Radiation vs. surgery

Hi every one.
I am 56 with a gleason score of 6. 3+3.
The cancer is still in the prostate with a psa of 5.4.
My urologist immediately mentioned removal of prostate.
I don't like the side effects and plus I am low risk,
I've radiation is good for my type. Can someone share their experience?

Vivagreen, One of the challenges of prostate cancer is there are so many ways of treating it. A Gleason 6 diagnosis may never need treatment beyond active surveillance. I believe you’ll find this forum an excellent place to ask questions and learn about this disease. The more information you share the more people here can offer help. Things like your PSA history, information concerning your biopsy like how many cores were positive and how many cores were taken can be helpful as well. What your prostate normal size, and has any imaging been done are also helpful. Learning to use the signature option is easy and helpful. If you want specific recommendations a location may also lead to helpful suggestions.

Don’t be surprised that your urologist brought up the surgery option since that’s the medicine that know and practice. For a lot of G6 guys surgery may not be the best option and it’s a good idea to seek the advice of a radiation oncologist. For me surgery would have been a very poor choice; however, my urologist recommended it. No matter what treatment option you find best I always recommend the decision be an informed one. I found this forum helped provide the information I needed to make an informed decision.

Well, you are very low risk, so no hurry to do anything. Any surgeon that jumps on G6 is clearly 10 years behind times, in my opinion. Screams of overtreatment. If G6 is what you have, there is probably no need to treat especially with invasive treatment. Do check in to dedicated Active Surveillance programs. Amazing your urologist didn’t discuss that with you. Clearly he is not a PCa specialist.

If you need to treat, then many radiation options are on the table. No magic to surgery. Start seeing different radiation oncologists that specialize in High Dose Rate brachytherapy and SBRT. Don’t bother with traditional fraction external beam as SBRT is much better for you.

You are not at immediate risk. You have lots of time. Do your research by having personal assessments by board certified specialists. Do not discuss radiotherapy with your urologist. He is not board certified. See the board certified radiation oncologist for their speciality treatment.

I do suggest you have your slides read by either Johnathan Epstein at John’s Hopkins or David Boskin. They are the very best at PCa and a second opinion from either is well advised.

Vivagreen, OK, that makes things a little complicated. However, and I want to emphasize, that Active Surveillance is definitely an option for you. What it means, in detail is that you do several things (which defines the Active part): you get regular PSA readings. Within 6 months or a year you have another biopsy, this time with an MRI to target the biopsy. The key idea is that as long as the G6 is confirmed, you don't do anything aggressive until---or unless (it may not) it does something warranting treatment.

Would you have treatment there, or would (or could) you come to the states for treatment?

Hi, I would have have treatment here.
ON Feburay 01,2021 I had an Multi Parametric MRI with contrast.
My prostate gland is L 2.3cm x ap4.2cm x t4.2.
My biopsy was done on 02/12/2021.
I have an appointment with an oncologist on Tuesday.
Thanks everybody! Just knowing that I don't have to rush, makes things easier.

I was also diagnosed with G6 but post surgery wound up G4+3=7. My advice would be if you are seriously considering AS that you get a confirmation biopsy that you don't have a more serious issue. I also wouldn't wait...its a slow growing cancer relative others but its still cancer. If you do decide on treatment, sure take a month, but get it done.

Viv, welcome to the forum. JNF and Halbert mentioned that it would be a good idea to get a second opinion on the biopsy slides fromdr Jonathan Epstein at John’s Hopkins in the US. I’m sure this can be done from DR, it’s just a matter of shipping the slides. I would say not only is it a good idea, buts very important. You want to be sure as possible that it’s a G6 before deciding on active Surveillance, if that’s what you decide.

Reading biopsy slides is an art, it is somewhat subjective, and you don’t want to make decisions based only on one local pathologist who reads many types of slides, in a typical day, from breast, to uterine to Prostate.
Epstein and his team are focused on Prostate Cancer and are recognized experts in the field. I was originally diagnosed as G8(3+5), but Epstein called it a G6 which was confirmed by pathologists at Memorial Sloan Kettering in NY.

Here is information on how to get a second opinion from Dr Epstein...

https://pathology.jhu.edu/department/services/secondopinion.cfm

For all those considering SBRT, I would ask my RO if they have seen the MSK study I posted about in this thread The question has arisen as to whether the standard total doses are sufficient.

Djin

Hey Viva - you're getting a lot of good info and details thrown at you in a hurry here. So please just take a long breath, let it out, and then take another one, same!

Begin the process by sending your slides to Dr. Epstein; Pratoman has kindly given you the link and it's an easy process that doesn't take too long. I won't speculate on the quality of doctors, including pathologists, that you're seeing where you are. It doesn't matter anyway. Urologists are surgeons and surgery is their default. I'm in Los Angeles and my first uro wanted to remove my prostate too. Even those of us at Comprehensive Cancer Centers rely on the Epstein read because his is the gold standard.

It's great that you're going to see an oncologist - I assume a radiation oncologist (RO generally in here and elsewhere). I would also recommend some books - there are several good ones, and imo the best for an overview of general knowledge (in a field that seems to be changing daily) is "The Keys to Prostate Cancer," edited by Dr. Mark Scholz, who is well-known to many here. (I should add that Scholz promulgates his own color-coded staging scheme for PCa; personally I find even the Grade Groupings a little redundant and am happy with the good old Gleason scores)

In fact if you have the time Dr. Scholz is hosting a day-long webinar a week from Saturday. Many here have found his events helpful. And it's free. Here's the link if you're interested (no, they don't pay me anything, and Dr. Scholz is not my doctor!):

https://pcri.org/2021-mid-year-update

Finally, yeah we're all different. I have a similar diagnosis to yours, though I'm older, and I've been on Active Surveillance (AS) for nearly 3 years. There are guys here who've been doing it for far longer. Since you have time right now, do use it to educate yourself. Coming to this forum is a great start.

Good luck - keep us posted!
David

Terry, indeed. My two main points about the newer RT treatments are first, that longer-term data isn't at soon at hand. I often see the "long-term" used in the titles of papers reporting 8-15 year outcomes. That is fine, and progress holds great promise, but a 50- or 60-year-old can legitimately ask what may happen two or three decades after treatment.

My other point is a related one that RO themselves usually point out for new modalities with shorter track records. BCR stats are a stand in for, and do not always translate into, the gold standard of better overall, and better cancer-free, survival rates, which, of course are known only with long- and very long-term studies. This is a necessary tradeoff we have with changing modalities and regimes.

I'm not saying either of these concerns has to dissuade anyone from any newer approach, but only that these are legitimate unknowns that may (or may not!) be of concern to someone deciding on treatment. Back to SBRT, as the tech is being applied to increasingly higher risk groups, I see that the optimal regimes (fraction numbers and total doses) are still being worked out. Again, part of the tradeoff. This all takes time. If I am correct, SBRT is about 20 years old, but only recently have I seen the first studies for treating high-risk disease.

The SBRT study from MSK was of particular interest to me, because I learned about the research use of 2-yr biopsies after RT to gain insight as to what's going on with PCa cells that far out ftom the time of radiation.

DjIn

Vivagreen, surgery or radiation is a difficult choice ... both have side effects. There's no one right decision.
Remember radiation can have side effects too - they just tend to show up later.

Personally I wouldn't go the active surveillance if I were you. While your biopsy indicates 'just' a 3+3, this is really only indicative - it may be actually higher. Plus I don't see the advantage of waiting until the cancer becomes more aggressive or spreads before taking action. Just my thoughts.

Hi everyone.
This is really tough.
If I get the radiation, can I live more than 10 years, or just with surgery?

Thank you Tudpock.
I will read the books.
I already obtained Surviving Prostate Cancer" by Dr. Walsh