Radiation vs. Surgery -- Success Rates and Choices

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Hope4Happiness
Regular Member


Date Joined Apr 2010
Total Posts : 37
   Posted 10/4/2017 1:34 PM (GMT -6)   
During the past few months (and especially since my diagnosis), I have been reading a lot about surgical and the various radiological treatments. Most current studies are showing the rates of success to be fairly congruent.

It appears, however, that most folks that I've been speaking to and coming in contact with here -- who had the choice -- chose the surgical option.

I'm just wondering what were the factors that swayed that decision in either direction -- type of side effects? chance of recurrence? your age? studies available at the time? doctor suggestion?

Thanks in advance for any replies.
Age 52 at Dx - 8/17 (5th biopsy); MSKCC - NYC
2/14 cores: Right base medial, G6 (3+3), 1%, 0.1mm; Right apex medial, G6 (3+3), 3%, 0.5mm
6/17, Pre-biopsy: Prostate MRI - PI-RADS 3 - hypointensity in peripheral zone; no dominant lesion or adenopathy
Prostate size: 6.4x3.4x3.8cm; vol. 43cc
PCA3 = 29
PSA at Dx: 6.19, fPSA = 23%
On MSKCC's Active Surveillance (AS) program

Post Edited (Hope4Happiness) : 10/4/2017 3:20:15 PM (GMT-6)


NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 613
   Posted 10/4/2017 1:46 PM (GMT -6)   
Hope4Happiness said...
During the past few months (and especially since my diagnosis), I have been reading a lot about surgical and the various radiological treatments. Most current studies are showing the rates of success to be fairly congruent.

It appears, however, that most folks that I've been speaking to and coming in contact with here -- who had the choice -- chose the surgical option.

I'm just wondering what were the factors swayed that decision in either direction -- type of side effects? chance of recurrence? studies available at the time? doctor suggestion?

Thanks in advance for any replies.



Chance for recurrence (cancer control) is far, far more dependent on the patient's case characteristics than on the type of treatment. It only makes sense to look at cases similar to yours for comparison.

For low-risk cases like yours (and not even as favorable as yours), the cancer control is the same for all treatment modes AND for no treatment. There's no cancer control advantage for treatment. (No side-effect advantage for choosing treatment, either...haha.)

Post Edited (NKinney) : 10/4/2017 2:20:54 PM (GMT-6)


Paxton
Veteran Member


Date Joined Aug 2016
Total Posts : 843
   Posted 10/4/2017 1:54 PM (GMT -6)   
H4H - I second the notion that you need be in no rush to treatment with your current situation. AS would seem to be a perfectly applicable path to take at the present time. Should you choose active treatment, you will have the dilemma faces by most favorable to favorable intermediate risk patients - that of a bewildering array of treatment choices, each having roughly the same disease control capabilities and mortality results. I was kind of like the proverbial "deer in the headlights" for a while, too.

My own discernment process took me down the radiation path rather quickly. At the time of my diagnosis, I had already had some serious surgery under my belt (open heart surgery, hernias, etc.), I have a pacemaker, too. I simply did not want to accept the risk involved in yet another major surgical procedure, so I read up on radiation therapies for PCa. Once I learned that the efficacy is similar between surgery and radiation for my risk category, I was off to the races researching radiation therapies. So, in general, I wasn't so much drawn to one path of treatment as I was pushed away from the other.

Now, once I decided upon radiation, the choice of radiation modality was a whole different journey, one which I hope you never need to take.
Age 68 at Dx
PSA history: 2000-2012 0.9-1.2; 06/2012 started T replacement
2013-2015 3.0-3.3 (new normal); 11/2015 4.6; 05/2016 5.7
Biopsy: 12-core biopsy 07/2016; 3 cores G3+3, 5% or less; 1 core 3+4, 15%; 1 core HGPIN; 2% of gland involved. Summary G3+4.
CyberKnife SBRT with Dr. Hirsch; start 11/15/16, finish 11/23

mattamx
Regular Member


Date Joined Aug 2015
Total Posts : 211
   Posted 10/4/2017 2:02 PM (GMT -6)   
I did surgery followed by RT because that’s what my Uro and RO said was best. They both were part of the largest Urological group in Tucson, so maybe they tag teamed me. lol. Prior to my diagnosis I assumed doctors would always recommend what is best when it came to something as important as cancer treatment. I probably was naive. Did my doctors do their jobs without personal or financial bias? Maybe. Did I choose the right treatment plan? There’s no way of knowing.
The tragic recommendations of the USPSTF led me to where I am.
Dx: April 2015, Age 54, pT3bN0MX
Initial PSA: 20.8
Bx: All cores high volume G7 (4+3)
Bone scan and MRI: clear
RALP: June 2015
Pathology: G8 (4+4), focal areas of 5; Positive margins; 3 Nodes negative
Adj. IMRT: Aug 2015
PSA nadir: 0.1
Steady PSA increase. Recent PSA: 5.3
CT and bone scans, July 2017: Both clear

ASAdvocate
Veteran Member


Date Joined Feb 2015
Total Posts : 596
   Posted 10/4/2017 3:18 PM (GMT -6)   
Hope, The reason most men have surgery is because the diagnosing physician is a urologist, who is a surgeon. Usually, the patient is told that "you have cancer" and "I can cure you" in that same discussion. That, and only knowing that the usual method of treating cancer is "getting it out".

Most family and friends only know that option. They usually have no clue that prostate cancer is slow growing, has multiple cures, or, in many cases, does not require any treatment. As a result, many men are rushed into surgery and needlessly overtreated, suffering lifelong side effects.

Things are changing, very fast. In the Washington DC area, almost nobody did AS 10 years ago. Today, it is about fifty percent of the men diagnosed as Gleason 6.

However, small practices lag way behind in recommending AS, compared to large practices and institutions. I suspect isolation, reluctance to change, and greed are factors in that statistic.
DOB: May 1944
In AS program at Johns Hopkins
Five biopsies from 2009 to 2014. The third and fourth biopsies were positive with one core and three cores <5% and G 3+3. Fifth biopsy was negative.
OncotypeDX: 86 percent chance of PCa remaining indolent
August 2015: tests are stable; no MRI or biopsy this year for my AS program
August 2016: MRI unchanged from 2/2014; PSA=3.9; FPSA= 26; PHI =28

Post Edited (ASAdvocate) : 10/4/2017 5:01:34 PM (GMT-6)


three 5's and a jack
Regular Member


Date Joined Jul 2017
Total Posts : 129
   Posted 10/4/2017 4:27 PM (GMT -6)   
H4H: As you see from my signature I have not had treatment as of yet. I have made the final decision though.

My process as follows:
When DX on 8/11/2017 I had already started a "little" research here at HW. The Uro who did the BX and is a "open" style surgeon suggested right away that I should have surgery. He did go through the other options, it took 5 minutes, but felt surgery should be my choice. I said thanks I would think about it. Next day I called his office and asked to have a referral to an RO from their same group (just to get the ball rolling).
On the 15th I saw the RO, who by the way was not an MD but she is a DO.??????? She said I should do IMRT with 44 visits over 9 weeks and that I should start with 2-4 months HT then the IMRT and then follow with up to 16 months HT. I said thanks I'll think about it.
On the 16th I got in touch with the University of Washington Med Center in Seattle and scheduled appointments with an RO for the 21st and with Expert RALP Surgeon for the 31st.
Spent hours every day on line, mostly at HW, researching.
On the 21st saw the RO. Could not do Brachy LDR as my prostate is too large 60cc. They did not offer HDR nor did they offer SBRT. He suggested IMRT but felt HT was not called for. I said thanks I'll think about it.
Spent the next 9 days continuing to do research ( some how at this point I let SBRT slip through the cracks ). By the time of my Surgical appointment with William Ellis I had convinced myself that if he would take me I would have the RALP. The extended number of visits for IMRT was a deal breaker for me as I could not stay at home and take treatments. I would have to live near the treatment center for 9 weeks. Well Dr. Ellis said I was perfect for RALP, explained all of the SE's and gave me a 90% cure estimate, the other 10% because unknown if the cancer has spread. I agreed and scheduled. This is a great surgeon with an amazing track record and a great personality.
Came home and started reading even more, mostly personal stories of RALPers. Within 3-4 days I was beginning to waiver and then, all of a sudden SBRT jumped into my head. I said to myself, "self" you have not done your due diligence. You left out SBRT.....so into the vat I went again with hours more research. TA suggested Dr. Robert Meier RO at Swedish Hospital in Seattle as a leader in the field of SBRT. Appointment set and went to see him last thursday the 28Th of Sept. Accepted by him and now in the authorizing phase with the insurance people. Dr. Meier gave me a 90% chance of cure. Other 10% because can't guarantee all of the cancer is in the prostate.
Final reasons I used for choosing SBRT:

Quality of life issues. I am 69 with great health. Family history suggests life span of another 20-30 years.
After much thought I decided that reduced number of years with great QoL was more important to me than more years fighting fighting fighting. I just couldn't bring myself to do the surgery and take on what I thought of as guaranteed SE'S when with SBRT the SE's are a maybe and then generally reduced significance.

Brevity of the treatment. Treatment will be 2 days prior to treatment for marker placement and various
scans for mapping purposes. Then 5 treatments on consecutive days. Wah
Lah.....Done.

As almost everyone here at HW says..........All treatment options are personal. There is no solid treatment better than all others.

I hope I have been helpful and may you never need to go beyond AS.

Roger
Looking for the 4th 5
69yo weight 7/1-283# on 9/1-227# projected 190# by treatment time
PSA 6.01 6/17
BX 8/04/17 DX 8/11/17 5/16 cores
L mid/base 4/6 4+3=7 25%
L apex 1/2 3+4=7 30%
Sec opinion from UofW same GS7 but they called the overall a 3+4=7
Decided on SBRT at Swedish in Seattle with Dr. Meier.
Looks like the first week or two of Dec.

Terry's Cellar
Regular Member


Date Joined Mar 2017
Total Posts : 48
   Posted 10/4/2017 4:43 PM (GMT -6)   
For me it was all about the data. During the three months between diagnosis and treatment I spent a lot of time reviewing everything I could find on line about my treatment options. Once I was convinced that most of the treatments would result in the same success rate my focus was on side effects and quality of life issues of each treatment.

Also, I completely agree with ASAdvocate above. Most men don't take the time to weigh their options and get second and third opinions. My advice for most guys is to take the time to better understand this disease and explore your options. Don't be afraid to travel for what you believe is the best treatment. Without being too dramatic; in the end you maybe betting your life or at least the quality of your life on your choice.
Rising PSA
11/12 1.98
11/13 1.95
9/15 3.28
10/16 5.94
1/17 3.0
TRUS 1/17
Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3)
all on left side and <5%, no pni
DOB 7/21/47 good health.
Age 69 @ Dx
Family history uncles both sides.
Treated with SBRT by Dr. Tendulcar @
Cleveland Clinic 6/23/17
Reduced ejaculate is only side effect. Everything works.

ddyss
Regular Member


Date Joined Apr 2017
Total Posts : 121
   Posted 10/4/2017 5:26 PM (GMT -6)   
my decision was based on three main points:
1. salvage radiation is an option available if surgery failed (salvage surgery after radiation is an extremely difficult surgery to perform)
2. I had "frequent urination and restricted flow" issues that I wanted to take care of
3. I am relatively young - so was confident that my body could withstand surgery
I also had a misinformed fear of radiation - that it might cause cancer to nearby areas.
DX@ 48 Yrs PSA 03/15 4.45 DRE: Firm Right Base
04/18 Biopsy Right: Base 4+3, Middle 3+4, Apex: HPIN
Left 6 cores : -ve
5/20 MRI: Pirads 5, ECE:+ve
RALP 05/26 Mt. Sinai Miami - Dr. A. Bhandari
Path:
Gleason downgraded to 3+4 !! Stage T2C
Prostrate Size: 49grams Tumor:20%
LN/SV/ECE: -ve PNI: +ve
Cath Removed : 6/1
Full continence: 7/4
PSA: 7/7 <0.1

three 5's and a jack
Regular Member


Date Joined Jul 2017
Total Posts : 129
   Posted 10/4/2017 5:56 PM (GMT -6)   
ddyss I think mention that Salvage radiation IS available after failed radiation is appropriate. So mit's kind of a wash isn't?
Looking for the 4th 5
69yo weight 7/1-283# on 9/1-227# projected 190# by treatment time
PSA 6.01 6/17
BX 8/04/17 DX 8/11/17 5/16 cores
L mid/base 4/6 4+3=7 25%
L apex 1/2 3+4=7 30%
Sec opinion from UofW same GS7 but they called the overall a 3+4=7
Decided on SBRT at Swedish in Seattle with Dr. Meier.
Looks like the first week or two of Dec.

Reltnie
Veteran Member


Date Joined Feb 2013
Total Posts : 673
   Posted 10/4/2017 6:11 PM (GMT -6)   
For me it all revolved around my personality. AS was not an option. I would be wondering about every little ache and pain. With radiation you never really know because your PSA my never become undetectable. Bottom line is I wanted it out ASAP. Will be 6 years in February and so far so good with no important side effects. Good luck.
Tom
Age:64 Diagnosis January 2012 Age 58
Original PSA Level 3.9 ......Gleason: 3+4
Biopsy results: 3 of 12 tested positive for cancer
Da Vinci Surgery 2/10/12
Negative Margins, cancer contained to prostate
Continent after 3 weeks
Sexual function fine with Cialis and now without meds at allsmile
PSA undetectable for five years now.

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 7759
   Posted 10/4/2017 6:42 PM (GMT -6)   
I went with radiation because I am allergic to scalpels and people poking around inside my body. You want to put your hand where? I don't think so.
I'll be in the shop.
Age 57, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 3926
   Posted 10/5/2017 8:09 AM (GMT -6)   
Hope4Happiness said...


I'm just wondering what were the factors that swayed that decision in either direction -- type of side effects? chance of recurrence? your age? studies available at the time? doctor suggestion?

Thanks in advance for any replies.


First of all I'm impressed with the replies you already received from men who took their time, got educated and carefully reviewed their options before pulling the trigger.

For me, especially in retrospect, it seems pretty simple (not so simple at the time). The studies showed that the radiation options delivered equal chance of cure but with a significantly better chance of avoiding incontinence and ED. I didn't have any psychological hangups about "getting it out" nor did I have the need for immediate pathological information. What I wanted was the combo of cure + minimal sides effects so I went with an option that gave me the best chance of both. I chose LDR Brachy with great success but today would also give a long look at HDR Brachy and SBRT.

Jim
Forum Moderator-Prostate Cancer. Age 62 (71 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-9 yr: 1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3347
   Posted 10/5/2017 9:51 AM (GMT -6)   
My situation was a no-brainer. Surgery would not be curative. So why cut and damage?

My nomograms said 98% probability of cancer escape from the capsule and 75% probability of cancer in the lymph nodes. Surgery doesn't come close to those areas. So I would also need radiation. Radiation with a prostate is easy and very low side effects. Radiation without a prostate is difficult and much more toxic.

So three surgeons all said no surgery...get thee to a radiation oncologist. I did and have done very well.

For low and favorable intermediate risks the cancer control for both surgery and radiation are comparable. For intermediate and high risk the cancer control for radiation is superior. Simply it goes where surgery can not. In all cases, radiation presents less significant side effects. The worst case for side effects is surgery followed by radiation. Numerous studies have pointed all this out very clearly.

But remember, for low risk, invasive treatment really should not be pursued. To me treating low risk PCa with surgery is like using amputation for psoriasis.

You are ultra low risk on AS. Why even consider surgery? Over treatment by definition. You would be the situation everyone has been howling over for over treating with significant side effects.

Regarding choice..........Unfortunately, you will find that a great number of men who had surgery did not choose surgery. To choose means you have other options you have effectively and seriously considered. Too many were told by the urologist/surgeon that you have PCa and we and the DaVinci can get it right out this week. Too many were not told of other options, nor did they go meet with other doctors and get proper assessments of other options. These men did not chose, they merely did what they were told to do.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011

tennisplayer
Regular Member


Date Joined Nov 2016
Total Posts : 291
   Posted 10/5/2017 10:09 AM (GMT -6)   
You are young, and should be a good candidate for surgery. As others have said, with your diagnosis, surgery or radiation would be equally as effective.

I had surgery, and am happy with the outcome. The only radiation option I considered was IMRT. In hindsight, I would have felt better from a due diligence standpoint having learned more about SBRT.

One thing your should consider is the sexual SE of surgery. Many urologists don't volunteer enough information about it. I've read the younger you are, the more likely you will return- eventually - to the same level of potency you had prior to surgery. However, there are no guarantees.

I see you have been in AS at MSKCC. At Sloan, John Mulhall practices in the field of sexual rehab after RP. He's even written a book. You might want to consult with him on that aspect of your treatment.

Take your time, because you have time! Good luck.
Age at diagnosis-66 Diagnosed 6/16
RALP 10/16 at U of Chicago, Dr. Shalhav. Experienced internal bleeding post op requiring transfusion of 2 units.
Pathology Gleason 3+4=7, tumor volume 15% Margins negative except for one focal margin, .1mm
pT2c,N0,MX,R1
PSA @ 6 wks <0.02;16 wks <0.02; 5/17 <0.02; 10/17 <0.02
My storywww.healingwell.com/community/default.aspx?f=35&m=3777359

ddyss
Regular Member


Date Joined Apr 2017
Total Posts : 121
   Posted 10/5/2017 3:26 PM (GMT -6)   
Three 5's and a J
For potential curative scenario, I haven't seen many cases on this forum on folks who have had salvage radiation after failed primary radiation treatment. I have seen many going with triple play (imrt+brachytherapy + ht) , but that's not salvage radiation.
But , I'm relatively new here as well.
DX@ 48 Yrs PSA 03/15 4.45 DRE: Firm Right Base
04/18 Biopsy Right: Base 4+3, Middle 3+4, Apex: HPIN
Left 6 cores : -ve
5/20 MRI: Pirads 5, ECE:+ve
RALP 05/26 Mt. Sinai Miami - Dr. A. Bhandari
Path:
Gleason downgraded to 3+4 !! Stage T2C
Prostrate Size: 49grams Tumor:20%
LN/SV/ECE: -ve PNI: +ve
Cath Removed : 6/1
Full continence: 7/4
PSA History :
7/7 <0.1
10/2 <0.006

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3347
   Posted 10/5/2017 4:50 PM (GMT -6)   
ddyss

There is low incidence of salvage after radiation because radiation as an initial treatment is so effective. It covers a larger area than surgery and succeeds where surgery does not. about a third of surgeries in the intermediate and high risk cases require radiation salvage. My logic asks why not start with the treatment used to bail out failed surgery and save yourself the inherent harm that surgery does? Why cut when it just isn't necessary to achieve great results?
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011

halbert
Veteran Member


Date Joined Dec 2014
Total Posts : 3056
   Posted 10/5/2017 5:00 PM (GMT -6)   
So much depends on the actual diagnosis. For someone like JNF, at a higher risk level, surgery is likely not enough. There is another newbie who is very high risk AND has a huge prostate. For him surgery plus rads is probably a decent choice.

For low-to-intermediate risk patients, the cure rates are similar, with radiation apparently in the lead for SE's. However, I'm a surgery guy, and I've had a good outcome, so maybe I'm not the best responder. However, the guys who are angry and are feeling they were rushed into things without full knowledge may not be the best either.

The classic reasons for choosing surgery:
1. To know true pathology. For some guys (like me) that's really important. For others, not so much.
2. To get it done and over without repeated trips to a treatment facility. 36 hours of being an inpatient vs anywhere from 5-40 trips for treatment is significant for some.
3. For some (count me in) the idea of having radiation sources put inside me creeped me out.
4. Risk tolerance is an issue--which risks are manageable and which are not?

All in all, it's a truly individual choice, and none of us can walk that last few steps for you. We can share what we did, and how it turned out. We can aim you at the sources of information. In the end, however, it's your choice. Gather as much information as you can handle, then make the decision based on what is right for you and your situation.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
8/30/16: <0.04
2/15/17: <0.006
8/22/17: <0.006
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024

chris1960
Regular Member


Date Joined Dec 2016
Total Posts : 43
   Posted 10/5/2017 7:47 PM (GMT -6)   
Every story is different.

After diagnosis, i evaluated surgery, radiation and AS. With a family history of PCa (Dad had surgery 3 years age older than me and with a major spread of the cancer), AS did not seem like a good choice to me.

After discussions with doctors, reading, reviewing, i chose surgery. One factor was for the future option of radiation if needed and the treatment schedule for radiation. Also, with my age and health, i was confident in the outcome and recovery from surgery.

I don't regret my choice. If i was in the same situation again, i might choose differently, but every day there is more information available - so i don't second guess.
Age 56, Married, 3 kids, 3 grandchildren
PSA 4.7 / Family history of Prostate Cancer
Biopsy 7-18-16, Gleason 3+4, 3+3
Evaluated surgery, radiation, observation
RALP 10-31-16
Pathology Confirmed Previous Gleason, Cancer Contained to Prostate, Prostate = 85g
PSA = (12-21-16 = Undetectable)
PSA = (3-27-17 = Undetectable)
PSA = (10-4-17 = Undetectabe) <<<<

Gemlin
Veteran Member


Date Joined Jul 2015
Total Posts : 579
   Posted 10/6/2017 2:45 AM (GMT -6)   
We can often read here that RT has less side effects than RP. This seems to be true with short-term follow-up (1 to 3 years) and intermediate-term follow-up (4 to 5 years). But this study founds that men had similar levels of urinary incontinence, erectile dysfunction, and bowel urgency 15 years after treatment whether they were treated with surgery or radiation therapy. Do we have any veterans here that can share their long term outcomes?
Long-Term Functional Outcomes after Treatment for Localized Prostate Cancer

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 168
   Posted 10/6/2017 3:01 AM (GMT -6)   
Gemlin, I had not heard of fecal incontinence with RP only in very rare cases? Denis
65YO healthy man, PSA 4.1 for couple years PSA 5/17 4.6, MPMRI, 5/17 showed lesion. 13 core biopsy 3 positive 3+3 and one positive in a lesion, may be overlap All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. MRI in 11/17 to see if there are changes. Thanks Denis

ASAdvocate
Veteran Member


Date Joined Feb 2015
Total Posts : 596
   Posted 10/6/2017 7:55 AM (GMT -6)   
The study that Gremlin cites deals with patients recruited in the 1990's. I know, that's what is available.

Neither surgery nor radiation is the same now as it was then. Robotic surgery was just being introduced, and types of radiation like SBRT and HD brachytherapy were in the future.

Denis, I think that the common side effects of radiation in the 1990's have been greatly reduced by better accuracy and devices like SpaceOAR, which shield the rectum.
DOB: May 1944
In AS program at Johns Hopkins
Five biopsies from 2009 to 2014. The third and fourth biopsies were positive with one core and three cores <5% and G 3+3. Fifth biopsy was negative.
OncotypeDX: 86 percent chance of PCa remaining indolent
August 2015: tests are stable; no MRI or biopsy this year for my AS program
August 2016: MRI unchanged from 2/2014; PSA=3.9; FPSA= 26; PHI =28

Post Edited (ASAdvocate) : 10/6/2017 8:02:07 AM (GMT-6)


Hope4Happiness
Regular Member


Date Joined Apr 2010
Total Posts : 37
   Posted 10/6/2017 9:16 AM (GMT -6)   
Folks, I do appreciate the replies!

For clarity, I'm currently not making any decisions or looking for prescriptive advice. I just joined the active surveillance crew in September, so my next formal move is a PSA test in February 2018. Now, I know I could be looking at direct treatment in 6 months or 6 years, but I was just curious to get some insight from those who've traveled the path and how they've reached their respective decisions. I know a lot of it is dictated by the risk category we find ourselves in.

What I appreciate so much about this message board is the direct contact from the "soldiers" coming back from the "front," as it were, telling it like it is... as opposed to the "press releases" coming from the "state department" and those with a financial investment in certain treatments.
Age 52 at Dx - 8/17 (5th biopsy); MSKCC - NYC
2/14 cores: Right base medial, G6 (3+3), 1%, 0.1mm; Right apex medial, G6 (3+3), 3%, 0.5mm
6/17, Pre-biopsy: Prostate MRI - PI-RADS 3 - hypointensity in peripheral zone; no dominant lesion or adenopathy
Prostate size: 6.4x3.4x3.8cm; vol. 43cc
PCA3 = 29
PSA at Dx: 6.19, fPSA = 23%
On MSKCC's Active Surveillance (AS) program

ejc61
Regular Member


Date Joined Dec 2016
Total Posts : 22
   Posted 10/6/2017 10:14 AM (GMT -6)   
Hello H4H,

I'm kind of in the same place. It's complicated and confusing for sure. My urologist and a second opinion urologist that I consulted with, both, did not recommend surgery based on my data at this point in time. I'm on AS as well.
dx: 3/30/17; age 55
bx: 3 cores positive out of 12; all Gleason 3+3=6; 5%, 5%, 20%
PSA 1/27/17-4.4; FPSA 11.5%; PSA Density 0.16; Prostate Volume(cc) 28; T1c; Non-palp DRE
Initial bx result confirmed by Johns Hopkins
OncotypeDX GPS score 19
MRI 7/15/17; (2) lesions - Pi-Rad 3, Pi-Rad 2, otherwise none or normal results.
PSA 7/15/17-1.9

Post Edited (ejc61) : 10/6/2017 10:21:43 AM (GMT-6)


Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 168
   Posted 10/6/2017 10:57 AM (GMT -6)   
ASA spacoar was at the PCRI conference, very interesting. Denis
65YO healthy man, PSA 4.1 for couple years PSA 5/17 4.6, MPMRI, 5/17 showed lesion. 13 core biopsy 3 positive 3+3 and one positive in a lesion, may be overlap All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. MRI in 11/17 to see if there are changes. Thanks Denis

Philmire
New Member


Date Joined Oct 2017
Total Posts : 14
   Posted 10/6/2017 11:08 AM (GMT -6)   
You sound like a very intelligent man and AS is the smart thing at this point but if you want to talk to someone who knows his stuff talk to Tall Allen. He is one of the best on here and helped me tremendously. If down the road you seek treatment you'll know what to do. Allen was just a little worse than you when he had SBRT done and has been cancer free for years with no SE's. Most of us start like you and usually get worse. You have a 43cc vol and a PSA of 6 but your cores are non aggressive. That was where I started 5 years ago and my wife got small cell lung cancer so I forgot my cancer and took care of her till her death last year. My prostate now is bigger than a golf ball and I have a DNA that won't allow me to have radiation so radical is my only choice and I will lose most of the nerves and that means complete incontinence so don't wait too long like I did. Good luck
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