I have seen a radiation oncologist for a second conference this past Friday. I have also consulted with a surgeon who has completed over 800 robotic prostatectomy's. I began my concerns addressing questions about
the 3 + 5 Gleason score and the treatment this would require. The doctor shared I would require six months of hormone treatment, a combination of Lupron and Casodex. Two months prior to the radiation to help reduce his prostate and growth of cancer cells, two months during and two months following in case there are any cancer cells left behind. He has also encouraged me to take part in a clinical trial due to my advanced stage. I asked about
getting a second opinion for the 3 + 5 slide. He assured me he had a lot of confidence in "our pathologists." I asked if the second opinion uncovered a lesser score would this effect my treatment? The oncologist said it would. I may be able to avoid the hormone treatment and definitely the duration. I asked if I requested a second opinion if the additional delay in my treatment would be a danger and he said a couple of weeks would not effect starting my treatment. The oncologist agreed with my decision and is having the slides sent off for a second opinion. My question is, why didn't one of the doctors suggest this prior to my asking?
When I asked about
the radiation seeds the doctor stated because of my kidney function and my prostate being 51-52cc this was not an option. The oncologist has staged me a T2a and the urologist staged me a T1c. They are not in agreement with the staging. In my friend Lisa's research, based on the results of the biopsy, both lobes have malignant tumors this automatically stages me a T2c?
I asked the oncologist why he believed the radiation - hormone therapy was a better option than the prostatectomy. He didn't feel I was a good candidate for surgery due to being a Gleason 8 and his enlarged prostate, even though the surgeon had no concerns. I am not a candidate for seed radiation due to my kidney function. When asked how I could determine if the cancer has escaped the prostate without surgery and additional biopsy of the area, he said he would do an MRI before treatment and the radiation treatment would attack extra areas around the prostate. He confirmed that I would not be a candidate for surgery after radiation. I asked what was plan B if the radiation/hormone therapy was not successful. He shared if following radiation I see a slight rise in PSA they would simply monitor. If there is a rapid rise, he would continue hormone therapy and possibly chemotherapy. Side effects include; hot flashes, fatigue, muscle weakness, irritable bowel, rectal bleeding, urination frequency and most likely would be rendered impotent. I stand to have toxicity down the road following radiation.
This is all so much. I can't help but continue to believe my best option is surgery. If the surgery is not successful, I have the radiation and hormone treatment to fall back on. If the radiation/hormone is not successful, I have little else other than continued hormone treatments with horrible side effects and chemo.
I will let you know what I decide and my progress once the second opinion is received. Thank you for your support and sharing in my journey.
Michael_T said...
To logo's point, I *think* I recall that Epstein considers anything with some Gleason 5 cells in it to be a G9. Perhaps someone can confirm that.
That said, Easy E...regardless of whether or not you're a G8 or a G9, it likely wouldn't make a difference in your treatment. Between your age and high risk profile an aggressive combo radiation treatment (with HT) would likely make the most sense. Have you consulted an experienced radiation oncologist yet? When you say "your doctor" I presume that's the urologist that diagnosed you...if so, the perspective of an RO would be critical.
Good luck to you!