degree. It helps. A lot.
My understanding is that after any type of radiation, scar tissue is formed and prostate tissues are more fused to other organs. Salvage prostatectomy is more difficult.
Firstly I must say I’ve not seen a person as young as 39 on this forum- while that sucks, you should definitely remain positive because slowly but surely the treatments available for us are getting better and better. So stay the course and as you said - God is in control
What I’m keen to understand from Tall Allen whom we all respect is what did he mean by the comment “your an outlier for any therapy and they would rather just be rid of you than take a chance” - what does that actually mean?
I did but the day I went in for the consult with the doctor, his wife had their baby 6 weeks early and I was getting tired of waiting so, I went to see an Oncologist.
its political i know him well , did biopsy for near and dear, get a second opinion from Polascik, he wont do Tulsa or FLA , Duke has not adopted them, to big of a radiation and surgery lobby there. go to Dr. Eric Walser , UTMB , TX can always get it removed does both and they are developing histotrpisy for PCA . Dont be swayed, if ejaculation & erections are important and any man knows they are, if you can salvage part of your prostate do so. Cancer is a metabolic disease go listen to Dr Thomas Seyfried , research at Boston College. Ketogenic, non processed , use Fenbendozle, luteolin, nitazoxanide. avoid radiation and prostatectomy at any cost.
I had close to the same numbers back in 2014 and chose robotic prostate surgery and picked a great surgeon, I explored both radiation and surgery. So far so good, no PSA blips and little to no incontinence and everything still "works".
Look into all your options, I know its a big decision.
My father had a radical prostatectomy at 40. However, he was a higher risk than your current diagnosis. Of course, this was more than 30 years ago and treatment has come a long way. When PC finally decided to visit me, with Gleason 4+3 at age 51, I opted for SBRT as well, but had no other therapies, such as ADT. While SBRT has its side effects, brachytherapy has greater risks and side effects, especially over the long term. As many know from my posts, I always recommend documenting your questions and talking to a medical oncologist and radiation oncologist (or surgical oncologist, if that's your chosen route, but sounds like you've decided radiation like a lot of us). They will have better insight into the specifics of your condition and what to expect from your treatment choices. From your description, you are following a similar path to most of us and identical to mine with SpaceOAR (the gel between the rectum and prostate), the gold fiducials for help guiding treatment and likely the 5 radiation treatments. For many of us that are in the "younger" category, ADT may or may not be offered. I did not do ADT, and my PSA has been continuously dropping since the end of my treatment in September 2023, though it hasn't dropped as quickly as those on ADT, but I also haven't had to deal with any of the side effects most have had with ADT impacting my quality of life. I've mostly recovered normal sexual activity, though I still have some lingering urinary issues, but those existed prior to my treatment.
As for removing the prostate after radiation, I've yet to hear that being done. The risks associated with that would not likely outright the benefit. You would more likely have additional radiation therapy, if deemed necessary.
The point is, ask your doctors, Dr. Google and AI has lots of good and bad (often very bad) info, but doesn't know your details like a doctor does. Those docs have a lot of school, experience and training behind them, and get paid well enough to listen to your concerns. It sounds like you had an unfortunate experience with one, but don't let that one bad experience become a blanket for all oncologists. After all, your well-being is ultimately in their hands, and you should know everything they plan to do.
Hey and wow your on top of the treatment options and therapies which is to be commended, many become lazy through fear when they have to face that challenge. You sir are in the right track for YOU, ADT is a great option because you are young, it so your sex drive, no less told there, but u have to know what's more important to u, quality of life or being able to get more poompoom. I know that's a Lil crass but it's real, beside there are two good options to help with that if you want to try them. Your almost 40, there's plenty life experience waiting for you and unless that's how u make your living, if go ADT, take your shots every 30 days and meds daily and Leo it moving. My journey with this started on 09 with a RPT, Mets in the lymph system no metastasis though but a Gleason of 9.4, kept my prostate and ADT SINCE THEN sis n pills, currently nilutimide, have holiday from eligard since 2019 and lovin life with 0 mobility issues, some aches n pains yeah but I'm 67 now, gross like 40 to me. Make the best decision for your life bro you have a lot of it left. As you know Radiation and chemo KILLS, that's what it does and everyone just doesn't make it back from the assault it brings in the body, some do yes, but that's a hard road which u know already besides any med you take idkb if it's aspirin it Is CHEMO THERAPY just that is at the lowest level of strength. Ok so do what is practical and acceptable for You and YOU make the decision not wifey, not dad or mom or the pastor you make it, after all, you have to live in that body, not them. Cheers friend
Hi Wally - sorry you have got PC so young - however you have discovered it early which is fantastic.
I got diagnosed with PC at 52 and spent some time expolring the different options including SBRT / Bracchy / Prostatectomy. I saw 2 specialists in SBRT and they both refused to do SBRT on me due to my age dues to radiation in the surrounding tissue potentially causing downstream cancers.
For Prostatectomy I was looking at the best UK surgeon with margins tested during surgery - and using Retzius technique which has much faster recovery from Incontinence. However in my case I would probably not have had nerve sparing on one side due to the location of the tumours.
However ultimately I went with Bracchy LDR because of the excellent results the hospital had had. 6 year PSA free relapse was 97% for intermediate and 100% for Low. Braccy in the UK is deemed to be a Radical treatment like Prostatectomy. However new stereotactic radiation offerings are also very good but lack the length of evidence as it is newer.
5 years on after psa bounces which occurs in younger men my psa is now down to 0.143 and still dropping. The bounces are worrying at the time as you dont know if it relapse but evidence shows that bounces are actually a good indicator for long term success. The bounce effect is not very well understood but startes at 18 months.
On the Erectile function side of things Radiation has a small effect alongside getting older - so although not needed I sometimes use viagra.
Doctors will push you towards Radical Prostatectomy because of your age - for this you need the best doctor and look at Retzius. If you get nerve sparing it is likely you will recover full erectile function.
As stated above ADT doesnt have any real effect for intermediate although I did take Bicalutamide for 6 months as a belt and braces. However evidence does not back this up.
I went with Orgovyx as it could quickly be ended if the SE's were horrible. Finishing my 6 month course, SE's not fun, but definitely not devastating for me, especially if it has the potential of increasing survival.
I am 72 with GL 4+3 and 3+4. My experience with Duke was not good. I went to Sloan Kettering in New York afterwards for my 3rd & 4th opinions and my experience there was vastly superior to Duke Cancer Center. I live in NC, and have searched exhaustively, and, I don't believe there's any place in NC that compares to top centers of excellence such as: Kettering or Mayo or Johns Hopkins. At your age, I would certainly keep looking. Did you get a Decipher test at Duke?
Here is a video from a Kettering physician that has been shared in the PC forums. I highly recommend you watch it before making any decision if your sex life and urinary continence are important to you. The first 1 hour is his presentation, the second is Q & A. Good luck to you Wally!
i am not sure about brachytherapy. I ask about it but it was not on the table or option. I did proton radiation and ADT. I would ask about ADT but read about side possible effects. I was told surgery could be done after radiation but it is more complicated.
At age 54 in 2004 with psa 6.9 and gleason 3+3…(20+ years ago…) i had EBRT ( external beam radiation)…by RO in hospital in upstate NY…SBRT has now become more popular with having radiation…
in 2021 I had a BCR and was offered salvage treatment of either HD brachytherapy or cryotherapy…i had neither…
in 2021, MSK (in NYC) wouldn’t do RP (removing the prostate)…as others have said RP is usually not done after having radiation…
Being 39 and if you now have radiation, in the event you do have a recurrence, it could be a while. Treatment options could be different in 5, 10 or more years from now…
Bottom line, look at the SEs from your options and after choosing, don’ t look back. As you say…God is in control…Amen!
Your problem is that radiation is a late "killer". Second cancers start surfacing up after 10-15 years. So, for someone in his 70s or 80s something else will get him before the late toxicities of any past irradiation. This, more than explains to me Duke's reluctance to irradiate a 39 y.o.
Hint: Pediatric survivors have a 6-fold second cancer incidence than the general population.
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radiotherapy soon 
I need some advice
Newly Diagnosed high risk PCa at age 52
SBRT in Miami
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