New Diagnosis

Stage T1c prostate adenocarcinoma, Gleason's score of 4+4 in 2/14 core samples. Saw radiation onc doctor today and urology surgeon. Choices are 1) Surgery or 2) High dose Radiation then routine radiation + Bicoludamide and Lupron. So -- surgery ~OR~ radiation + hormones. Of course could need radiation later. CT and bone scan being done this week. Husband is tending towards surgery, because if surgery first can always do Radiation later if needed. Thoughts?

Welcome to HW, sorry you need to be here.

Could you share his PSA number? What is his age? It might make a difference in what folks suggest.

First wait for the scan before deciding.

In a high risk case, most often it would be RT+HT. The real question that needs to be asked is if the PC is still organ confined or if it's escaped the prostate. If it's still in the prostate bed then surgery is likely curative and so would RT+HT. However if the PC's escaped, then surgery generally wouldn't be recommended and you'd get HT. There are a lot of ifs and what ifs so the best to do now is to learn all you can about this thing.

And I say, plan for the best option that is curative in your case and don't concern yourself about backup plans. If primary radiation fails there are backup options for that. Personally, if I had that DX, I'd lean towards RT+HT. That's just me.

Finally, don't let anyone push you into a decision. It's your choice and the doctors are there to give you the information to decide what is best for you.

Hang in there and keep us updated on your progress,
Andrew

rosru-

I'm sorry to hear he has been diagnosed with high risk PC. I hope the bone scan and CT are negative. If so, there's very high probability that it can still be cured.

It is a very good idea to have the biopsy cores sent to Epstein's lab at Johns Hopkins for a second opinion. A change in Gleason scores can alter his treatment options. Just tell his urologist to send the slides - it's a common thing to do. IT may cost $250 if insurance doesn't cover it.

The treatment with the best history of success is external beam radiation with a brachytherapy boost to the prostate with hormone therapy. It is much better at curing the cancer than external beam radiation therapy alone or surgery even with salvage radiation. By "much" better, I mean that 20% of men who had this combined therapy had metastases with 10 years, while 40% of men who started with surgery had metastases within 10 years. Side effects are worse than external beam alone, but probably better than surgery with salvage radiation. You have to find a brachytherapy doctor who specializes in this. Where do you live? We may be able to recommend specialists in your area.

Share this article with your husband:
/pcnrv.blogspot.com/2017/02/for-very-high-risk-patients-ebrt-bt-is.html

TC327-

Please tell your worried friend that there are just as many salvage options after radiation. There is tremendous ignorance and misinformation about this, especially among urologists and their patients. This should be the least of his concerns. It saddens me that ignorance causes such distress.