Midpack
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
I hesitate to start another thread, but I sorta hijacked the BPH thread, so I thought I'd quit doing that.
In short, I have intermediate risk prostate cancer. While that's better than high risk, it appears I won't be able to avoid some sort of treatment. Unfortunately there is no obvious choice - all the options including doing nothing, come with tradeoffs regarding cure rates, recurrence, side effects, etc. I am leaning toward brachytherapy (seed radiation) or HIFU, the side effects of prostatectomy or EBRT (radiation) are daunting to me from a quality of life perspective.
The PIVOT study (table below) and the ProtecT study don't show nearly as much benefit from even the most aggressive treatments versus doing nothing in terms of life expectancy - that's puzzling. That gives me pause given the side effects of treatment.
In the end, it's just a problem I need to research thoroughly, and pick a course of action. It is what it is...
Details (optional): 70 yo. Finally went to a local PCP recommended urologist this year (RP surgeon). He recommended a series of tests. He described WW, AS, RP, EBRT & briefly focal treatment - but left it up to me. I chose AS and have another appt in 6 months. But I would expect I may have to pursue treatment sooner or later.
Unfortunately there is no central source to quantify the risk/reward of every treatment option. The patient has to defer to the doctor, or piece it all together themselves. The outcome of any given procedure hinges on the skill & experience of the doctor performing the procedure - but that information isn't readily available either. I have researched PCRI.org, Sloan Kettering, Mayo Clinic, Cleveland Clinic, Johns Hopkins and various other sources.
Quality of life is a very high priority to me, so RP and EBRT are not appealing so far. It appears brachytherapy or HIFU may be better options - but hard to be sure. Just making up numbers here (as I don't know what to use) - but l'd rather have 10 more years, than 15 years with urinary incontinence, ED, rectal damage, etc.
I have found PCRI to be an excellent resource, along with CancerBetter and several others.
My 10+ year PSA history shows a very slow progression, last result 4.88.
Free PSA 12%
MRI - Prostate volume: 45 cm3. One lesion 6x6x9mm left mid gland, posteromedial peripheral zone, focal low T2 lesion, PI-RADS 4
Fusion Biopsy -
Region of Interest from MRI: Gleason 3+4=7, 20%, grade 2, tumor 30% overall
Random 10 cores
LAL & LML Gleason 3+3
LBL & LMM Gleason 3+4, 30%, grade 2, tumor 5% of overall
LBM Gleason 3+4, 40%, grade 2, tumor 50% of overall
Right all 5 clear
Whole Body Bone Scan - Negative
Oncotype DX GPS (genetic testing)- 48% chance of metastasis, 14% chance of death within 10 years if treated. My Dad lived to 96 yo with no cancer of any kind, so evidently it comes from my Mom's side even though she never had cancer of any kind either and lived to 93 yo.
In short, I have intermediate risk prostate cancer. While that's better than high risk, it appears I won't be able to avoid some sort of treatment. Unfortunately there is no obvious choice - all the options including doing nothing, come with tradeoffs regarding cure rates, recurrence, side effects, etc. I am leaning toward brachytherapy (seed radiation) or HIFU, the side effects of prostatectomy or EBRT (radiation) are daunting to me from a quality of life perspective.
The PIVOT study (table below) and the ProtecT study don't show nearly as much benefit from even the most aggressive treatments versus doing nothing in terms of life expectancy - that's puzzling. That gives me pause given the side effects of treatment.
In the end, it's just a problem I need to research thoroughly, and pick a course of action. It is what it is...
Details (optional): 70 yo. Finally went to a local PCP recommended urologist this year (RP surgeon). He recommended a series of tests. He described WW, AS, RP, EBRT & briefly focal treatment - but left it up to me. I chose AS and have another appt in 6 months. But I would expect I may have to pursue treatment sooner or later.
Unfortunately there is no central source to quantify the risk/reward of every treatment option. The patient has to defer to the doctor, or piece it all together themselves. The outcome of any given procedure hinges on the skill & experience of the doctor performing the procedure - but that information isn't readily available either. I have researched PCRI.org, Sloan Kettering, Mayo Clinic, Cleveland Clinic, Johns Hopkins and various other sources.
Quality of life is a very high priority to me, so RP and EBRT are not appealing so far. It appears brachytherapy or HIFU may be better options - but hard to be sure. Just making up numbers here (as I don't know what to use) - but l'd rather have 10 more years, than 15 years with urinary incontinence, ED, rectal damage, etc.
I have found PCRI to be an excellent resource, along with CancerBetter and several others.
My 10+ year PSA history shows a very slow progression, last result 4.88.
Free PSA 12%
MRI - Prostate volume: 45 cm3. One lesion 6x6x9mm left mid gland, posteromedial peripheral zone, focal low T2 lesion, PI-RADS 4
Fusion Biopsy -
Region of Interest from MRI: Gleason 3+4=7, 20%, grade 2, tumor 30% overall
Random 10 cores
LAL & LML Gleason 3+3
LBL & LMM Gleason 3+4, 30%, grade 2, tumor 5% of overall
LBM Gleason 3+4, 40%, grade 2, tumor 50% of overall
Right all 5 clear
Whole Body Bone Scan - Negative
Oncotype DX GPS (genetic testing)- 48% chance of metastasis, 14% chance of death within 10 years if treated. My Dad lived to 96 yo with no cancer of any kind, so evidently it comes from my Mom's side even though she never had cancer of any kind either and lived to 93 yo.
| PIVOT Survival Rates upon initial diagnosis of intermediate PC | 4 yrs | 8 yrs | 12 yrs | 16 yrs |
| Radical prostatectomy | 98% | 96% | 95% | 92% |
| Watchful waiting | 98% | 94% | 90% | 86% |
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