The Bumpy Road to upcoming RALP

Welcome, and sorry you need to be here.

Others have a lot more experience, and will post, but I think you are overly concerned with life span. Read more here, especially the stickies. G7 isn't all that bad (I've got G9 and I'm still of the belief that this isn't going to affect how long I live -- sure there will be changes and uncertainties, but I'll deal with them).

There are other treatment options that you should investigate. But, despite what everyone will say, in the end it will be you decision on surgery or the radiation path.

Just as an FYI, I signed a surgery consent form when I got my diagnosis (because surgeries were being scheduled out 8 to 12 weeks), and told UR I was going to be exploring my options during this period. In the end, even with an upgrade from G8 to G9 with a second opinion (which you should get from Epstein), I've opted for radiation over surgery. But, it's all your call, and you need to do your investigation.

You are fortunate to find your way here. There's both lot's of information, and even more support from those who have been there and those of us just getting started.

My only comment would be if you "probably" need to have follow-up radiation, why not just start with radiation. Have you spoken with any radiation oncologists? If you've only met with a urologist (surgeon by training) they may not be talking about starting with radiation.

I agree with CA as to the life span. With a G7 diagnosis you're very likely to do well. The question is more about what SEs you'll get from treatment and if you have surgery AND radiation you do run the chances of more SEs. (Although quite a few guys here have had both and done fine...)

KC, welcome, sorry you are having to be here.
As the previous poster stated, G7 is not terrible, and not a death sentence by any stretch of the imagination. In fact g7(3+4) is considered low intermediate risk. If the MRI is accurate however, you may need further treatment after you’ve healed up from surgery.

Sounds like you are well on your way to surgery. It might not be a bad idea to ex-lord other options while you wait. Not that surgery is a wrong decision, there is no wrong decision. Just good to know all your options.

I’m a surgery guy, I too scheduled surgery but while I waited, I spoke with radiation Oncologists in various types of radiation.

Either way, you’ll get respect for your decision, and plenty of support here. And this will likely not affect your lifespan. Glad you found us.

KC, it sounds like you've moved from diagnosis to surgery pretty fast--reality is that PC is not like other cancers, particularly with your G6 G7 diagnosis, you have months to make your decision. If you look at the MSKCC nomograms--put in your age, diagnosis, other things, odds are that it will say you're 15 year non-advancing chance is greater than 90%. So, you've got plenty of years to go.

I'll repeat the suggestion to actually talk to one--or more than one---radiation oncologist. The radiaiton therapies have essentially the same cure rate as surgery, and generally better side effect profiles. And I say that as a surgery guy who has essentially zero side effects.

Best of luck to you..and if you came in here as a newly diagnosed guy looking for information, you've already gotten the major things we tell every newly diagnosed guy: slow down. Get a second opinion from Johns Hopkins on your biopsy slides. Actually talk to both surgeons and radiation oncologists. Don't worry about the need for future 'salvage' treatment--as a G6/G7, odds are against ever needing it. Plan for cure with minimal side effects as your primary choice.

Relax. Slow Down. Make an informed, not an emotional choice--you've only got one chance to get it right.

KC - I will echo the advice of the others. Take your time. Your pathology is similar to mine - mostly G6 with a bit of G3+4=7. This is considered favorable intermediate risk, and I think halbert mentioned, almost all of the primary treatments will have the same cure rates.

One thing to keep in mind when speaking with radiation oncologists. Whomever you are speaking with will ONLY be able to fully discuss those treatment modes that their office can deliver. They are NOT know-it-all's, regardless of what they may say. So, if you are interested in low-dose brachytherapy (permanent seed implants), and you are speaking with a specialist in external beam radiation, the doc may know very little about brachy. They will have an opinion, but it is only that. Be sure to meet with a doc who actually specializes in the exact type of treatment you seek. Then you will be assured that you are speaking with someone who knows all the answers to your questions and can back up their talk with action.

Whatever you choose, my own opinion is that your choice should be driven by the side effects of the treatments. You are a young guy and you will be living a long time with the side effects of your treatment. Choose a treatment whose side effects are acceptable to you. Remember, they will all have the same odds of cure.

Original Uro reviewed these with us - Namogram only had me at 6% SVI and 66% ECE, 5% lymph

progression free probability after RP = 5 years, 70%, 10 years 55%

All the more reason to look seriously at radiation: almost by definition, radiation therapies cover more ground and give better results with lymph node involvement. As someone else asked, if you're sure you'll need follow up radiation eventually, why do the surgery at all? If you wind up having to do both, then the side effects multiply.

Oh, don't buy the "if you do radiation first you can't have surgery later" line. That part is true...but the implication that if you do primary radiation there are no secondary options is far from true. That is a surgeon talking, and his job is to sell and do surgery.

Thanks to Halbert and Argent for their thoughts on the issue. I will do some additional research for me. I did have hernia surgery last year and it took awhile to fully recover, probably from being overweight. I have a clearer path to getting the weight under control on a daily basis

KC, you are doing everything right. You have spoken with various specialists, you are getting into shape for your recovery, and your RN wife is likely an excellent sounding board. Be aware that statistics - especially regarding RP vs RT are for large groups of men, but you are an individual. Much depends on your specific pathology... the actual location, extent and grade of your tumor(s). What worked well for one G7 will not necessarily work well for you.

The fact that you know ahead of time of the possibility of SVI is a tremendous advantage. Your surgeon will not know exactly what is going on until he gets in there. Frequently guys come out of surgery having found worse pathology than their scans and Bx had suggested beforehand. In such cases, adjuvant therapies are recommended. However, approximately 50% of men with SVI forego ART and enjoy statistically comparable overall survival.

Many guys have undergone the "trifecta" of RP+RT+HT and have come out clean. Your biopsy indicated possibly worse pathology than your simple numbers might suggest. The choices you've made are appropriate for your situation... that's the best we all can do at the moment. Some guys may become paralyzed with indecision and information overload from having too many options. There are indeed a lot of variables involved... not only medically but those involving your own particular life circumstances as well as your and your wife's long range plans.

I chose to throw everything at it. Just months after my RP my wife was diagnosed with primary bone lymphoma of her spine and pelvis. She is now in full remission, but cancer does change how you see everything. Do not dwell on your lifespan. Your weight is more likely to take you out before any cancer recurrence.

John_TX said...

halbert said...
... if you're sure you'll need follow up radiation eventually, why do the surgery at all?

I'm not going to second guess my preference for surgery - I made the best decision that I could with the data I had.

True that! I hear the first question all the time. It is just crowd noise.

One other thing to note...this community will support you no matter what treatment you decide on. We all have opinions, but more importantly we're all PCa brothers here.

KC, I'm new to this forum and new to prostate issues. My limited knowledge came from Patrick Walsh's book, "surviving prostate cancer". I had robotic surgery 3 months ago, my pathology was gleason 9/10 and tumor had broken out at the right seminal vesicle. I have had 2 follow up psa tests undetectable. Do your kegels! Urinary incontinence is a bigger issue than I was told. If you do the right things, life expectancy shouldn't be an issue, of course you could always get hit by a bus. Keep your chin up.