What Is The Best treatment

Easy,

Glad you found us but sorry you needed to look. Hope we can help.

Of the two options you mentioned the radiation is probably better. There is a rule of thumb that as a man gets much past 65 he does better with radiation since it gets harder and harder to recover from the surgery. So, at least from what you have told us the radiation seems the better choice.

I agree that you are a poor candidate for cryotherapy. Too much cancer there and too high risk.

If you want to add a third option to your list you could try to find a doctor who actually does brachytherapy (seeds). Doctors know what they can do with their specialty but don't always know what can be done by doctors in other specialties. Surgeons are often a bit pessimistic about what can be done with radiation, especially with brachytherapy. And that might actually be a good option for you to look at.

We have a "sticky" thread (one that always stays at the top of the list) that you might read through. In particular, look at the part about getting a second opinion on your biopsy slides. There are a few labs that specialize in prostate cancer pathology and they can sometimes give a better reading. Here's a link you can click:

Newly diagnosed with PC? – read this thread first.

If your biopsy is right you are a fairly high risk case. The highest Gleason score is used to determine the risk category and with your Gleason 9 core you are in a very high risk cagtegory. (Welcome to the club, by the way, we keep a list of Gleason 9 members and you will need to be added.)

Have your doctors talked to you about hormone therapy? It can be used to keep the cancer from progressing while you arrange for surgery or radiation and if you do choose radiation the hormones "sensitize" the cancer to the radiation and make it work better. It also seems to improve the results with surgery for high-risk disease, too. Something to talk to your radiation guy about.

Welcome to the forum, and welcome to the Gleason 9 club.

Try to take it easy, Easy, this stuff ain't easy, but it is doable.

Easy - here's the problem: both will work to cure the cancer. The question is which would you tolerate better. So difficult to say. The general wisdom would suggest radiation at your age, but I know guys at your age who'd tolerate surgery just fine.

Have you discussed this with a radiation oncologist yet? Personally I am slight biased towards doing RT, but then I am not a doctor just a random guy on the internet. I think you'd do well with RT and would have fewer issues than with surgery.

It's not an easy decision.
Hang in there,
Andrew

Congrats on the negative bone scan! As has been pointed out, you're on the high risk side...along with what others have said about surgery and your age, a G9 cancer is more aggressive so there's a higher chance that your cancer may have moved on. In that case, surgery won't get the whole thing and you'd need radiation as a back-up. (Tall Allen recently posted some excellent info about salvage radiation.) To that end, starting with radiation is likely to make the most sense for you.

I would urge you to talk to a knowledge about radiation oncologist (or more than one really). You'd want to know about brachytherapy (both low dose and high dose) as well as a treatment called SBRT (which Tall Allen can tell you more about and I'm sure he'll show up soon).

BTW, my stats are fairly similar to yours (although I'm younger) and I had the triple play of HDR brachy, external beam radiation and hormone therapy. It's still the early innings, but I'm doing quite well for now.

Good luck and let us know how we can help.

Good luck with your decision. It's not easy.

You. An read what I went through bu clicking on the link in my signature.

There is no real *best* treatment because there have never been any head-to-head studies. It often comes down to who is doing the particular treatment.

Consult a doctor that specializes in LDR brachytherapy and hear his views on your case. There is one in Chicago named Dr. Brian Moran. He's done more seed implants than anyone else I can think of.

Consult someone like Dr Jeffrey Demanes in Los Angeles, at UCLA, for HDR brachytherapy. See what he recommends.

Dear Easy:

With those stats there is some chance that surgery alone or brachytherapy alone will not be curative. If it was me, I would choose a combo radiation therapy, e.g. LDR Brachy + IMRT or HDR Brachy + IMRT.

Good luck,

Jim