Advice: Robotic Surgery OR Hormones, Radiation & Seeds

Welcome to the forum
I'm afraid I'm not qualified to make decisons about what you should do as there are so many factors to be weighed up that only you and the docs can know enough about, so I won't be casting a vote (and I don't think anyone else here can choose or should try to choose for you either).
All we/I can do is suggest places you can look to help you find out as much info as possible so you can make an informed decision. The top thread has loads of links to such places, and most people recommend Myers' book.

You mention the choice between surgery or HT+RT+Seeds, but I would assume that the latter is an additional choice between RT+HT or seeds +HT.

It would also help us to help you if you include a few more details about your situation, such as what your PSA level has been over recent time and whether your Gelason 7 is a (3+4 or a 4+3), how many cores you had done in your biopsy and how much cancer was found in them etc.

Alf

Welcome, sorry you've had to find us but I think you'll be very glad that you did. As Alf mentioned it would help us, help you, if you could provide more information; look at the "signature lines" in most of our postings for good examples.

In the meantime please don't feel rushed into a decision until you have learned all you can about this beast as well as the different treatments available - you do have some time for this. This forum/site is a great place to hear from those that have "been there, done that" and most will offer up their experiences. Also plan on spending tons of time on the Internet, there's lots of information out there and try to sort through to get to the reports and studies versus opinons and advertisements.

Plan on talking to a number of medical professionals in the different disciplines - surgery, LDR / HDR Brachytherapy, the various external radiation approaches and so on. When you do keep in mind that most (not all, but certainly most) will lean more towards what they do versus what in the end may be the "best" for you and your PCa statistics - an unfortunate reality but I can assure you, very real.

I would also suggest sending your slides out for a 2nd opinion and read, something that is very common / accepted as part of this journey you are now beginning. Epstein and Bostwick are the top two most often mentioned although I am sure there are more.

Don't panic, this thing is beatable - the best thing you can do is arm yourself with as much information from all of the available resources, and then make YOUR decision on treatment - be your own advocate - it's your life and quality of life.

Best to you.

Thanks so much for the quick replies! I understand no one can tell me exactly what to decide; but I'm just trying to figure out how I can make the best decision.

More info on my test results below. I wasn't sure how to make the below info as concise as your footers! Guess I don't understand it all yet.

‪(A )  Right apex:  Adenocarcinoma (gleason score 3 + 4 = 7) involving 5% of the specimen (1 of 1 cores contain cancer)  Gleason pattern 4 comprises 35% of the cancer.  cancer length 0.06 cm.‬
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‪(b )  right mid:   Benign prostatic tissue.‬
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‪(c )  Right base:   Benign prostatic tissue.‬
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‪(d  )  Left apex:   Adenocarcinoma (gleason score 3+ 4 = 7) involving 30% of the specimen (1 of 1 cores contain cancer).  Gleason pattern 4 comprises 40% of the cancer.  Cancer length 0.39 cm.‬
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‪(e )  Left mid:    Adenocarcinoma (gleason score 3 + 4 = 7) involving 25% of the specimen (1 of 1 cores contain cancer).  Gleason pattern 4 comprises 40% of the cancer.  cancer length 0.33 cm.‬
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‪(f  )   Left base:   Benign prostatic tissue.‬

‪On 11/3/12 a transrectal ultrasound guided sextant biopsy of the prostate was performed.  This showed a gleason score of 3+4 a 7 adenocarcinoma involving the right and left apex and left mid gland.  The remaining sextant biopsy was negative for malignancy.‬

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62 yrs old, excellent health (marathon runner) - DX'd with PC 11/12
PSA 5.3 - 11/12 (was 4.8 - 9/12)
Biopsy 11/12
Gleason 7 (3+4)

Welcome to our corner of the world - sorry you need to be here but it's a great place to be.

How do you decide? That the tough question here but with your numbers surgery, seeds, or beam radiation will all likely work just fine. The side effects vary and the effectiveness of each can be argued. In the end it comes done to a numbers game where you try to pick the most effective treatment with the least side effects based on probabilities and a lot of guess work.

As to the suggestion you get HT and radiation now - that seems excessive for a G7. A more common approach at your stage would be to do one treatment and wait to see what happens to the PSA. Then only if there are signs the treatment failed would you move on to the next treatment. You would on really consider HT if the cancer has escaped the prostate bed.

At this point you really need to learn more and you should really get a second or third opinion before deciding. You might also want to consider reading some of the great books out there. Dr. Walsh's book, "Surviving Prostate Cancer" is a good place to start.

In your case I'd think the choice for a first treatment would come down to either surgery or radiation (beam or seeds do about the same). The difference is really in side effects. With surgery you wake up with side effects like incontinence and ED but with radiation the bowel symptoms and ED can take longer to show up. Take a look at some of the recent threads on this site where we've listed the different effects of our primary treatments for some first hand accounts of what could happen.

So I'll ask you this question, "what is your gut feeling on what you want to do?" What treatment would you feel most comfortable with. You strong and fit so you'll do fine with either treatment.

Sorry for not being able to give you a scientific method but there's no clear cut best way. That one of the many things that is difficult about this PC - so much is uncertain and all we can do is take our best shot and hope it works.

All the best,
Andrew

HiSunshine,

You came to the right place for info and actual experiences from guys who have had a wide variety of experiences with all the treatment options. Keep reading a while both here and elsewhere on each treatment and the side effects. Both surgery and radiation are good options for you. As already pointed out, it will come down to what feels right for you.

I was dx'd at age 67 and started out thinking surgery. After further study, including a lot of reading here on HW, I changed my mind and chose a combo of BT and IGRT. I really did not want to have major surgery at 67 and risk some of the SE's associated with it....especially incontinence. I ended up doing what I felt most comfortable with and am very satisfied with the results. 

Will I have some delayed issues later due to the radiation? Maybe so...I don't know. But I may have had some immediate issues with surgery and for a longer period of time. What I do know is that I have no major issues for over 2.5 years so far.

In the end you will do what feels right to you based on your prioities. Regards,

Joe

 

HiSunshineMI:

A Gleason of 3+4 is considered imtermediate risk localized CaP. But 4+3 , is also a 7 , but is considered a little more agressive than 3+4. So I'm not sure what your Doc. meant by his comment.

Have you thought about CyberKnife SBRT ? 5 high dose radiation treatments, one a day for 5 days.

Your handle ends in MI. Are you from Michigan ?? If so, shoot me a PM and I can recommend a CK radiation Oncologist in Ann Arbor at St. Joe's and give you more info.

Also, please check my website with some links you may be interested in :

http://members.triton.net/vandenbe/CAP/CaPArticles_AUAGuidlines.htm

Good luck on your journey. Please get all the info. you can before making YOUR decision. You have months ( not weeks ) to make a decision, according to John Hopkins Urology. CaP is a very slow growing cancer.