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Having a problem chosing treatment

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Prostate Cancer
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Posted 9/7/2015 2:41 PM (GMT -5)
I was just diagnosed with prostate cancer in June. Since then I have talked to a couple of doctors about possible treatments and was told both surgery or radiation were feasible.I'm having a hard time deciding what form of treatment to pursue. I'm leaning toward SBRT and seed since it seems to have the least down time and the shortest treatment time but could have the most side effects. I 'd like to hear from anyone who has gone this route and how they made out.Also would like to hear opinions on other treatments.

Age 72
diagnosed-6/15
PSA 6.1
Biopsy 12 specimens,9-GS 3+4, 2-GS 4+3, Stage T1C, intermediate risk
CT-clear
Bone scan-clear
Posted 9/7/2015 3:18 PM (GMT -5)
Welcome to HW, sorry you need to be talking to us.

With your numbers any treatment would work fine and be in the curative zone. Enough to drive you crazy.

SBRT is a great choice. A few guys here have gone that route. They'll be along to share. Don't know where you hear it had the most side effects. Generally SBRT has few, has a short treatment time and a speedy recovery time. At your age, I'd think this would be perfect.

There are arguments on both sides of the surgery vs. RT discussion, but it often comes down to personal choice and preference. I selected IMRT because I didn't want to go through the trauma of surgery and there was a good RO nearby. It's worked fine for me so far.

Hang in there and keep us updated on your progress.
Andrew
Posted 9/7/2015 3:21 PM (GMT -5)
Sorry about your diagnosis and the fact that you have to be here. Your Gleason score of 4+3 actually puts you on the unfavorable end of intermediate risk, but you certainly still have very good odds of being successfully treated. That said, it probably does point to having treatment sooner than later if you were diagnosed in June. Also, if you haven't done this you should have your biopsy slides reviewed by Dr Epstein at Johns Hopkins to make sure you're really a 4+3. That could make a factor in your treatment decision.

In general, you have the full range of options available to you, which is probably why you're having such a difficult time choosing. Some would say at your age that you're a better candidate for radiation than surgery (although there are guys here that are in the 70s and did fine with surgery.) Several members of our club here have had SBRT, including Tall Allen, one of our most knowledgable participants--hopefully, he'll weigh in soon. Brachytherapy, either seeds or HDR, would also be a good choice.

I'm typing away and have realized I haven't given you much specific guidance. Can you tell use where you're located or which doctors you've spoken with? That may help us chime in with more substantial comments.
Posted 9/7/2015 3:28 PM (GMT -5)
Pg72: If you research SBRT and/or LDR BT (seeds) I think you will find very good info revealing minimal side effects. That is not to say that Surgery would be just as curative with your stats. I would recommend a second read on your biopsy as indicated in the sticky threads at the top of the page.

Continue your research as you wait for the second read and talk to those folks who have gone through this. Making a choice is not easy but must be done with the realization that it will affect the rest of your life. Best wishes and keep us posted.
Posted 9/7/2015 3:59 PM (GMT -5)
You sound like a perfect LDR brachy candidate to me. One and done...few if any SE's... great results.
Posted 9/7/2015 5:17 PM (GMT -5)
the only question in my mind would be BT or BT + IGRT. if both sides of the organ were cancerous, a majority of cores were positive, and/or volume was high I would elect for treating the prostate and the prostate bed. i.e., BT + IGRT. that's what I did but we also added nine months of Lupron.

good luck.

ed
Posted 9/8/2015 6:21 PM (GMT 0)
Hi pg72 and welcome,

SBRT actually has the least amount of side effects of any therapy other than active surveillance. You can read the latest about it on the following links and in the two links in my signature.

Quality of life after three different first-line radiation therapies for localized disease: Part 1

High Dose Rate (HDR) brachytherapy was not included in that study, but it has very similar outcomes to SBRT because it is radiologically identical.

Seeds did have the most side effects of the three radiation therapies in that study. However, with your GS4+3, I think a lot of seed doctors would prefer to give you a combination of seeds and external beam radiation.
Posted 9/10/2015 7:48 PM (GMT -5)
Michael_T, to answer some of your inquires, I'm from upstate New York,had Dr Epstein read my biopsy slides and have seen doctors at Johns Hopkins,Memorial Sloan-Kettering and a local radiologist. Hopkins recommended IMRT.
I actually saw 2 doctors at MKSCC a surgeon and a radiologist whose specialty is brachtherapy.The radiologist recommended seed and 5 treatments of IMRT. I also saw a local radiologist who recommended a treatment of 2 shots of hormone followed by 30-35 sessions of IGRT. So you see why I'm having a hard time deciding. But I'm thinking of having it done locally since it seems the least troublesome, although I haven't read much if any of his proposed treatment but sounds like SBRT. I'm going to make a decision sometime in the next few days. Any further comments would be appreciated.
Posted 9/10/2015 9:23 PM (GMT -5)
If you can get to NYC for the 5 treatments, I highly recommend Alan Katz in Flushing. See the two links in my signature. He will be reporting his 9 year results at ASTRO next month and I don't expect any major changes.
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