Surgery or Radiation? Gleason 7 with possible extension

First, welcome to the place I am sure you didn't want to come to.

That isn't an easy question. Do you have a recommendation from your doctors? Have you seen both a urologist and a radiation oncologist?

A URO is likely to say surgery while a RO is likely to say radiation. Not helpful I know. With your numbers either is likely to be okay the only real question is containment. If it's all in the gland then surgery is likely best. If it's already out then it's likely HT and radiation. How sure are you that it's spread? That would be the question I'd be asking. Is surgery a waste? Hate to say but you likely won't know until after surgery. I guess that isn't helpful but it's the choice we face.

A second, and/or third opinion would be helpful to you. You've got plenty of time to make a good solid informed choice.

I am at G7 and decided on radiation as my first treatment because I wouldn't tolerate surgery well and because I was concerned about PC on the margins. IGRT can target those areas just fine. If that doesn't work I still have options.

The one good thing about doing surgery first is that you still clearly have the options to move on to radiation and HT if it fails. Surgery is harder to do after radiation.

All the best,
Andrew

I set surgery for June 1 at Sloan Kettering with Laudone on the robot....but then he did not have the MRI until last week and now I am having second thoughts...the MRI says:

There is a focus of significant restricted diffusion which can be seen in a recent or neoplasms in the central right base measuring 11 x 6 mm area this demonstrates corresponding focal hypointense T2 signal and early hypervascular enhancement compatible with malignancy. There is irregular capsular bulging at this level with disruption of hypointense T2 signal and a rim, suspicious for extracapsular extension.

The radio oncologist says just to skip the surgery and that I will need to do radiation anyway as soon as possible with hormones...

The surgeon has not yet talked to me about the MRI....

Sounds like you have a good team to evaluate your options with. Take you time and get all the information you need.

Good luck to you.

Red,

I know exactly where you are at - you have questions with no clear answers. I personally agonized over my choice of surgery + HT/RT or just HT/RT. The choice comes down to you and where you are at. I too scheduled surgery while exploring other options. Our pathologies are similar except my PSA was much higher which puts me in the high risk category. My surgeon stated that I would almost certainly need adjuvant HT/RT. As to weather surgery + HT/RT gives you a better outcome, the surgeon stated that there is some research that debulking with surgery first gives better outcomes. The radiation and medical oncologist did not directly dispute this, but they did say that the evidence is not overwhelming. The standard argument is that if you have aggressive PCa and you are young, (yes - 55 is young), you hit it with everything. The counter argument is that the side effects from multiple treatments start to add up. It was not clear to me until later, that the SE from adjuvant RT are worse that RT as your primary therapy.

Best wishes for the best possible outcome.

-Winter

Thanks for all your input. My surgeon got back to me on the phone, basically trying to reassure me that the surgery may well be successful and I may not need radiation...

My urologist who does not do any treatments basically said I could go either way...

I am tempted to switch to radiation because of the SE I hear about from surgery....This is not easy!

My surgeon got back to me on the phone, basically trying to reassure me that the surgery may well be successful and I may not need radiation...

sounds like wishful thinking to me.  i believe you have a better than average chance that the PC has jumped the capsule and you have a 40% chance that the actual pathology is worse than the numbers you have now.

as far as side effects go, i would be more concerned about the SEs of radiation after the prostate has been removed.

if you have surgery it's very likely, IN MY OPINION, that you'll also need radiation.  you should know that from the get-go.  my numbers are similar to yours and i went with a combination treatment.  my urologist, a surgeon, did not recommend surgery.

good luck.

ed

 

Red,

  You are getting some excellent input from all the previous posts.  From what I read, I'd agree with the assertion of skip the surgery and go right to HT and Radiation.  Sounds like the probability of needing radiation is high based on what you have presented here.  If that is the case, going through surgery and all it's SE's, just to have to do radiation anyway sucks.

  If you are getting lots of conflicting suggestions from different specialists, one thing you can do is a multi-disciplinary consult at one of the major Prostate Cancer universities.  I did this at Johns Hopkins and it was well worth it.  They get the Urologist, Oncologist, Radiation Oncologist, Radiologist all in the same room to discuss your case.  Then bring you a common recommendation, hopefully without bias because it is coming from all disciplines together.  Sounds like you are near Sloan Kettering.  They may have a multi-disciplinary consult program.  If so, get in to see them.  I found it to be well worth it in dealing with this treatment debate.

Possible extracapsular extension on MRI does not necessarily mean that one will have positive margins at surgery. The surgeon might make a wide excision on that side (take the NVB).