Surgery or Radiation?'

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dough boy
New Member

Date Joined Nov 2010
Total Posts : 1
   Posted 11/23/2010 11:58 PM (GMT -6)   
I am new at this so please be gentle.  I am 57 years old and have prostate cancer.  <i am trying to decide between radiation and surgery,  Been talking to doctors for 6 weeks now and still confused.  i have a gleason score of 7 but a very high PSA of 27.  They believe it is contained in the prostate.  Sorry about typing <i am in <Mexico and cant see very well and the numbers are worn off keyboaurd,  I just wanted to talk to patients and get their feedback.  Sex is very important to me and that has to be a consideration for me. 
Please advise:::  thanks

Veteran Member

Date Joined Feb 2010
Total Posts : 3984
   Posted 11/24/2010 12:14 AM (GMT -6)   
i have a gleason score of 7 (3+4) and my PSA was 6.8.  my prostate is small and DREs were normal.  the doctors say i have a 60% probability that the cancer is out of the capsule.  also, there's pretty good chance that my actual pathology is worse, but i'll never know because i opted for hormone therapy + brachytherapy + IGRT.  i wish you the best whatever you decide.  take care.
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10

Regular Member

Date Joined Sep 2010
Total Posts : 148
   Posted 11/24/2010 12:14 AM (GMT -6)   
I can't tell you what is better for you. Each man and many times his woman have to come to that decision by themselves. I am 49 and opted for surgury. I was really considering BT but my prostate was too large. A cheap second oppinion would be to read Dr Walshes' book - A guide to surviving prostate cancer. If you have questions about side effects and symptoms many here on this board can answer from first hand knowlege. The ED comes really fast with the surgury and I am hoping that it will go away soon for me.
You should work with a doctor or oncologist fairly soon in my oppinion but do take the time to research and understand.
Welcome to the board and good luck.

Post Edited (Highwayman) : 11/23/2010 10:45:09 PM (GMT-7)

Regular Member

Date Joined Nov 2010
Total Posts : 264
   Posted 11/24/2010 12:54 AM (GMT -6)   
Welcome aboard.

I chose radiation after I had done a lot of studying and talking to people.
To tell the truth I was afraid of surgery and all of the after effects it can have.
The statistical cure rates are equal or better for radiation than surgery.

I have not really had any problems to speak of. The IMRT made me have some tired
spells but that went away after the treatments stopped. I was in and out for the
brachytherapy in 1 day. I chose a Friday so I could rest for the weekend and then
go back to work on Monday.

Another book that I am reading now is Invasion of the Prostate Snatchers. It has a
lot of good info in it.

You're wise to think about what kind of quality of sex life you want to have going
forward. I can testify in my case it is the same now as it was before. 2-3 times per
week. Use it or lose it is what my radiation oncologist told me.

But each person has to decide for themselves and live with it.
age 57 2/2010
PSA 8.2 2/2010
biopsy 2/2010 - 2 of 8 left & 2 of 8 right positive, Gleason 3+4=7
attended support group - advised to get a second opinion
second opinion on pathology from John Hopkins 4+4=8
PSA 15 4/2010 just before IMRT began
5 weeks IMRT 4/2010-6/2010 at Copley Hospital in Aurora, IL
91 implants of palladium 103 7/2010 at Chicago Prostate Center, Westmont, IL
PSA 3.97 10/2010

Veteran Member

Date Joined May 2008
Total Posts : 1010
   Posted 11/24/2010 9:26 AM (GMT -6)   
Hello DB,
My stats are very similar to yours. (AGE, PSA, Gleason) One difference was that I had a lymph node that was swollen as detected on a CT scan. I did not have a needle biopsy done.  I got a second opinion on best path forward at Mayo and the recommendation there was surgery, salvage radiation and HT. A trifecta! After much research and soul searching I opted to do IGRT/IMRT with concurrent HT. My radiation was 25 full pelvic and 45 prostate focal for a dose of 80Gray total. The full pelvic and focal were done concurrently. I had mild diarrhea and some minor fatigue near the end of the treatment. I recovered rapidly after the last session. The HT was different story. Was doing OK the first year on it but the second year I gained the weight (20 lbs) and cannot seem to shake it. I have had ED but recently I have had some minor erectile function. Not "blue steel" more like a foam noodle. I have not tried any of the ED drugs as I do not have a partner so it is not that important to me.
You did not indicate whether or not you have had bone and CT scans or a second opinion. It may be useful for you to do these to get a better feel for what you are up against.
Best of luck to you.
Diagnosed 04/10/08 Age 58
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
IGRT/IMRT with adjuvant HT (lupron) 2yrs
02/08 21.5
07/08 0.82
10/08 .642
09/09 0.32
03/10 0.32
06/10 0.32
07/10 0.10

Forum Moderator

Date Joined Sep 2008
Total Posts : 4271
   Posted 11/24/2010 10:52 AM (GMT -6)   
Dear dough boy:
Sorry you have to be here but welcome.  You will find lots of caring and helpful folks on this forum.
Your question is the age old one that has been discussed and debated many times here.  May I suggest you scroll back through some of the old threads and you will see lots of info on both sides of the equation.
Without repeating too much, let me just say that there is long term evidence that shows the cure rates are similar for both surgery and radiation.  However, many of us radiation patients have concluded that the side effects are considerably less onerous for those choosing radiation than surgery.  If quality of life is important to you I suggest you Google "New England Journal of Medicine Quality of Life Study".  That will provide a pretty even handed review of what to expect 2 years particular for sexual functionality for example you will see that 43% of surgery patients reported "overall sexual problems" vs. their baseline of 12% pre-treatment.  The same stats for OLDER brachytherapy patients was 30% vs. a baseline of 18%.  You do the math...
Feel free to cut and paste the link in my signature if a first person brachytherapy journey is of interest to you.
Good luck and please keep us up to date on your progress,
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 9/10/10. 6 month PSA 1.4, 1 year PSA at 1.0. My docs are "delighted"! My journey:

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 11/24/2010 1:27 PM (GMT -6)   
I would be concerned with a psa of 27 that your cancer is contained. I would ask why the doctors belive this, has it been confirmed with either an MRIS or a color doppler? You have to confirm this before choosing a treatment. Also what is the size and location of the tumor? if the doctors can't tell you this they really can't make a valid recommendation. With a high psa, radiation to both the prostate and to the pelvic lymphnodes along with a course of Hormone Therapy would give you the best chance of a favorable outcome.
A good doctor would estimate the psa generated by your tumor and prostate size and try to determine the source of any excess psa. Before I had surgery the doctors would have to prove to me with a high degree of probability that the tumor was indeed contained and this can only be done with an MRIS or some other type of scan of the prostate. It is doubtful that a body CT scan or a bone scan will show anything, but they should also be done with a psa of 27. A high psa can be caused by an infection, a transition zone tumor or pc that has spread to the lymphnodes. If you cannot determine the cause than you have to assume that it is in the nodes and surgery would be off the table as a cure.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Veteran Member

Date Joined Jul 2009
Total Posts : 504
   Posted 11/24/2010 2:46 PM (GMT -6)   
Dough boy,

To help in your decision process you may want to ask each Dr:

"If the treatment you are proposing were done to you and it FAILED what would you do ?"

Veteran Member

Date Joined Jul 2010
Total Posts : 3887
   Posted 11/24/2010 2:56 PM (GMT -6)   
John T's advise is sound as usual...Your PSA of 27 makes surgery a long shot, Was your DRE normal or abnormal? and the size of your prostate..Make your doctors earn their money..Surgery seems to carry a fairly high risk of impotence. Even with "nerve sparing" techniques, enough blood vessels get cut to cause erection problems in most surgery patients..Don't believe everything the surgeons tell you..This is a major operation and things "down below" are never going to be the same..

Radiation on the other hand leaves the plumbing system intact and usually functioning normally for a while but as time goes on, the damage caused to the healthy tissue slowly becomes apparent. The latest methods of delivering radiation have gone a long ways towards minimizing these problems, but they still exist...The combination of seeds and beam radiation offer the best chance of a cure, but the odds of side-effects are increased also. With hormone therapy, your sex life is pretty much over if you have any left after the surgery and radiation...

So to sum it up, ALL of the treatments for PC will have a negative impact on your sex-life but radiation will probably have the least amount..Read and learn, make your decision and don't look back..
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