radiation vs surgery

The first option to consider is Active Surveillance. You seem to be a perfect candidate. Get your biopsy slides sent to Epstein at Johns Hopkins for a second opinion.

You have barely begun to scratch the surface of your treatment options. If you are convinced you need treatment, you should begin making appointments to meet with specialists in SBRT, LDR brachytherapy, and HDR brachytherapy, and even focal ablation (on a clinical trial only). All of them offer a 95+% chance of curing you.I don't know where you are, or I would possibly recommend some doctors. Your choices may be limited depending on if you are on an HMO or limited network, or can't travel for treatment. The only reasons to undergo 40 treatments of external beam radiation anymore are if you can't be treated by an RO who can do it in fewer treatments, or if you are a glutton for punishment and want to make your RO rich.

There are salvage treatments for every therapy - surgery, radiation or focal ablation. If you want to know about salvage treatments for radiation, you can read this article:
/pcnrv.blogspot.com/2017/09/focal-salvage-ablation-for-radio.html

More importantly, with 95+% odds of a cure, salvage should not be a concern in your decision process. Here are some questions to ask yourself:

/pcnrv.blogspot.com/2017/12/questions-to-ask-yourself-in-deciding.html

Your question will likely draw lots of responses. First off, with your diagnosis you have every reason to expect a complete cure no matter what treatment you have. While that's obviously great news, it also makes it much harder to choose a treatment option!

As to radiation, there are several types and the typical RO only practices one. You'll only learn about the other types by seeing an RO that specializes in that. It sounds like the RO that you're talking to practices IMRT, an external beam radiation that takes the 35-40 treatments you mentioned. There is also SBRT, which typically takes only five treatments. There's a lot of guys here that are big advocates of that since the cure is the same (or better) and it's quicker. Then there's brachytherapy in which radiation is inserted directly into the prostate, either permanently (seeds) or temporarily (high dose).

As to your specific question, yes surgery is very difficult after radiation. But--and this is often overlooked...that does not imply there is not a back-up with radiation! There are different salvage radiation options so you shouldn't feel like you get two choices with surgery and only one with radiation.

To me the biggest advantage of surgery is that your PSA quickly drops to 0, so you know in a matter of months whether or not it was effective. With any of the types of radiation it takes time for the drop to occur and sometimes it can bounce around so it's a longer ride. Also with surgery, you get a full pathology of your prostate--that's important to some guys here. (Although personally, I never saw the benefit to that.)

It sounds like you're taking your time since you were diagnosed in October and I think that's a smart thing to do with your G6 diagnosis. My advice would be to talk to some additional ROs and get a better feel for the other radiation options and potential SEs of that vs surgery. With your chances of a cure being so good, I personally would want to focus on the potential SEs of the treatments, which they all have.

Last question, did you consider AS? It is the only treatment option with no SEs if you're open to that.

Good luck to you!

Welcome to HW.

I like to add to the AS voices. Likely you don't need treatment at this time. Find a good AS program and do that.

If you do decide to go with treatment, I'd suggest looking into SBRT - fast, effective and low on side effects. Surgery is a bit extreme in your case.

Andrew

Many options, none perfect. I agree with others that you can spend some time learning what are the right options for your case. I learned from the knowledged advices given here, but I have learned even more from the forum individual stories. And do not dismiss your doctor opinion, it can be biased but generally it is also a knowledged opinion.

You are a lucky guy with those biopsy results. Zero need to rush into a decision - as others have said probably no need to do anything except AS.

I was diagnosed with Prostate cancer in 2013 - Gleason 9 and after a second opinion i decided on surgery. Following surgery it was believed it was totally contained nothing showed in margins etc. Over time my PSA began 5 years later it was 0.16 and i decided to undergo radiation and lupron. Personally i am glad i did the surgery first as i was able to do a follow up treatment. Current reading are 0.02 will see how it goes

TheProstateCancerCoach-

Welcome to HW. Your post reminds me that we certainly have come a long way since you made your treatment decision in 2013. I don't know who you coach, but you can get a lot of updated info from my blog - in fact, I recently published an article about men in your situation. I hope your PSA stays just where it is.

I belong to two live prostate cancer support groups in LA. But we don't restrict it to men under 60 - why do you? Are you a psychotherapist/social worker?

1. Dave....again, take a deep breath, research a lot, and relax. You have time!

2. Dennis....welcome to the club. We can always use more data, experience and opinions. BUT, please note we already have an 'official' Prostate Cancer Coach, who has almost 10,000 posts.

3. There are few, if any, issues around here discussing the most intimate 'below the belt' problems, and if there's a 'wall of silence' on THIS forum, at ANY age, I haven't seen it.

There's a heck of a lot of experience on this forum, so hang around. We all can learn from each other!

Dennis,

Interesting that your Prostate Cancer Coaching is "mostly aimed at men between the ages of 35 and 60.....", but PCa mostly affects men from 60-80 with about two-thirds of the PCa diagnoses coming after age 60. I agree that awareness in younger men is very important.

What guidance does you group provide regarding PSA testing? How do people find you? Are you nationwide, or have local and/or regional concentrations? A website, perhaps? How do you go about your coaching?

Welcome to the website and thanks for your contribution.

TheProstateCancerCoach said...
....We offer men an opportunity to call us for a 20 min no fee chat if they have questions....

Does this mean that you have a 'fee based', but not for profit, service?

Prostate Cancer Coach said...
On PSA testing we suggest that men get a base line reading at age 40 or so

That is a recipe for disaster. The danger is creating a young generation of men who cannot have sex, father children, and may have 50 years of incontinence. I raised this with Andrew Vickers at MSKCC. he convinced me that MSKCC might be able to pull it off because they also put a very impressive program in place to steer men to active surveillance. Without MSK's resources and protocols in place, this would be a terrible idea - and Vickers agrees.

Apologies for kidnapping the thread.