Prostate Radiation vs Surgery

[marko]

Thought I'd start a separate thread not to step on @Midpack thread of a similar nature. Main hope of posting is to possibly help others in this journey.
This is an extension of what I posted on a BPH Options thread but that is no longer the best place to continue the discussion.

From "BPH Options" thread BPH Options

Update: met with a three doctor team today (1/7/2025) at Mass General (one of the best facilities on the planet). Oncologist, radiologist and robotic surgeon. They did an impressive job of reviewing my case earlier in the day and even consulted with the original surgeon.

My case is somewhat unique in that I had 80% of my prostate removed 18 months ago, showed no cancer but now there is some. Because of the prior surgery, I'm not a candidate for surgery nor the new "cyberknife" radiation.

So, the plan is traditional radiation, "five days for six weeks" coupled with hormone therapy. The good news is that my PETscan shows no migration anywhere. Also the radiation center is four miles from my house so an easy commute with minor inconvenience. (Aiming for early morning sessions) Radiologist and oncologist will co-lead the effort.

I'm extremely encouraged. At least now we have a plan. They all echoed "entirely curable", obviously with no guarantees. There's a lot of preparation involved including a SOAR procedure (if you don't know, don't ask) but I should be good to start mid-February and have it wrapped up by April.

I'll keep you posted.

 

[marko]

Next step is to meet with my regular urologist on Friday and start the prep process of blood work, scheduling a SOAR and scheduling the radiation. When he does the SOAR he will also install three small gold markers that will allow the technicians to focus the beam.

Oddly, while this is all ahead of me, for me, the worst part was not having a plan. Now that I know what direction we're going, I'm feeling very confident and almost (almost) like the worst is behind me.

 

[Midpack]

Thanks for sharing your journey. I probably would have chosen IMRT myself if the place I chose for treatment wasn’t 150 miles from home (I chose SBRT). I’ve read tons on PCa and IMRT has a very high success rate and very low short and long term side effects.

Best of luck, please keep us posted.

To reinforce something you said. My separate meetings with a world class robotic surgeon, a medical oncologist and a radiation oncologist one after another in one day was invaluable for me. I’d done as much research as possible in advance so those consults made it easy for me to decide on a plan of treatment. Decided in Sept, zero regrets. What I’m saying to others, do NOT let a urologist, or any specialist, alone guide your treatment plan. Know all your options, no single doctor can do them all justice. Surgery is over prescribed for PCa for a variety of reasons - but I am not saying surgery is never the best course.

 

[marko]

Thanks for sharing your journey. I probably would have chosen IMRT myself if the place I chose for treatment wasn’t 150 miles away, so I chose SBRT. I’ve read tons on PCa and IMRT has a very high success rate and very low short and long term side effects. Best of luck, please keep us posted.

I had been hoping for a short, 5 day session but have to go the long route....
Between the two of us, I hope there's a few out there who can benefit.
Good luck to us both! DM me anytime.
m

 

[marko]

To reinforce something you said. My separate meetings with a world class robotic surgeon, a medical oncologist and a radiation oncologist one after another in one day was invaluable for me. I’d done as much research as possible in advance so those consults made it easy for me to decide on a plan of treatment. What I’m saying to others, do NOT let a urologist, or any specialist, alone guide your treatment plan. Surgery is over prescribed for PCa for a variety of reasons - but I am not saying surgery is never the best course.

Yes! My meeting with "the Trinity" put a lot of fears to rest and I believe that having trust, belief and confidence in your team is critical to a good result.

It was refreshing (sort of) to hear the surgeon say that she would outright refuse me if I demanded surgery.

I also asked the radiologist how many patients at one time he had (about 20-25). Comforting that if I hit a snag, that he doesn't have to look up who I am.

 

[Midpack]

Marko: I was very concerned leading up to it. I had SpaceOAR done yesterday, quick and relatively painless, and (to my surprise) I was conscious the whole time. Fiducial markers (which you don’t need) and SpaceOAR took just over 12 minutes. The prep was harder than the procedure(s). And SpaceOAR is a game changer for reducing EBRT side effects.

 

[rodi]

Adding my 2 cents in here. Hubby finished EBRT early November. He's at the tail end of the lupron Depot. We meet with the urological surgeon who said surgery was best. Then the EBRT radiologist. Outside his healthcare network we had phone consults about TULSA (up in LA... So a hike), and EBRT (Orange county, so again a hike.). EBRT and Tulsa were not available within 100 miles, hence the phone consults). We also looked at SBRT but since it's newer the data didn't go out as far but the risk to the rectum made hubby nervous.

With EBRT no incontinence although he did start on flomax about halfway through the process. He was tired at the end, so I drive him the last week. That reminded quickly once he stopped radiation. His first follow-up checkup had low PSA numbers as hoped. All things considered it went well.

 

[Teacher Terry]

My ex husband number 3 had prostrate cancer young at 49. They only found it because he was impotent even on viagra. He had the radiation seeds and almost 20 years later still cancer free. It did leave him with some urinary problems. I’m sure lots has changed since then and wish everyone the best in dealing with this issue.

 

[street]

Thanks also for sharing your story and looking forward if you continue to share your journey. This is a great thread and good information being shared.

One question were your PSA numbers out of parameters, or did you have symptoms to where you found out that way. I understand if you don't care to answer those question.

I wish you well through the process.

 

[Midpack]

Thanks also for sharing your story and looking forward if you continue to share your journey. This is a great thread and good information being shared.

One question were your PSA numbers out of parameters, or did you have symptoms to where you found out that way. I understand if you don't care to answer those question.

I wish you well through the process.

I have no symptoms to this day.

My PSA was very slowly drifting higher, reaching 4.88 about a year ago. That’s not really high for a 70, as the prostate often gets larger with age, my PSA density was normal. With no PCa in my family, I assumed it was “just” BPH. But I then had:
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

As you probably know, there are several things that can result in an elevated PSA that are not an indication of anything. Any elevated result should lead to a retest several weeks later where the patient avoids certain things. And you can have an elevated PSA with no PCa or PCa with a low PSA. More here Myths About PSA Tests and Prostate Cancer Screening

 

[marko]

Thanks also for sharing your story and looking forward if you continue to share your journey. This is a great thread and good information being shared.

One question were your PSA numbers out of parameters, or did you have symptoms to where you found out that way. I understand if you don't care to answer those question.

Thanks. My PSA shot up from 2 to 17, twenty five years ago after a bad UTI. It stayed there in the teens ever since and my urologist and I agreed that it was a false positive. Negative biopsy at the time but I almost died from sepsis. Literally.

Last year I had 80% of my prostate removed (because it was 10X normal size and couldn't pee) and the PSA went to 4. Biopsy then showed no cancer.

Six months later it was 8 and six months after that, back at 10. Urologist wasn't happy.

From there we went to an MRI, biopsies (4+3 positive), petscan (negative for migration) and here I am.

 

[street]

Thank you Midpack and you were pro-active and early detection is a big deal.
I believe doing a biopsy is probably the best test to find cancer, is that true?

 

[marko]

My ex husband number 3 had prostrate cancer young at 49. They only found it because he was impotent even on viagra. He had the radiation seeds and almost 20 years later still cancer free. It did leave him with some urinary problems. I’m sure lots has changed since then and wish everyone the best in dealing with this issue.

Thanks. At age 72.5, I could be happy with 20 years ahead of me.

Most in my family easily reach their 90s with a good quality of life. That's my plan.

 

[Midpack]

Thank you Midpack and you were pro-active and early detection is a big deal.
I believe doing a biopsy is probably the best test to find cancer, is that true?

AFAIK a biopsy is the most conclusive test for PCa, preceded by a MRI showing lesion(s). That’s said, there are risks and side effects with a prostate biopsy so I plan to avoid them as much as possible. I had side effects for about 2 months. I’d like to think I wouldn’t have another one until/unless my PSA spikes again after treatment and recovery have run their course. YMMV

Prostate biopsy - Mayo Clinic

www.mayoclinic.org

 

[street]

Great information! My Doctor told me a few days ago that same thing. He said the biopsy has risks just like you have said.

My PSA test has elevated some through the ten year history and the most in the last two years. The numbers are still in parameters of the blood test chart.

I do want to be pro-active and stay on top of it as I age. My doctor is doing to get back to me on the MRI test.

 

[Midpack]

Great information! My Doctor told me a few days ago that same thing. He said the biopsy has risks just like you have said.

My PSA test has elevated some through the ten year history and the most in the last two years. The numbers are still in parameters of the blood test chart.

I do want to be pro-active and stay on top of it as I age. My doctor is doing to get back to me on the MRI test.

Yep. There are more treatment options the sooner it’s detected. Surgery and biopsies have their place, but they’re both over prescribed often. Best wishes.

 

[MarieIG]

DF had prostrate cancer. IIRC he had a Gleason Score circa 7. He had hormone treatment (a pellet inserted in his arm) and the radiated seeds. I do recall him having hot flashes early on with the hormone treatment which tapered off, and that Flomax was one of his medications. The PC did not return.

 

[Car-Guy]

I'm sure I've posted this before, but a good friend of mine has been on his PC journey for a little over 3 years now, and he's shared a lot of details with me. IIRC, he had a PSA of over 20 and a Gleason score of 9 with metastasis outside the prostate but considered "local" (Whatever that means?). He underwent 9 weeks of radiation therapy as well as 2+ years of hormone treatment. He's still taking some sort of medication (?) daily but other than that, he's done. His scans (Pet?) have shown he's cancer free. He said the worse side effects by far was while he was on the hormone therapy. He got off that last year and says things are now improving.

I hope I never have to go through this myself but the good thing is they are coming out with all sorts of new and advanced treatment options all the time and clearly it is often curable.

Best of luck to you Marco and others going through this.

 

[Teacher Terry]

A good friend of mine had prostrate cancer and refused to get a biopsy and just ignored his high psa score for years. Finally he went to Germany for treatment where it doesn’t cure the cancer but keeps it from progressing. He had to go once a year. Then covid came and he couldn’t go.

Then he had some unapproved 20k treatment in an office and decided he was cancer free because the provider told him he was. He died 2 years ago from cancer. He didn’t believe in standard treatment as it was too toxic. It’s really sad because he was 75 and would still be alive.

 

[marko]

I'm sure I've posted this before, but a good friend of mine has been on his PC journey for a little over 3 years now, and he's shared a lot of details with me. IIRC, he had a PSA of over 20 and a Gleason score of 9 with metastasis outside the prostate but considered "local" (Whatever that means?). He underwent 9 weeks of radiation therapy as well as 2+ years of hormone treatment. He's still taking some sort of medication (?) daily but other than that, he's done. His scans (Pet?) have shown he's cancer free. He said the worse side effects by far was while he was on the hormone therapy. He got off that last year and says things are now improving.

I hope I never have to go through this myself but the good thing is they are coming out with all sorts of new and advanced treatment options all the time and clearly it is often curable.

Best of luck to you Marco and others going through this.

Thanks carguy. This is encouraging.

 

[joesxm3]

Today I watched a couple you tube videos with a Boston College biology professor named Thomas Seyfried.

He claims cancer is caused by metabolic disorder rather than genetic mutation. Long story short he claims that reducing glucose (processed carbs and sugar) and increasing ketones significantly slows cancer growth.

I bring this up because I have seen some experts say that all prostate cancer patients have micro metastasis that is not detectable. I have a!so heard it said that all people have naturally occurring cancer cells but the majority are cleaned up by the immune system before they get out of hand.

So it seems to me that giving whatever treatment we choose a helping hand by switching to a metabolically healthy diet and more exercise is a good idea.

 

[marko]

They say laughter is the best medicine, so I thought I might add a little levity:
I called my best friend in California to give him the run-down.
Told him how I'm starting hormones as a first step which will totally stop the growth as the tumors feed on testosterone. I added that hot flashes and being more emotional could be some of the side effects.

He said: "Oh no! You're gonna be like a woman! My God, he'll be an even bigger b!tch than he was before!!"

Made my day. Still laughing.

 

[Koolau]

They say laughter is the best medicine, so I thought I might add a little levity:
I called my best friend in California to give him the run-down.
Told him how I'm starting hormones as a first step which will totally stop the growth as the tumors feed on testosterone. I added that hot flashes and being more emotional could be some of the side effects.

He said: "Oh no! You're gonna be like a woman! My God, he'll be an even bigger b!tch than he was before!!"

Made my day. Still laughing.

I love it. Sounds like my brand of humor.

 

[Healthy Lifestyle]

Laughter can be the best medicine. Good luck Marko.

 

[marko]

Update: looks like I'll start radiation mid- February. Started hormones yesterday. The prep work right now seems to be more hassle and work than the routine of daily radiation itself: blood tests, Lupron (hormone) injection, SpaceOAR and installation of three small gold nuggets for beam focusing, some sort of pre- radiation beam focus prep, several nurse follow ups.

A complication: they may or may not be able to install the SpaceeSOAR because my prior surgery somehow makes it very difficult...a 50/50 chance it can be done but they won't know until they get there. If they can't we still go ahead..."we did radiation for decades before SpaceOAR came out."

I'm looking forward to just a daily routine of six weeks of a routine daily blast. I have to say that the practical scheduling, coordination and efficiency of it all is impressive and very well done. Quite the well oiled machine.

I'm also lucky and happy that all of it is a 12 minute, 4 mile drive from home which makes it all (hopefully) a minor inconvenience than a major disruption to the day.

More later.