Newly diagnosed- tough decision to make

Sorry you are here. I didn't see your age. Is there any concern on how well you'd handle surgery? That would be a big factor

It was the toughest decision of my life for sure.

You could start on hormone therapy and that would put things in check while you decide but I'm not sure you need to. I'm not a doc but normally, at least in the US, the first line of HT is Lupron. That would be a shot in your backside that lasts about 3 months.

If you chose surgery I wouldn't think they would suggest hormones in addition to it so you would go though the SE's needlessly. I actually chose surgery so I would not have to do the hormones.

Prostate cancer is slow growing. You are a G7 (3+4) with no solid evidence of escape. Again, I'm not a doc but that gives you a roughly 80% chance of either RT or surgery being a "cure" for you.

So the other factors come into play. Past heart issues and prior ED are factors as you noted. Your current age and overall health should be considered. If you are in your mid 50's vs mid 70's you might chose a different treatment or if late 70's just monitoring. Tell us more about yourself and others with more knowledge will be able to offer better advice.

Welcome to our not so exclusive club, sorry about the reason you're here.

I'm a bit surprised your Doc is already talking about hormone therapy since it appears your Pca is contained in the capsule. Some of us have had a totally miserable time on HT due to the side effects, me included. If they are suggesting a three month dose, be aware the side effects will last another two or three months. I'm praying I'll *never* need another injection of Lupron.

It sounds like you are a candidate for surgery or some sort of radiation. I opted for surgery and I'm glad I did, the Doc found one positive node out of 40 something he excised; I preferred knowing what was going on down there. Also my Gleason was upgraded to a 4+3 from a 3+4 (originally read as a 3+3 by a local lab.) So then it was time for HT and salvage radiation - one step at a time.

The usual recommendation for a first step is to get your slides re-read by a specialist, search this forum for their names.

My recommendation is to go to a nationally or internationally recognized center like Hopkins, MD Anderson, etc. and let them work you up and provide options.

If you want to go the seed route, success is greatly dependent on the skill of the physician doing the implanting.

Surgery and radiation are the two main options for you with your diagnosis, although there are several types of radiation. Pretty much any of those has an excellent chance of curing you so I would focus on the potential side effects of each treatment. If you already have ED, surgery would typically make that worse. That said, if you already need shots, maybe that's a moot point.

Regarding radiation, the option being offered you is SBRT/Cyberknife, which certainly make sense. To fully do your homework, you should also check into brachytherapy. When it comes to radiation treatments, different ROs specialize in different ones so it likely means seeking out an additional specialist. BTW, I'm also surprised about the HT prior to SBRT/Cyberknife with a G7 diagnosis, as that it generally reserved for more aggressive diagnoses. The SEs of HT are nothing to be taken lightly.

One last thing--as has been suggested, get your biopsy slides re-read by Dr Epstein's lab at Johns Hopkins. That's a cheap and easy thing to do and you really want to make sure you're actually a G7 (3+4). The newly diagnosed sticky has info on how to do that.

I know the scary feeling of having cancer inside you, and how that can make one's imagination go wild. But prostate cancer, even high risk prostate cancer, is slow growing. Studies have shown that taking 3 months or more to decide had no effect on outcomes. Also, there is no evidence that adjuvant hormone therapy does anything useful for a GS 3+4.

/pcnrv.blogspot.com/2016/08/treatment-delay-in-primary-radiation.html

You are right that starting out with poor erectile function, it is likely to worsen after treatment. You said the injection was painful. That's often because of one of the ingredients in trimax, alprostadil. You can ask your doctor to write a scrip to be filled at a compounding pharmacy that has less alprostadil. Or, you can try "bimix" that dispenses with it entirely. It sometimes takes some experimenting to find the right mix and right dose for you.

SBRT is certainly a good option for you, as is surgery, and both kinds of brachytherapy. Where are you located? We may be able to recommend specialists in your area. You may be interested in a recent clinical trial that had very high cure rates for intermediate risk men like yourself.

/pcnrv.blogspot.com/2016/09/5-year-sbrt-trial-high-cancer-control.html

Welcome to the club no one wants to be a part of. Read, read, read, talk to to your family and doc and then you and only you get to make this decision. I am also a 3 - 4 and went with the surgery. I am one year and doing okay. Good luck and remember you to get to make this call.

Bui-welcome to our club. You will find tremendous support here. I am the wife of a post-treatment PCa hubby. We went through SBRT as did many others here in August of this year at MSKCC in NYC. My hubby had some bowel issues previous so he asked about the spacer and was told his insurance (Federal BCBS) would cover in full. They did use it and all went well. There was no reluctance on the part of the physician. My hubby also did have to have hormone therapy prior to SBRT. He had to have a Lupron shot once a month for 2 months and also take Casodex pills daily for 2 months. It did cause a lot of hot flashes (or as my hubby called them 'power surges'). The reason the doctor added the hormone therapy was because on his MRI there was a suspicious looking area (a PIRADS 5 lesion) that the doctor thought could very well be a more advanced cancer. He did have repeat Fusion Biopsies to try and capture this but they all came back as before-3+4 and 3+3. My husband also was suffering from some urinary retention prior to therapy so he was also put on 2 Flomax a day to help alleviate those symptoms. He is 3 months out from therapy and all is well, really well. He is down to 1 Flomax and PSA is way down. Just keep in mind that everyone is different and therapies will vary.
There is a lot of discussion about SpaceOAR out there. It has to be a personal discussion between you and your doctor. Check with your insurance though.
BTW-hubby was fortunate, he had no early or late toxicity issues with his bowels, but we are still watching.
Good luck, you are in the right place here. Take notes, read up and ask alot of questions. There are so many wonderful people here to help.

Post Edited (InquisitiveOne) : 12/5/2016 4:31:44 AM (GMT-7)

Thanks
With these discussions maybe am leaning away from surgery.
Will look more closely at radiation and how to get more definite answers for my case for cure and minimize SE including secondary radiation effects.
Will summarize my thoughts and questions for my next meetings this week with the specialists.

Bui-

At the end of the sticky for the newly diagnosed there are some questions to ask doctors during meetings that you may find useful.

Bui,

Experience of the lead doctor and the team is huge. The general consensus if you're having surgery, is to find a lead surgeon who has a minimum of 500 cases done, and more is better. There are some here in the US who are well into the thousands. The comments are similar for the various radiation methods.

There are highly skilled and experienced surgeons in the UK--we've had members from there who spoke highly of their treatment. Here in the US, there are a lot of really good ones. Again, if you choose to come to the US, we can aim you to some good practitioners, just tell us which treatment you're interested in.

Bui,
In Houston, check out MD Anderson, comes highly recommended.

Good luck,
Kris

Bui

Pat yourself on the back, you made it to this forum at least, which helped me considerably since June of this year when I was in your boat.

I ended up going the surgery route after debating between RT... I was actually leaning towards HDR BT, but in the end ... based on feedback, choose a highly skilled Dr. in NYC for RP...

I think the best thing I learned from going through the process was not to rush, seek out and read all the valuable resources here, there are some excellent questions in the newbie guide that TA pointed about above... it's great stuff, just don't panic and you'll do fine. Remember, thinking positive is huge!

Zzarth