Update and request for opinions

Hi,

So I had my follow-up today for my MRI and bone scan. The bone scan I had already called in for and found out it was negative. The MRI also came back negative. The Doctor did not receive a copy of my Johns Hopkins biopsy report so I gave him a copy. He says with the two reports I'm on the cusp of intermediate and high risk. I personally weight the Johns Hopkins report higher than the local lab.

So the choices he suggested are either surgery or radiation. Not both. He said the radiation would most likely include hormonal therapy as well. He made an appointment for me to see the local radiologist. I think whatever I do I will be going up to Boston. Most likely Brigham and Woman's.

He said that it is hard to do surgery after radiation so if the cancer returns the options are more limited. He said the younger a person is the more important this issue is. Me being 63 he said I'm on the younger side, so he seems to prefer surgery but he is leaving it completely up to me. He said the chances of some form of E.D. is about 50% with surgery. But he said hormonal therapy can cause that too.

What does everyone think about this? Are there any members that have a similar situation as mine... similar numbers... similar age? If so, what did you choose and how did it all go or is going.

Thank you,
Tim

Urologists always say that, and it's misleading. If the radiation doesn't work, you have salvage opportunities with focal brachytherapy or focal ablation.

You have Gleason 4+3, which is classified as unfavorable intermediate risk. I just reviewed a study from U of Mich, and was particularly impressed by the high cure rates they reported for the combination of brachytherapy and IMRT (look at the section titled oncological outcomes), and potency preservation was excellent as well:

/pcnrv.blogspot.com/2017/03/vessel-sparing-imrt-spares-erectile.html

You can use the following nomogram to see your odds of surgery being curative:

/www.mskcc.org/nomograms/prostate/pre-op

As you can see, your odds are quite a bit lower with surgery. If you have salvage radiation after surgery, you would expect that to be curative about half the time, which would still be lower than the brachy boost therapy but would add considerably to side effects.

If you have access to radiation oncologists in the Boston area, why mess with anyone local? You have Irving Kaplan at Beth Israel Deaconess, Anthony Zietman at Mass General, and Anthony D'Amico at Brigham and Women's. You won't find better than those anywhere.

My diagnoses was a bit worse. Radiation turns your insides into mush, which means you can not operate after radiation. For me, I had surgery followed by 38 rounds of radiation and nine months into hormonal therapy.

Congrats on the negative bone scans! And while you can't have surgery after radiation, that doesn't imply that surgery gives you more options. There are still back-up options when you have radiation first (it's just the surgery isn't one of them), as was pointed out above.

The treatment that Allen outlines above is what I had (as a Gleason 9) and I'm doing very well several years later. Cancer is (apparently) gone and everything works just like it always did, with the exception that I don't pee quite as well as I used to. I will point out that HT is not a lot of fun...

If you want an assessment regarding radiation you only consult with the radiation oncologist that uses the specific radiation you are seeking. Not any urologist. The urologist is not an expert on radiation...period. Conversely you would not talk to a radiation oncologist about surgery. Keep the specialities specific. Given the types of radiation you may need several different consultations to get the best assessment.

I considered both HDR brachytherapy and permanent seeds. So I met with two different radiation oncologists as neither did both.

In my opinion and based on my experience I suggest you use HDR brachytherapy, IMRT/IGRT external beam radiation and some period of time on ADT. You risk factor is somewhat similar to mine but my PSA was higher. This combination has controlled the cancer and I am essentially side effect free. Completely continent and sexually fine without any need for any medical assistance. The only side effect is a reduced amonunt of ejaculate.

Good afternoon, We are just about in the same boat. I also was a unfavorable intermediate G7 (4+3). I chose SBRT and HT. My Ro said the standard of care for my case would be 6 mo of HT. which I am in the later part of my fourth month. Side effects from the radiation have been minimal and very manageable. The HT has really been the most problem with hot flashes, night sweats and aching all over. Sexually everything works I just don't care if it does or not at this time, I am hoping that will change when the Lupron wears off. The 7yr study of SBRT shows as good of curative rates as surgery for guys like you and me. Only time will tell but I am confident that the long term outcome will be good. With all that being said no two of us are alike what works for me might not for anyone else. I suggest you get as much information about all options then make your decision and don't look back.
Good luck
Perry