Treatment options ?

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dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 4/27/2008 7:03 AM (GMT -7)   
I just returned from a discussion with my second opinion doctor, he is suggesting 3 months of hormone therapy to shrink the tumor, followed by bracytherapy, and two weeks later followed by EBRT.  Has anyone had this treatment and how has it seemed to work.
 
My urologist of course recommende surgery but my second opinion doc. thought there is a better chance of cure by the radiation because the tumor is leaning up against the lining of the prostate and there is a possibility (30-40%) that there has been some leakage into the seminal vessels which the radiation should get. I did get a chance to see the MRI and it did look the way my second opinion doc. explained it.
 
I know the decision is mine but I'm looking for input from some of you who might have been in a similar situation.
 
David  
 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-4.1
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 Now trying to decide on treatment choice.


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 4/27/2008 7:10 AM (GMT -7)   
I need to correct one thing, my second opinion doc. was talking about the possibility of extra capsular invasion not seminal invasion.  I know this makes a difference.
 
Sorry about the mistake.
 
David
 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-4.1
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 Now trying to decide on treatment choice.


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 4/27/2008 8:37 AM (GMT -7)   
I wanted to bump your post to the top so you will get a few responses. My father opted for a different route, however, there are a number of forum members who have had similar treatment to the recommendation you received. Just curious, was your second opinion doctor a radiation oncologist?
My father had the surgery and had a lymph node involved, therefore, he ended up having to go through salvage radiation and is on HT. I feel as though there are two ways of looking at it....We felt better about my father having the surgery and getting rid of the majority of the cancer, we were obviously hoping to get rid of it all. His MRI showed no lymph node involvement, but it was in fact wrong as we learned afterwards. We also learned afterwards, that the MRI's are wrong the majority of the time. I think they are only 20-40% accurate. Ask your doctor about this, because we didn't and were so shocked when we received the post op pathology report. Hopefully, yours is correct, but something to be aware of.
It is such a personal decision and I am glad that my father had the surgery first, however, he might tell you something different. He made it through radiation with minimal side effects and seems to be doing well. We are hoping that the cancer is gone and does not return and I hope whatever decision you decide on gets rid of your cancer for good too!
My last piece of advice...if your second opinion was a radiation oncologist, I would possibly get a third opinion from an oncologist. Our experience was that the urologists recommend surgery and the radiation oncologist recommend radiation. Be your own advocate like you are doing and get all the information you can to make the best educated decision and then go with what your head and heart are telling you to do. Just my advice..take it or leave it. Best of luck in whatever you decide. Keep us posted.
Father's Information
DX July 15, 2007

Age 62 (now 63)

PSA 5.5

Original Gleason 3+4=7

Post Surgery Gleason- 4+3=7

DaVinci Surgery Aug 31, 2007

Focally Positive Right Margin

One positive node

Bone Scan/CT Negative (Sept. 10, 2007)

T3a N1 M0

Oct. 17 PSA 0.07

Nov. 13 PSA 0.05

Casodex adm. Nov 07

Lupron beg. Dec 03, 2007 2 yr

Radiation started March 03-April 22, 2008- 8 weeks 5x a week

8 weeks of radiation down!!!

Praying for a cured dad. First PSA 3 months!


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 4/27/2008 8:46 AM (GMT -7)   

My second opinion was from a radiation oncologist, I am factoring that in.  That is a good idea to get at least one more opinion before a decision is finalized. 

Thanks for the response.

 

David


 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-4.1
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 Now trying to decide on treatment choice.


DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 4/27/2008 9:23 AM (GMT -7)   

David,

Not saying one is right and one is wrong, because there are few absolutes, but note that seminal vesicles are removed during surgery, so I do not follow the statement from the oncologist that radiation would treat that portion of the possible cancer better.  As I assume you know, radiation as a follow-up to surgery is common, but surgery after radiation is problematic.

In addition, I believe that a lymph node dissection can be done before full-blown surgery or radiation (but not certain about that...) to determine node involvement.  This is much more reliable than a MRI.

If I were in your shoes, I would get a third opinion, since it appears that you got two very different opinions from two very different types of physicians.

Good luck in your decision-making process.

DanMan


Danman Bob, Born 1951
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer
Post-op pathology stated that cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)
100 MG Viagra 3 times a week beginning December 2007
Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008
30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008
Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008


Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 4/27/2008 4:09 PM (GMT -7)   

David:

Do you have access to "color doppler"?  If so, it might give you a better idea of the location and extent of the cancer.  The last two men we mentored had this test and both found the cancer had escaped the capsule which ruled out surgery.  Just another tool to use when making a treatment decision.   Best of luck in your search for the treatment best for YOU!

Dutch


Diagnosed Feb 2001  (Age 65)  Currently 72
PSA 4.8      Gleason 3+3=6      Stage   T2b
Completed Proton Therapy @ Loma Linda - 2001 - No side effects.  My journey is at: http://www.healingwell.com/community/default.aspx?f=35&m=727565
7yr PSA - 0.2
Our responsibility now is to educate men about Pca, PSA and the importance of early detection. 
 
 
 

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