NewDiagnoses

I am in the radiation camp (+ ADT) for a case like yours, but others may well disagree. As you have noted, there are arguments in favor of both approaches.

Feedsack, welcome to Healingwell.
First, and , there is no right or wrong answer, only the answer that is right for you.

With that said, is there evidence on the MRI of the cancer having escaped the capsule? If so, or if the surgeon thinks its in a tough place and you need to be prepared for possible positive margins, poor pathology, you might think twice about surgery, since that brings the possibility that after surgery you might need radiation anyway. (Which is always a possiblity, see my signature).

Its important for you to educate yourself as much as possible. There are books by Dr Patrick Walsh https://www.amazon.com/patrick-walshs-surviving-prostate-cancer/dp/1455504181 and Dr Mark Scholz https://www.amazon.com/invasion-prostate-snatchers-essential-managing/dp/1590515153/ref=sr_1_2?dchild=1&keywords=mark+scholz&qid=1611253741&s=books&sr=1-2 That will help you. Others here will chime in with more extensive information as well.
Understand the side effects, understand the chance of cure for each of the treatments, understand the different types of radiation.

As far as radiation +ADT, i had both, and i had ADT for 6 months. Its not fun, but it was very manageable at least for me. Everyone is different. But 4 months shouldnt be too bad. With a 4+3 Gleason i think most if not all Radiation Oncologists would strongly recommend ADT as part of your treatment.

Good luck, stay tuned for more responses, and please keep us posted.

I live outside of Houston Texas I am in the Kelsey Seybold Advantage plan and have been since I turned 65 I am 66 plus now almost 67
My PSA scores have been going up but have never not even now been above 10 currently 8.7
I have had a bone scan and they found nothing beyond what the one MRI Focused biopsy found

Final Diagnosis:
A. Prostate, LLB, needle core biopsy: - Prostatic adenocarcinoma, Gleason score 4+3=7 (grade group 3), which measures 3 mm.

B. Prostate, LLM, needle core biopsy: - Benign prostatic tissue. - No tumor is identified.

C. Prostate, LLA, needle core biopsy: - Benign prostatic tissue. - No tumor is identified.

D. Prostate, LB, needle core biopsy: - Atypical small acinar proliferation.

E. Prostate, LM, needle core biopsy: - Benign prostatic tissue. - No tumor is identified.

F. Prostate, LA, needle core biopsy: - Benign prostatic tissue. - No tumor is identified.

G. Prostate, RB, needle core biopsy: - Benign prostatic tissue. - No tumor is identified.

H. Prostate, RM needle core biopsy: - Benign prostatic tissue. - No tumor is identified.

I. Prostate, RA, needle core biopsy: - Benign prostatic tissue. - No tumor is identified.

J. Prostate, RLB, needle core biopsy: - Benign prostatic tissue. - No tumor is identified.

K. Prostate, RLM, needle core biopsy: - Benign prostatic tissue. - No tumor is identified.

L. Prostate, RLA, needle core biopsy: - Single atypical small gland.

M. Prostate, ROI 1, needle core biopsy: - Benign prostatic tissue.
Block Specimen Source

Number Pieces
Measurement
A. LLB 1 19 mm. E. LM 1 18
B. LLM 2 8,15 mm. F. LA 3 1, 11, 22 mm.
C. LLA 2 1, 7 mm. G. RB 1 13 mm.
D. LB 1 18 mm. H. RM 1 16 mm.
I. RA 3 1, 1, 9 mm. J. RLB 1 10 mm.
K. RLM 2 1, 2 mm. L. RLA 4 1, 1, 2, 11 mm.
M1. ROI 1 3 3, 7, 10 mm.
M2. ROI 1 4 1, 1, 3, 8 mm

I wouldn’t do anything without a second opinion on those slides.

That’s me.

(MDA will want to see those slides for themselves. One man’s opinion)

Some quick thoughts, you should start getting copies of all your records now as you proceed on this journey. It may take a couple of calls, email, and/or filling out release forms to get everything that is yours. The biopsy report and the MRI report will have info in them that is lost in conversation so getting paper or electronic copies into a folder is the start of what becomes a handy reference file as you go forward. I even got the imaging on CD that I like to study for my medical issues.

I was at the same age and had a similar start with more positive cores and lower PSA. I chose surgery and found my cancer was worse once the pathologist had the whole prostate to look at thus also did preemptive radiation without a measurable PSA some months later. I found radiation to be easier than surgery but it took a few months vs. one day of surgery and 2 months of recovery. There are faster radiation schemes that can be pursued for primary treatment that you can ask about.

The MD Anderson second opinion is a good idea if your Advantage plan permits that. Good luck.

I know it was “bad” news, but they did find something with the number “4” attached to it, and two different pathologists think they see a “4”. So yeah you have PCa and you will have to take some action.

And you have! you have already seen two drs and had your pathology read twice. Not too shabby!

As odd as this may sound, since it was only 1 of 12 cores consider yourself fortunate it was discovered. Too many men are diagnosed far later than you and they have a steep hill to climb.

Answering your question, basically you get to pick the side effects you may have to live with. They are potentially real things.

For surgery there is a chance of losing the ability to have/maintain a natural erection. There is also the chance you may need to wear a pad for incontinence of varying degrees for a long time afterwards. If you are in good physical shape the risk of these adverse events is reduced.

Although the tech has improved greatly there is a chance radiation might damage nearby structures (bladder/rectum etc...) and that damage might not manifest for years. Another consideration for radiation is that if you get something else that requires radiation down the road that treatment might be hindered by the dose you receive this time.

The hormone therapy the radiation oncologist mentioned also has side effects. Tiredness/lack of energy. Some bone loss. Hot flashes. Man boobs. Some of these things can be mitigated by supplements and exercise. Four months of this therapy is not long however, and will go fast.

With surgery they pull it out and look at it under a microscope and you get a definitive pathology report of what was there....no fuzzy images. On the way in they will also take some nearby lymph nodes to check for cancer. Again no fuzzy images. They look at them under a microscope.

If surgery does not get it all you are them stuck with getting radiation and hormone therapy anyway You do however get two amazingly solid swings at it but you would have to run the gauntlet of all the potential side effects.

Good luck! When it comes to cancer its nice to have curative choices.....and we are talking curative at this point.

I'm a Gleason 9.
I did the Radiation and the Hormone treatment.

As of now I am in a quandary I do not want surgery because of the results from such a large prostrate 111mm but I read that there are issues radiating a extremely large prostrate but can’t find any information on that

It appears that the advantage plan can block you asking for a second opinion. They do this by not approving the request, If you go and see someone outside the plan because of your age they ask you if you have Medicare When you answer yes then the circle continues, If you offer to pay cash the circle continues by them not approving the request because it makes their doctors look bad I'm guessing here though I'm not finished investigating

Tud Yep your correct I could have gotten another plan in fact I should have gotten another plan only because of this issue I suppose There was another option that would have cost me just 77 dollars more a month small price to pay though thinking back. just ten days or so. This all started by them though because of their refusal to send the pathology reports to MD Anderson for a second opinion, I was willing to pay for the opinion myself but they are refusing to send the material ie. slides and or whatever else its called

Initially we had difficulty going out of network with our Medicare Advantage Plan. We wanted a second opinion from Cleveland Clinic and to explore SBRT there. Our provider said that EBRT was available locally (Pittsburgh) and denied our request. We were persistent and filed an on line appeal and finally got the OK to be evaluated at CCI. In the end we ended up with SBRT at CCI and saved our insurance company more than $10,000 since five SBRT treatments cost less than the 42 EBRT treatments locally. I appreciate our then provider giving us the OK to go out of network but we have changed insurance providers to one that has CCI in network. Stubbornness can be a virtue...sometimes.

As far as radiation for a large prostate I have no experience. That said, I would seek the advice of a RO whom specializes in prostate cancer rather than one who treats many different cancers. The best plumber usually doesn’t work on electrical problems.

I appreciate your feedback your honesty and candor In fact I appreciate everyone of you men that replied to my post If I could I would buy each of you a beer or two
just to say thank you