Need help - Stage 3 C prostate cancer treatment option

Radiation and surgery can both cure you. However, surgery works best if the cancer is still contained within the prostate gland and has not spread into neighboring tissue. If it has moved beyond the prostate gland, the surgeon must cut a wider swath to get all of the cancerous cells, with the result that you are more likely to suffer unfortunate side effects -- ED and incontinence. The key to making a good decision, it seems to me, is to learn as much as you can about where the cancer is and whether it is still "organ contained." If it is organ contained, surgery is a great option. If it's not, radiation is probably better. It is not important for you to act quickly; you have time to make an informed decision.

Optimist, Sorry to meet you here with a tough diagnosis; however, there are a lot of guys here with similar challenges and doing very well. For high risk guys I believe the data suggests that some version of the triple play offers the best chance for a cure. I don’t believe surgery as a monotherapy is likely to cure you and you’re likely to end up with hormone therapy and radiation latter which often leads to worse long term side effects for guys with a failed surgery. I believe the best bet is to put the cancer ‘on hold’ with ADT and wipe it out later with radiation. Keep us posted and keep investigating your options. Terry

Optimiswt, i gree with the others, surgery is probably not the best option with such an aggressive diagnosis. Have you had an MRI? That might show whether cancer has left the capsule, which if thats the case, surgery should probably be off the table.
Triple Play (external bean, HDR Brachytherapy, and ADT (Hormone Therapy) makes sense to me. But I'm not a doctor. You should be meeting with a Radiation Oncologist to discuss this and other radiation options. Dont look for answers / info on radiation treatments from your urologist, he is not an expert in that treatment modality Most urologists are surgeons. None of them, as far as i know, are specialists in radiation.

Tough diagnosis, but certainly treatable and manageable. Good luck

I'd like to change my original post. I didn't see that you have a 4+5 sample. I agree with the otherss that with a G9 you are better off with an option other than surgery. I had surgery followed by radiation when the surgery failed. The side effects are worst when you need both.

Gentlemen, Thank you for All of you for your input. After talking to my radiology urologist I had an appointment with my urologist/surgeon. This time he told me he recommend radiation therapy because of my age (68). Last time he told us he doesnt recommend surgery for men over 75 of age. When we had questioned it he said he's not recommending surgery because I have a heart condition and he would need written clearence from my cardiologist. Finally he said he decided few months ego that he stop doing surgery (but he will assist) and he referred us to one of his partner. We'll talk to the new urologist next week. Also I'll see the cardiologist next week. We have to discuss how each therapy will effect my heart. I have mitral valve issues and its monitored in the last 20 years, and last october I had a pacemaker inplant. The radiology oncologist he referred us has only 2.5 years experience . We liked him, he seems very knowledgeble but I would be more comfortable with someone who has more experience. He doesn't do seed inplant. I'm still waiting for the medical oncology appointment. I should receive the Decipher test result in 2 weeks. I have no mets and the doctors did not felt any abnormality during examination. I would like to ask you how long did you have blood in your semen after biopsy?

Forgot.... the beast is more likely in the capsule.

Optimist53 said...
.... the beast is more likely in the capsule.

I was told that same thing six years ago following a T3 MRI fusion biopsy. I chose surgery because it left open the possibility of future radiation. When the surgeon got in there he discovered that the cancer was NOT contained but had spread into both seminal vesicles and I required adjuvant radiation within one year.

I have avoided responding in this thread so far because there are always those who would say "you should have had radiation instead". But I was working with the information I had available at the time. Looking back, I wonder if a radiologist would have treated only my prostate and entirely missed the surrounding tissues.

My clinical staging was T2 (prostate contained) but pathological staging was T3b, invaded surrounding organs. That's a BIG difference. Your case is my first encounter with T3C staging, as I have not been reading much about PCa lately, more about leukemia.

A few years back there was talk of adding stage "C" to indicate bladder neck invasion, but now it appears they use C vs B to indicate the presence of grade group 5. In other words, T3b appears to be for G8 or below, while T3c is for G9 or 10. That seems redundant. Note that the difference between grade 4 and grade 5 is a judgement call. What one pathologist may call G5, another might call G4.

Some members here refer to getting ADT and two forms of radiation as "triple play", which seems to me to be inaccurate. ADT almost always accompanies radiation, and radiation is radiation, whether it is internal or external. The actual use of three different forms of treatment, surgery, HT and radiation is referred to as Max-RP, while the combination of various forms of radiation is known as Max-RT... just FYI.

Excellent data, Djin & Rob.... Thanks!

To your other question, I had blood in semen for maybe 8 weeks or 2 months after biopsy. I then found out that is not uncommon. I guess it depends on number of cores and what they damage in the process.

Rob, you shouldn’t avoid this forum. Nobody will ever tell you “I told you so..” we all have and had our struggle to make treatment decisions. It’s tough to decide and all of us make our choices by educating ourself about different treatment, procedures, trials etc. we are talking about our life. Nobody have the magic ball. Do not look back, there are no if’s. I was told that after surgery more likely I will need radiation and maybe hormon treatment Your post was very educational. Thank you. What will be your next treatment? I wish you good luck with your treatment

I believe a PSMA PET scan provides the most definitive results as to whether the PCa has gone beyond the capsule. I too had Gleason 8&9 with PNI and it invoked seminal vessels and one pelvic lymph node.

I’m receiving proton therapy (PBT) and ADT at WashU/Siteman CC in STL and skipped surgery knowing I would still require RT to conquer the beast. RP and RT seem to have similar long-term results but RT seems to have less severe SE. My RO said PBT has the least SE (though I’ve read that is disputed). I’m actually more concerned about the SE for 24 months of ADT.

I would seek out treatment at a major medical center that is associated with a Med School.

BTW- I have UHC/Medicare Advantage. My doc said UHC is about the only insurer approving PBT and they even rejected it the first time.

I’d recommend reading the book “You Can Beat Prostate Cancer” by Robert Marckini. I thought it the best out of the several books I read. I don’t think you can have to much information to help in making your decision. (However you can get information overload and have to take a breather from it.)

GOOD LUCK in your journey. This is a great group of extremely knowledgeable guys (& some wives are here too).

Actually guys I believe the radiation is better than surgery debate will become more in focus when insurance starts approving PET scans at diagnosis and the some of the shift may be back for surgery and holding off on RT and ADT.