Time to decide.

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Regular Member

Date Joined Jan 2009
Total Posts : 32
   Posted 3/30/2011 5:26 AM (GMT -6)   
Hi group,
got diagnosed 2.5 years ago, and i have kept the monster at bay while active waiting.  Last psa test jumped up to 5.6, subsequent test 5.3 so i went for a biopsy.  . 
Left apex (2 cores) 6.5 mm (60%, 50%) ,
Left lateral apex (2 cores) 1.3 mm (5%, 20%) 
no perineural invasion or extension into extraprostatic fat
gleason grade 3 + 4 = 7
So i need to do something,
So it's back to surgery vs radiation, or is there anything new?
I was leaning toward radiation, till doc mentioned recurrance.
I am 61 and have no other health issues.  Doc (when pressed) said surgery is best solution because it has a lesser chance of recurrance.  Side effects are immediate but go away.  Where with radiation side effects may come later.
His radiation solution is the one night hospital stay,  insert , and direct radiation, with a 5 week external radiation treatment. ( does that sound right?)
Where do i find info about recurrance?
Thanks for your help,  this forum is awesome
Age 59, very healthy
Psa 2007 3.2
Psa fall 2008 4.9 two weeks later 4.4
11/2008 biopsy, T1c, gleason 3+3=6 low-volume prostrate carcinoma
1 of 12 samples malignant
Left lateral mid .05mm (5%)
CT scan negative
Consultation 12/2008 decided active waiting (diet) while researching options.
Followup PSA in March 2009

3/2009 3.5
7/2009 3.2
11/2009 4.2
5/2010 4.0
9/2010 3.9

Veteran Member

Date Joined Feb 2011
Total Posts : 4093
   Posted 3/30/2011 6:08 AM (GMT -6)   
side effects ar enot always immediate and don't always go away. IN my case, I had none.

Surgery was a no-brainer for me but I'm 40. At 61 I might have given radiation or seeds a bigger thought.

Watched my boss go through hormone treatment followed by seeds and wouldn't recommend that to anyone. Hormone Treatment had an effect on his mind and libido, and then when he started doing the seeds he would pee himself while on public transportaton or while walking around the city. It looked to be very hard on him. My surgery, by contrast, was a breeze.

God luck with whatever you choose.

Veteran Member

Date Joined Feb 2010
Total Posts : 3800
   Posted 3/30/2011 7:02 AM (GMT -6)   
>>Watched my boss go through hormone treatment followed by seeds and wouldn't recommend that to anyone. Hormone Treatment had an effect on his mind and libido, and then when he started doing the seeds he would pee himself while on public transportaton or while walking around the city<<
you have a much better chance of peeing yourself after surgery.  i had seeds, HT and IMRT and i would recommend it in cases where PC has a high probability of local spread.  i've never peed myself.  the OP sound likes a candidate for a combo therapy.  my doctor did not like to operate knowing there was a high probability for SRT later.  it had more to do with effectiveness and permanent side effects and nothing to do with age.
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Regular Member

Date Joined Jun 2010
Total Posts : 416
   Posted 3/30/2011 7:18 AM (GMT -6)   
Br, sorry you have to make a decision. I expect others will follow my post with deeper perspective.

I was 51 - healthy, and then a psa of 4 suggested biopsy which came back 3+4. I had rrp, but 4+3 with titiary 5 and pos margins suggested it had escaped the prostate, and sure enough it returned per a psa test 6 mo after. I then went 7 weeks radiation... finishing up just last mo. My surgery was by Davinci robot, which I feel allowed to to recouperate much sooner. But that was me.

*None of the choices comes without Side Effects. And they are not guranteed to be temporary. I've found mine to be acceptable.

As I understand it... And VERY generally speaking... if they think the pca is contained in the prostate, then surgery is often the choice for a young guy like you. Removing the prostate is effectively a cure, if contained within. Unfortunately, its hard to know if it's contained UNTIL surgery, where pathology can see if cancer cells are found at the margins of where your surgen cut the prostate out. There are lymph nodes and the like that can also be analyzed when surgery os the choice.

If they think the pca has escaped the prostate, surgery likely cant solve the problem because even removing the prostate, there are likely cells in the prostate bed, which Rad Therapy is better at dealing with.

And if the pca has spread beyond, then Hormone Therapy can often provide many years of beating back the pca.. but I understand that effectively loses it's power vs pca.

So I guess the trick is using the best option based on your specific age and body, the type, stage and grade of your specific pca, along with your personal view of Quality of Life issues.

The surgery results in you needing a catheter for a time and then learning to use new muscles to pee again. Guys have varying results, but a young guy like you should expect a good chance of regaiing nearly all control. Then there's the sexual factor.. removing a prostate effects the nerves that help us gain an erection. They can take a year or more to recover. Not everyone recovers. But there are the Viagra drugs and the like that can help. My experience has been that those in a loving marriage, the wife is worried about the husband being alive.. and everything else is 2nd place.

Radiation Seeds is also a viable option if the pca is assumed to be contained. I'm not overly familiar with them, but are certainly worth looking into if your dr thinks that makes sense.

Beamed Radiation as a primary treatment is often suggested when the pca is thought to have escaped the prostate. They radiate the prostate bed to try and reach the typically slow growing pca. I had Salvage Radiation last mo, and I got through it ok.. I lift weights a little, walk a few miles a day. If not for my pca, i'd be in the best shape i've been in for a decade.

I understand that beamed and seed radiation therapy has gotten significantly better over the past few years. So some studies you may read going back years may be worse than one would expect today.

Hormone Therapy "HT" as I mentioned is not considered as a "cure" - as RT and RRP could potentially be. But it certainly has it's place among bullets many of us will need at some point. I dont think it is often used by itself as the 1st option for most who's pca is not thought to have spread further than the prostate. I may be wrong.

On This Site you will see a discussion from a few days ago regarding study results come out showing that 6 months of HT along with RT was found to increase life expectancy at 10.6 by 50% over just RT alone.

If that is the case, that is an important result to consider. They suggest that the 6 months of HT is not soo long that it can have some nasty side effecfts that long term HT can have.. as I understand it.

Here is a link to that study result:

WELL BR, I didnt plan on going on and on here like this... I guess it's hard to put into a few simple words. NOTHING simple about this. But I wanted to give you some food for thought before some of the more experienced guys chime in. Dont take what I say as gospel - just trying to lay out the playbook, if you will.

Wishing you the best in whatever you decide is best for you!

Cape Bob
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