Not a lot of new advice to add, you've gotten some great advice from the fine folks here and are doing a wonderful job of educating yourself. Your low PSA, G10 disease is in a class of its own and extremely high risk and needs careful determination of treatment.The treatment decisions are difficult and everyone's situation is different as far as their prostate cancer, their expectations, and life circumstances - I think yours even more so. As you can see in my signature below, my husband was, on biopsy, a G7/8. His decision was to opt for surgery and he went in fully aware of the potential side effects of that course of treatment. Overall, he just wanted first, to know exactly what he was dealing with (didn't want the mind games of not knowing), and secondly to know that he would have the whole arsenal of treatments available to him over time. In all of the research conducted and published that I have read, there is no true, clear laser cut advantage of any treatment over another that is generalizable to the larger population. I am used to reading medical research studies and sadly, they frequently lean toward the specialty of the team conducting the research and can give a bit of a slanted view. Rad oncs lean toward radiation and surgeons toward surgery. Not to mention, with the near similar outcomes for all, one of the true decision factors among the various modalities to be considered (besides the likelihood of killing the cancer) is the side effects that ultimately show up from the respective treatment chosen - basically, do you want side effects sooner or later? As a disease that can tend to become a more chronic issue once you pass that magic Gleason 6, ongoing treatment becomes a reality for many. My husband did exceptionally well with surgery and recovery, nearly fully continent within a week of the cath being removed. A year out, near zero drips except with the occasional sudden cough or sneeze. He ended up being upgraded to the 4+5 with a positive node, EPE, and +SVI and is now on ADT, and just finished his radiation therapy in May. PSA was pretty fixed at 0.06 following surgery, but dropped to non-detectable levels shortly after beginning ADT and continues so at this point. As far as QOL issues - his libido is suffering from the ADT, but both of us feel a bump in the sex life is a better option than the other outcomes. His attitude in regards to the ADT is to endure the course. The radiation therapy was a different bird, not bad in the initial phases, but evolved into extreme fatigue and the usual bowel concerns toward the end. Amazingly, in his focus on enduring, he managed to work 40+ hours a week through all of it. Ongoing opportunity to wander this mortal plane together is our choice for as long as we can with some decent health, and we have accepted this new "normal", as LadyJane referred to in her wise post. Overall, prostate cancer is a b***h, but we've chosen to be aggressive in our approach to it and to go on living life. We could be depressed (living in the past), make our selves crazy with anxiety (living in the future/unknown), or simply choose the present. I'm rambling here and not really adding much except to wish you the best in your decision - you've done the research to help you decide what will fit you and your circumstances with an especially high-risk level of disease.I wish you the best as you navigate this path.
Husband’s info: Dx July 2018. 6 of 12 cores positive - 3 cores 4+3 and 3 cores 4+4. PSA 5.7 2/18, 6.2 5/18 RALP 8/29/18. 9/27/18. Path report: G9 4+5 pT3b, N1. EPE+, SVI +, + margin left bladder neck, lymph nodes 1/9 positive, prostate 48g, prostate involvement 35% 12/18/18 Axumin PET- neg 12/19/18 Casodex; 1/2/19 Eligard 9/18 1st post-op PSA 0.06; 12/6 0.06; 1/2/19 <0.04;1/31 0.04; to date <0.04
Post Edited (Nytngale) : 8/13/2019 9:29:57 PM (GMT-6)