Prostate Radiation vs Surgery

[marko]

Update:
I had my final radiation on Friday, April 4! Rang the bell and the whole waiting room on the other side of the wall exploded in applause! Heartening.

After 28 sessions, I've had zero, I mean zero side effects from the radiation. None. I joked with my radiologist wondering if the machine was plugged in. The Lupron and Casodex side effects have been minimal: occasional headache (Tylenol) and not sleeping very soundly at night (afternoon naps).

My PSA just came in at 0.06 which doesn't mean much right now as it is driven by the hormones. I got my second, three month Lupron shot today and will stay on Casodex for another three months. Oncologist is very pleased with where I am at this point. I don't go back to him until September as the hormones wear off.

For me, the hard part starts now. I don't handle uncertainty well. Not well at all. But it could be as late as December or later before we can declare victory as the hormones fade away and a new set of real PSAs show their colors.

My main worry is that my PSA has always run high: mid-teens for almost 20 years with no signs of cancer until this year. If that was accurate, I wouldn't be here now. As PSA is the primary indicator post radiation, I wonder and worry if I'll return to my former false highs after the hormones. Then what? Only time will tell. That's for another day.

All the doctors have echoed "Entirely curable" so I'm hanging onto that. If it was possible, DW and I have grown even closer which has been an added blessing. I remain positive and hopeful envisioning a long future. Longevity runs in the family and at 73, I'm keeping my sights on breaking mom's record of 93.

I'll be back for another update toward year's end once I get a final disposition! Thanks to all for your encouragement

 

[Koolau]

In June of 2020 I was diagnosed with PCa after 2 years of above 4 PSA level, 5.1-5.3. My biopsy showed that I had cancer in 3 of 12 samples. My doctor assigned me a Gleason Score of 6. Due to my age and overall health my doctor recommended “active surveillance“. I opted for a second opinion at a larger hospital and received the same recommendation. During Christmas of 2021 my entire family came down with Covid, everyone recover without any issues. I added ivermectin to my daily regimen for the Covid. I had read a couple of studies that had positive results with ivermectin treating PCa. Since I had started the ivermectin for Covid I continued and increased the dosage every day for 5 months. I then cut it back to 3x/week for a year. A year after my biopsy I had a MRI. The MRI showed no changes, so “active surveillance” was recommended to be continued. When I mentioned the studies and my taking ivermectin to my doctor he poo, pooed it and said I probably wouldn’t help nor hurt. In May of 2023 I had my second biopsy. 12 of the 12 samples came back clear. I’m still on “active surveillance” and now take ivermectin twice a week. Was it the ivermectin, my high D blood level, other vitamin/supplements I’m taking, sampling a mm outside the PCa area, dietary changes, some combination or the hand of God? IDK. Would I have chosen this path if my Gleason Score was higher and there was an urgency to act, probably not. Never the less, so far, so good.

I suppose it could even have been due to being infected with Covid! In any case, great news. I hope you continue with good check ups.

 

[Koolau]

Update:
I had my final radiation on Friday, April 4! Rang the bell and the whole waiting room on the other side of the wall exploded in applause! Heartening.

After 28 sessions, I've had zero, I mean zero side effects from the radiation. None. I joked with my radiologist wondering if the machine was plugged in. The Lupron and Casodex side effects have been minimal: occasional headache (Tylenol) and not sleeping very soundly at night (afternoon naps).

My PSA just came in at 0.06 which doesn't mean much right now as it is driven by the hormones. I got my second, three month Lupron shot today and will stay on Casodex for another three months. Oncologist is very pleased with where I am at this point. I don't go back to him until September as the hormones wear off.

For me, the hard part starts now. I don't handle uncertainty well. Not well at all. But it could be as late as December or later before we can declare victory as the hormones fade away and a new set of real PSAs show their colors.

My main worry is that my PSA has always run high: mid-teens for almost 20 years with no signs of cancer until this year. If that was accurate, I wouldn't be here now. As PSA is the primary indicator post radiation, I wonder and worry if I'll return to my former false highs after the hormones. Then what? Only time will tell. That's for another day.

All the doctors have echoed "Entirely curable" so I'm hanging onto that. If it was possible, DW and I have grown even closer which has been an added blessing. I remain positive and hopeful envisioning a long future. Longevity runs in the family and at 73, I'm keeping my sights on breaking mom's record of 93.

I'll be back for another update toward year's end once I get a final disposition! Thanks to all for your encouragement

Thanks for the great update, marko. We're all happy for you.

I love your sense of humor with your radiologist. I hope s/he appreciated it too. I've had docs with zero sense of humor. Laughter might not be the best medicine, but it really is helpful. Blessings.

 

[Healthy Lifestyle]

Thanks for the update and sending best wishes your way.

 

[YellowSubmarine]

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.

Four years ago, I had a procedure done, developed by Boston Scientific, that freezes the impending cells in the urinary tract. It is an outpatient procedure but takes a couple weeks for recovery and longer for total recovery. The advantage over other procedures...adjacent, healthy cells are not destroyed in the "freeze" process. After two years, I really noticed a profound improvement. Less bathroom visits and less urgency and better flow. Good luck to all...it seems to be a common male issue.

 

[rodi]

Some I bought I from an Indian Pharmacy (12mg pill form) and some I bought through a veterinary supply house (1% solution). I never used the horse paste but it is widely available.

The good news is you don't have to worry about scabies.

 

[Fahshah]

The good news is you don't have to worry about scabies.

Or worms & parasites! Sounds like a win-win

 

[marko]

Update:
Finished radiation in April and then had my second 3 month Lupron shot along with my second 3 month regimen of Casodex. Very minimal side effects, if any.

After six months, I finished my last Casodex pill yesterday and this afternoon's PSA came in at <0.03. Very happy with that but realize that it's doesn't mean very much as its 99% Casodex driven.

The real test is going forward as the Casodex hormones wear off and I start rebuilding my testosterone. My next PSA test is in September and, I'd guess another in December and hopefully being able to declare victory after an April test.

I see my oncologist this Friday but I expect it to be more of a pro-forma visit.

As noted earlier, I don't handle uncertainty well, so this will weigh on me (just a bit) at least until we get to see a trend in the PSA. I also have been running false high PSAs in the teens for over 15 years so I worry about false highs or the idea of a false high faking everyone out.

Updates to follow at that time. Thanks for all the well wishes along the way!

 

[Lsbcal]

Marko, thanks for the update. You have really been bravely going through quite a trial by fire.

I had a radical prostatectomy 10 days ago. So am following your journey closely. The urologist, radiation doc, and oncologist all had recommended surgery. My urologist has a very good reputation with the other 2 docs.

Getting better each day. The first few days of recovery were really unpleasant. I seem to be completely normal after the "void trial" (catheter removal). That is quite a relief. Apparently my urologist hit a home run for me.

So I'll find out about the PSA results in about a month. Not sure about this but the urologist handout said the prostate pathology report would be coming at my pre-opt appointment in that same time frame as the PSA results.

 

[Koolau]

Continued good wishes for all. I appreciate your candor and frequent updates! Blessings.

 

[Midpack]

Thanks for the update, sounds pretty good to me. I completed SBRT in Feb, and had my first post radiation PSA in May, all in another thread. So far so good, but it’s a journey of years with no defined end. I am in the same boat essentially, hopeful waiting.

As far as uncertainty, I know it’s well worn but this always help me put things in perspective…
Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

 

[marko]

Marko, thanks for the update. You have really been bravely going through quite a trial by fire.

I had a radical prostatectomy 10 days ago. So am following your journey closely. The urologist, radiation doc, and oncologist all had recommended surgery. My urologist has a very good reputation with the other 2 docs.

Getting better each day. The first few days of recovery were really unpleasant. I seem to be completely normal after the "void trial" (catheter removal). That is quite a relief. Apparently my urologist hit a home run for me.

So I'll find out about the PSA results in about a month. Not sure about this but the urologist handout said the prostate pathology report would be coming at my pre-opt appointment in that same time frame as the PSA results.

Good news on the void trial! Keep us updated.

 

[street]

Thanks for the update, sounds pretty good to me. I completed SBRT in Feb, and had my first post radiation PSA in May, all in another thread. So far so good, but it’s a journey of years with no defined end. I am in the same boat essentially, hopeful waiting.

As far as uncertainty, I know it’s well worn but this always help me put things in perspective…
Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

Glad to hear the good reports and thank you for the updates.

Midpack, that phrase is says it all.

 

[Lsbcal]

I am posting this chart of my PSA history as an example to those guys reading this thread and wondering about their numbers (or lack of data):

I was always on the high side for men my age. The numbers go up linearly and then there was a slope increase to 10.1 which triggered my urologist to suggest either a biopsy or MRI. I chose biopsy since I did not want to go back to San Francisco and go through all the loud clanging and banging again in that machine. The biopsy was done in surgery so I could have anesthesia and that worked out well. Was suppose to be low risk and gave the information the urologist needed most.

So take those PSA results seriously and if you have not tested, start getting tested!

 

[Midpack]

Like Lsbcal, just to share PSA history for others who may be interested and/or tracking their own. Even though my PSA was relatively low for my age, I did indeed have PCa - fortunately caught pretty early. Treated earlier this year. Now we just wait and watch for a PSA nadir which takes 2 years on average for radiation patients, and watch the trend thereafter. Obviously completely different for other treatments (surgery, hormones, other). For radiation patients, as long as PSA doesn't increase more than 2 mg/nL from the nadir, no action required. FYI

 

[Healthy Lifestyle]

Thank you all for sharing.
I am hesitating to follow up with my urologist and hoping that PCa is not in my cards.
I do not want to know bad news, as I do not handle stress well.
However, if I recognize more serious PSA issues, test results, sleepless nights, it will make me see my urologist.

 

[Midpack]

Thank you all for sharing.
I am hesitating to follow up with my urologist and hoping that PCa is not in my cards.
I do not want to know bad news, as I do not handle stress well.
However, if I recognize more serious PSA issues, test results, sleepless nights, it will make me see my urologist.

None of us like bad news, but the difference between early detection and not are literally between life and death most likely. 'Hoping,' 'hesitation' and self-diagnosis could end your life early with years of poor quality of life.

My outlook is relatively good. Odds are my 76 yo sister will be gone by Thanksgiving this year, her cancer was detected too late. It would have been very treatable detected earlier, but she hesitated and hoped, and the cancer metastasized. She went into hospice in May, treatment is futile, and she's had more than two 'second opinions ' from multiple oncologists. Our parents lived to 93 and 96 respectively so her expected longevity was far more than 76.

I apologize if this sounds harsh, not intended that way at all.

 

[marko]

None of us like bad news, but the difference between early detection and not can literally be life and death. 'Hoping,' 'hesitation' and self-diagnosis could end your life early with years of poor quality of life.

My outlook is relatively good. Odds are my 76 yo sister will be gone by Thanksgiving this year, her cancer was detected too late. She is in hospice as of May, treatment is futile, and she's had more than two 'second opinions ' from multiple oncologists. Our parents lived to 93 and 96 respectively so her expected longevity was far more than 76.

+1000. When it came time and they asked when I'd like to start radiation (or delay and spend the winter in Florida...some guys do), all I said was "what are you guys doing this Wednesday? "

 

[Healthy Lifestyle]

I totally agree and understand, but my procrastination causes me stress.

 

[marko]

I totally agree and understand, but my procrastination causes me stress.

That's not...ummmm....a Healthy Lifestyle.

 

[REWahoo]

None of us like bad news, but the difference between early detection and not are literally between life and death most likely. 'Hoping,' 'hesitation' and self-diagnosis could end your life early with years of poor quality of life.

^ What Midpack said.

A few years ago an acquaintance got some troubling PSA results and delayed doing anything for a full year. He was self-employed and he was on his wife's insurance, which had just changed to an HMO he didn't like as he questioned the quality of the physicians in the network.

When her insurance changed to a better network the following year and he saw a urologist, it was bad news. His prostate cancer had spread and his treatment options were poor. He was gone in 18 months.

Would he still be around if he'd not delayed that year? No way to know, but his family wishes he'd at least tried instead of waited.

 

[marko]

^ What Midpack said.

A few years ago an acquaintance got some troubling PSA results and delayed doing anything for a full year. He was self-employed and he was on his wife's insurance, which had just changed to an HMO he didn't like as he questioned the quality of the physicians in the network.

When her insurance changed to a better network the following year and he saw a urologist, it was bad news. His prostate cancer had spread and his treatment options were poor. He was gone in 18 months.

Would he still be around if he'd not delayed that year? No way to know, but his family wishes he'd at least tried instead of waited.

My urologist mentioned that a lot of patients will just take the Lupron shot, head to Florida for thrre months and then head to treatment when they return. Not an option I was willing to even remotely consider.

My neighbor deferred his treatment by six months in order to winter in California. Bad decision. He passed a year ago.

 

[Teacher Terry]

My urologist mentioned that a lot of patients will just take the Lupron shot, head to Florida for thrre months and then head to treatment when they return. Not an option I was willing to even remotely consider.

My neighbor deferred his treatment by six months in order to winter in California. Bad decision. He passed a year ago.

I don’t think some people take prostrate cancer seriously enough. Maybe that’s the case because it’s very common in older man. When husband number three got it at age 49 that was indeed scary. He is now 66 and it has not returned.

He’s my ex-husband now and he called me yesterday to talk and he’s having a lot of prostate problems and he constantly leaks small amounts of urine and sometimes he can’t pee at all and he’s had to go to the ER and be catheterized. They are now sending him up to Stanford to see a specialist. I don’t know, but I wonder if the issues are a result of the radiation seeds that he got all those years ago.

 

[Lsbcal]

I think some men don't feel the urgency of the matter because they feel no symptoms.

When it was diagnosed I pushed for the earliest possible surgery.

 

[jollystomper]

I totally agree and understand, but my procrastination causes me stress.

I would add to those to encourage you to get it checked out as soon as possible. While I have BPH, the symptoms are minor and right now very controllable based on what I drink. I did have a biopsy the first time my PSA was elevated, but fortunately it was negative. However, continued monitoring and followup on my PSA results has led to a detection of what is likely a benign kidney mass, but still has a good chance of being kidney cancer. Fortunately all other tests have shown every other organ normal, so if it is cancer it was caught very early. I will soon start another thread with details as not to distract from this one.