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Posted 3/20/2017 5:36 PM (GMT 0)
Met with Dr. David Thiel, urologist (department chairman of urology)/surgeon following biopsy and discussed treatment options. He said I was too young and healthy for watchful waiting given the volume of my G7 disease. We went over all the risks and potential side effects of robotic surgery, together with the likely outcome (cure) which he indicated would be approximately the same no matter which treatment chosen. At the time I had not really begun my education about all this so my questions and responses in this consultation were somewhat limited. Dr. Thiel addressed the big three (cure rate, incontinence, and ED) . He was quite positive about the first two, but less so about the sexual function. Basically, he indicated that a return to current capability would be the ultimate, but that would be dependent upon many potential things in the surgery plus my ability to recover physically. Dr. Thiel was quite optimistic about my ability to recover in general from the surgery trauma because of my current overall health and lack of previous medical issues. He also indicated that I would be a good candidate for radiotherapy given the small size of my prostate together with an AUA score of 2.
Met with Mayo radiation oncologist Dr. Katherine Tzou. She stated that she thought I was an excellent candidate for the robotic surgery or radiation therapy with hormone therapy. Dr. Tzou said that if I chose radiation as a treatment plan, her recommendation would be definitive radiation therapy with neoadjuvant, concurrent, and adjuvant hormone therapy for a total of 6 months.
After reading and watching videos for a month and a half, I feel somewhat biased toward surgery. I admit to being one who wants the problem out of me and I also find the post-operative pathology report appealing. However, I am conflicted by some of the discussions I have had with guys who opted for radiation treatment and have reported no side effects whatsoever even out 10+ years (brother-in-law who had proton beam therapy). Guess all this means is that I'm in the same boat everyone is in when considering treatment options for this level and severity of prostate disease. So confusing.
One other thing that is significant to me is that to this date, I have had no real emotional trauma from all this. Honestly, I have been so blessed with good health for almost 70 years, that I just can't find it in myself to get too upset over having to deal with this issue. So many folks are coping with problems that are infinitely worse so maybe that has given me some perspective about this fight. That doesn't mean that I won't be nervous when treated, but I'm a very fortunate man, husband, father and grandfather......and I am well aware of that. I wish all the people who are unfortunate enough to need to be on this board the very best of outcomes through all that this disease entails.
Posted 3/20/2017 6:07 PM (GMT 0)
Welcome. You are in a great position to explore treatment options.

Since both surgery and radiation will generally be equal for cancer control, I suggest you focus on the potential side effects and choose the treatment method that hurts you the least. That is most often radiation therapy. No cutting, no bleeding, no voids in the body that other tissues must fill in, no risk of infection from a hospital stay, etc.

With radiation you can choose external beam or interstitial brachytherapy (from within). With the external beam you have the traditional IMRT/IGRT methods that require 40 or so treatments and the newer SBRT/Cyberknife that require five or six treatments. With brachytherapy you can choose Low Dose Rate permanent seeds or High Dose Rate temporary. LDR is done in one procedure and HDR is done in either one or two procedures. All of these will accomplish the desired result of effective cancer control and low side effects. A lot of it comes down to convenience.

I used a combination of HDRBT, IMRT and ADT due to my high risk dx. I chose HDR over seeds for its better use of technology. I used IMRT as the SBRT option wasn't in broad use at the time. As to ADT, many radiation oncologists will use it to sensitize the PCa so it is more vulnerable to the radiation and to shrink the prostate to be a better more concise target. So far after more than six years my cancer control is total and I have no side effects from the radiation. Much like your brother's experience.

For information on these treatments and HDRBT specifically see www.cetmc.com the website of Dr. Jeffrey Demanes. He is the father of HDR having used it to treat cancers since 1981 and he also is the head of the department at the UCLA Medical Center.

As to "wanting this out of me" that occurs with both surgery and radiation. Removal of the tumors is the same result as killing them and letting the body flush the dead PCA cells out as waste. Gone or dead the cancer control results are the same.
Posted 3/20/2017 6:26 PM (GMT 0)
Sorry that you are here but there are some great and knowledgeable people here. While G7 is at a point that you want to treat it, it falls under the area that it could be cured. That is great news!

Radiation and surgery have about the same good outcomes. For me I went with surgery because it allows for radiation as a secondary treatment (which I had). It is hard to do surgery if you had radiation first as it turns your insides into "mush".

I expect good results for you with either treatment. Good luck!
Posted 3/20/2017 7:26 PM (GMT 0)
I agree with JNF. For your "low intermediate risk" case, all whole gland treatments have about the same chance (90+%) of curing you. There's a list of questions at the end of the sticky for the newly diagnosed that you may wish to ask doctors and yourself.
Posted 3/20/2017 7:50 PM (GMT 0)
Hi,

I'm a little younger than you are, but had a similar diagnosis. I chose surgery. I wanted the cancer out of me, plus I was supposed to be a good candidate for surgery. I was in great shape, and athletic.

My story is linked in my signature. But the short version is I had side effects from surgery. Excessive internal bleeding post op, and then blood clots about two weeks later. I'm just fine now, although on a regimen of blood thinners for maybe another month. But the 2-3 weeks after surgery were a bit of a struggle.

So, do your homework. Radiation is a viable option, and you should find out what you can before making a decision. There are a lot of people here who have been treated by radiation. Read what they have to say.

Surgery does have side effects, some perhaps more serious than radiation. It just depends ...

Good luck
Posted 3/22/2017 1:29 PM (GMT 0)
Thanks to all for your insightful and helpful comments. My education goes on each day along with continued conditioning in preparation for whatever treatment lies ahead. One thing I can report on as a "newbie" is that at least in my case, meetings with surgeon and OR were not as productive as they would be if I were doing it today. My initial consultations were almost immediately after biopsy and before much reading and forum scrutiny. My future consultations will be more informative due to better preparation, mostly from information derived from the good people on this board.
Posted 3/22/2017 2:28 PM (GMT 0)
Good Morning, like you I am a G 7 but a 4+3 and my URO and RO said surgery or radiation either would likely be curative. I chose SBRT 5 fractions ending Nov. 27 2016. To date I have no adverse side effects. I have always had a sensitive digestive system and as we say in Alabama would get the green apple trots often and I still do. The biggest problem is with the HT it is no fun but tolerable. I am on my last month of 6mo lupron shots. I have never had ED problems and everything still works its just that the Lupron makes me not care. I understand that in most men when the shots wear off that will improve. I have had energy problems and can tell I am weaker than before. I have been able to do about anything I could do before the treatment just lack the drive to do so. I just didn't want surgery plain and simple. My thinking was if radiation has side effects 10yr down the road I'll worry about that then but with the studies I have read I don't think that will be the case. That being said your doctors are correct in my opinion either will be curative for you its just like the TV ad says "pay me now or pay me later". Learn all you can about all options make your choice and don't look back.
Good luck
Perry
Posted 3/22/2017 3:07 PM (GMT 0)
Here is a link to a piece that ran in my local newspaper today that may be of interest to you.
http://jamanetwork.com/journals/jama/fullarticle/2612597
Perry
Posted 3/22/2017 3:33 PM (GMT 0)
Two things that stood out to me.

Results included:

—Among men who had normal sexual function before treatment in the Chen study, poor sexual function was reported by more than 57 percent of surgery patients two years later, versus 34 percent of those who had radiation implants, 27 percent who had external radiation and 25 percent who chose observation.

—Three years after treatment in the Barocas study, 14 percent of surgery patients said urinary incontinence was a significant problem, versus 6 percent of men who chose observation and 5 percent of radiation patients.
Posted 3/22/2017 4:46 PM (GMT 0)
Thank you for the informative studies, Chipmaker. From my consultations with surgeon and RO, I have been specifically informed of the potential side effects of surgery vs radiation treatments (those side effects are listed repetitively on this board) while keeping in mind that the cure rate with my grade of disease is pretty much the same no matter the treatment chosen. With those specific side effects in mind, my observation to date from reading and watching videos has been a plethora of post operative experiences that chronicle everything from virtually no side effects, particularly related to continence or ED to very significant, long lasting (sometimes permanent) continence and/or ED issues. Conversely, and it may just be because of my search parameters, I have found very little specific post-treatment complaints from different radiation treatments. While the RO's are adamant about the potential for the known side effects, my reading from patients chronicles and talking to people who have had radiation treatments of one sort or another find almost no acknowledged side effects of any significance. That is quite puzzling to me and makes the quandary worse regarding choice of treatment. I would like to make an informed choice and have been leaning toward robotic surgery at least partly because of the cautions from the RO about potential collateral damage over time from radiation, particularly to the bowel area, urethra, etc. However, I just haven't seen evidence of much of that at all. Am I just missing it? I know there are many forms of radiation treatment that target the cancer in a variety of ways, but it's my understanding that there is no way currently to completely rule out any damage to adjacent tissue even with the safeguards inherent and unique to each form of treatment.
Posted 3/22/2017 5:15 PM (GMT 0)
I also went to the Mayo. I went to the one in Jax though. You can read what I went through by clicking on the link in my signature.

Good luck. Take your time and be comfortable with your decision. You only have one chance.
Posted 3/22/2017 6:00 PM (GMT 0)
Every treatment has side effects. You can talk to lots of people, but that won't tell you (1) what can be expected to happen on average across the entire treated population - you can only get that from large-scale studies, or (2) what will happen to you.

The first ever randomized comparative study of surgery, external beam radiation (of a kind) and active surveillance (of a kind) was the ProtecT study. Here's what it says about side effects of each:

/pcnrv.blogspot.com/2016/09/patient-reported-outcomes-from-protect.html

Here are more specific side effects of IMRT and surgery with estimates of incidence:

/prostatecancerinfolink.net/2015/12/14/understanding-the-range-of-risks-associated-with-prostate-cancer-surgery-today/

/pcnrv.blogspot.com/2016/08/adverse-effects-of-primary-imrt.html
Posted 3/22/2017 6:07 PM (GMT 0)
Gleason6
Thank you for the link to your story. I also am going to Mayo in Jacksonville and very much look forward to reading the account of your experience.

Tall Allen
You are a wealth of information. I very much appreciate your guidance and thoughts regarding the information that needs to be digested prior to making "the big decision". Thanks again.
Posted 3/22/2017 9:08 PM (GMT 0)

19tarpon47 said...
I have found very little specific post-treatment complaints from different radiation treatments. While the RO's are adamant about the potential for the known side effects, my reading from patients chronicles and talking to people who have had radiation treatments of one sort or another find almost no acknowledged side effects of any significance. That is quite puzzling to me and makes the quandary worse regarding choice of treatment..

19tar, the reason for this may be fairly simple...and explained easily in the links provided by TA as well and the AMA article referenced by Chipmaker. The fact is that there is a larger incidence of the ONEROUS side effects among surgical patients than among radiation patients. Forgetting about recurrance for the moment, the HW pages are littered with threads about ED and incontinence of men who have chosen surgery. You will also find the secondary surgical complaints such as shortened penis, long recovery time, ejaculation of urine, etc. and these match up with the secondary radiological complaints like strictures, urgency, loose bowels, etc. Then there is the tail end of the curve with surgical nightmares like patients dying on the table or radiological nightmares like secondary rectal cancer.

At the end of the day both options give you a likely cure. The trade off is immediate knowledge of pathology vs. avoidance of SE's. You have to decide which is more important to you.

Jim
Posted 3/23/2017 3:26 AM (GMT 0)
Wow, thanks Tudpock....I did read all the recommended study results and it has definitely given me pause to rethink all my sentiments to date. I believe I need to open my mind to all potential treatments. Tomorrow, I plan to make appts with Dr's that offer some alternatives that I really had not given much thought to but will now. The emphasis on QOL really got my mind racing. I've been approaching this issue from the perspective of just get it out of me.
Posted 3/23/2017 12:50 PM (GMT 0)
19 - I'm about your age, and have been on this journey since last summer when I was diagnosed with G 3+4=7 PCa. Since I have been a frequent flyer on the OR table for some pretty major stuff, I never really leaned toward surgery. I was sort of aware of the radiation options in advance, having several friends who have been down that path. Once I started visiting this site, I became aware of some of the less common but still proven radiation therapies, like HDR Brachy and SBRT/CyberKnife.

I chose the CyberKnife for a lot of reasons - efficacy that is among the better, short treatment duration, logistically convenient and having found a wonderful SBRT RO. I took the plunge and finished my treatment the day before Thanksgiving, 2016.

My journey has not been without side effects. Prior to treatment, for many years, I have had IBS (irritable bowel syndrome). I was cautioned by others here that this could be a problem, but after some discussion with my RO, decided to proceed. It was not a mistake, but I have had some rather uncomfortable times in the past 4 months. You know what? If I had the choice all over again, my choice would be exactly the same. The discomfort I've had is minor compared to what I would expect from most of the other mainstream primary treatments. If this is how it is, I can deal with it.

As to having any worries about secondary cancer resulting from radiation treatment - I have no worries. Yes, theoretically it can happen, but the probabilities are very low. This is especially true with modalities like SBRT, which has such tight beam control that the radiation can be focused to less than 1mm, allowing the RO's to reduce unwanted radiation of other tissues.

Also, with your pathology and PSA, I doubt that the doc would prescribe ADT. That is usually reserved for the more aggressive prostate cancers, which our 3+4=7 is not.

Take your time. Learn, discern, then make the decision that is best for you. You already know that any of the mainstream primary therapies should do the job for you.
Posted 3/23/2017 1:04 PM (GMT 0)
19tarpon47,
Based on your original post you seem to be in a similar state of mind that I was in at this time last year. You sound very level-headed and seem to be doing your research. I decided on surgery but you are a bit older than me so if I was your age I would have struggled a bit more with my decision. I wanted the pathology report. I was not as concerned about ED as a lot of folks seem to be. I had no serious complications during or after surgery which is typical for treatment of MD Anderson patients. I was told by my oncologist and surgeon that either would be a great option for me. I wanted the immediate side effects instead of wandering if and when I would ever get permanent side effects from radiation. I was incontinent for 2 days after surgery, since then not even a drip. I do have some ED. I can get an erection but it takes a lot of physical stimulation and does not happen just by thinking sexual thoughts like it used to before surgery. It is slowly improving but not sure if it will ever be back to pre-surgery performance. I did have minimal ED prior to surgery. Other than that I have no after effects from surgery and would do it all over. There are many failed surgeries and horror stories regarding both surgery and radiation and I believe those tend to stand out when you are trying to make your decision. I believe that those are not the norm if you are treated at a quality facility that specializes in PCa. I wish you the best in your decision.
Posted 3/23/2017 7:29 PM (GMT 0)
Paxton
I appreciate your insight very much. The bowel issue does concern me with any radiation procedure. Actually, I've never had any bowel issues of any kind, but I really don't want to start either, so that is naturally a potential issue for me. So far, I've only had just the one consultation with a RO and that was at Mayo. She recommended IMRT along with ADT. I really do not like the idea of the hormone deprivation. That would be different potentially if my diagnosis was more high risk but it's not.....at least right now. I have been giving the available treatments for recurrence major weight in my thinking but now I'm not so sure that is a valid issue. I'm definitely researching all the radiation modalities now, particularly because of the possible lesser impact on QOL. Again, thanks for your helpful thoughts.

KeepOT
You are younger than I am but I have read many accounts of the robotic surgery working out much as you described and the pathology report together with the apparent better options for recurrence treatments have had me leaning toward the surgery since diagnosis. Now I'm not so sure. Even though I am older, I still have a wonderfully successful and active sex life. I've had some mild ED but have been taking 5mg daily Cialis for some time and as long as I stay active and fit, my Willy works quite well for sexual intercourse. Not like I was 30 years old, but that's ok with both my wife and myself. Obviously, if this was ONLY a question of treatment or not surviving, I would be interested in only a cure. But since the cure rates are essentially the same across most available treatments for my diagnosis, I am now giving very serious consideration to the QOL issues and it would seem that the winner in that area in most cases is radiation treatment. Thanks for the comments and I wish you the best.
Posted 3/23/2017 7:48 PM (GMT 0)
Great analysis. I like how you came down with QOL as a deciding factor. Again, I'm a bit younger, and didn't look close enough at radiation. Probably thought I was healthy enough for surgery, and I was, but still ended up with complications. They certainly can happen. But other than ED, which should get better, I'm happy with my QOL right now.

If I'd been 69, I bet I'd have researched radiation more. Like you, I'd be concerned about bowel issues. The risks there are probably small.

I think you'll do fine with radiation and most likely have the QOL you and your wife desire.
Posted 3/23/2017 8:07 PM (GMT 0)
ADT has never been shown to be beneficial with favorable intermediate risk cancer. Now there is no reason to go through the ordeal of 38-44 IMRT treatments (see my other thread). I think you might want to talk to other ROs.
Posted 3/23/2017 8:17 PM (GMT 0)
Hi Tarpon,
Here's my experience FWIW. I was 69 at Dx, 5 cores positive. I met with three surgeons at different practices, and since I was in good health, no meds, and regular exercise, each said I was a good candidate for surgery. None considered my nearing 70 to be a negative factor, and that I should regain continence within 6-12 months. Surgery went well with no complications. After two years, I still have mild incontinence, and ED, and will most likely stay this way. My PSA' have been undetectable, but QOL is an issue. Unfortunately I did not discover this site until after surgery, nor did I fully explore radiation treatments. I talked to one RO about brachy, but due to my previous Green Light procedure, I was not a good candidate for seeds. There is a wealth of information on this site provided by the HW fraternity that supplements information provided by physicians. My advice is to explore all options to the extent that you can before making a decision on treatment.
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