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Deciding my PCa treatment

I was recently diagnosed with PSA 16, G3+4=7, very involved in the left node (5 of 6 cores, but mostly grade 3 (80%) and near the mid margin.

I am researching treatment options before my meeting with my urologist next week.

There seems to be a good likelihood of spread beyond the prostate (according to statistics), but my CAT scan and bone scan were normal (good news.)

I'm mainly considering proton (radiation) therapy or Da Vinci surgery.

I'm considering the proton option due to the minimal side effects and the extra half-inch margin treated around the capsule.

But this radiation treatment has no post-surgery pathology that would definitively tell if cancer has spread to the lymph nodes.
Also only one nerve bundle would be spared, which would probably(?) eliminate any chance for erections, and there are plenty of SE horror stories on the web.

Does anyone have any thoughts about these two options?

Re: Deciding my PCa treatment

Rick,
My sense is that you see your situation quite sensibly and your plans are most appropriate. And I for one cannot point you in one direction or the other.

The cancer could be encapsulated still, somewhat outside the prostate but still in the local area, or with some metastatic progress that is not yet detectable. Given the likelihoods, you now focus on the best treatment possible for the second (local) possibility.

I might suggest that you take a strong, healthy diet approach in the interim to decrease the chances that there could be any progression while awaiting treatment.

I've no idea what SE is, but in your situation you probably need to make cancer treatment the primary objective and leave erection issues secondary.

Best wishes,

Re: Deciding my PCa treatment

Thanks, Bill, for your sensible comments.

(SE = side effects)

I guess I was mainly wondering how valuable the post-surgery pathology is (e.g. lymph nodes) vs a proton radiation treatment followed by just watching PSA levels to make sure they don't rise.

Re: Deciding my PCa treatment

I understand your concerns. I recently had my surgery and initially was told everything looked good and the cancer appeared to be contained. However, the pathology disclosed that the cancer had spread outside the prostate. I had positive margins and they found considerable cancer in the seminal vesicles. I am now looking at radiation and hormone therapy. None of this would have been known without the post-surgery pathology.

I can't tell you the best way to go, but I think the pathology report proved a very valuable test in my case. Good luck with your decision.

Re: Deciding my PCa treatment

I'd be curious to know if the cancer in your seminal vesicles was near the prostate gland, or throughout the vesicles.

Proton therapy apparently treats the part of the vesicles near the prostate gland, but does not treat the whole vesicle, as surgury does.

What an impossibly hard decision this is, especially for someone like me who likes everything to be "known" beforehand.

Soon, I'm going to have to just flip a coin and move on and hope for the best...

Thanks to everyone who replied to my post.

Re: Deciding my PCa treatment

My cancer in the seminal vesicles was in the portion close to the prostate. According to the pathologist, it occupied a "moderate" amount of both seminals. Because of this they are now recommending both radiation and hormone therapy.

Re: Deciding my PCa treatment

Thanks for your reply, Wendell,

Supposedly, proton radiation zaps the part of the seminal vesicles nearest the prostate.

But during surgery, I understand that they usually remove the vesicles entirely, so it's interesting that they still want to do some kind of radiation and hormones, maybe just as insurance.

I just saw my Urologist yesterday - he seems very competent and with a lot of radical and da Vinci experience under his belt. Also, his patients that I've met (3 or 4) have all had good results.
But the proton radiation stories are also convincing.

If secondary radiation is needed, I'm wondering if combining two forms of radation (proton + photon) is as reliable or has better or worse side effects than the surgery + photon radiation combination.

Re: Deciding my PCa treatment

I had a da Vinci followed by traditional radiation. My PCa was all in the gland but I needed radiation because the surgeon left some of it behind. If I had it all to do over again, I'd go with just the radiation.

Re: Deciding my PCa treatment

Hello,

Did you also consider to have no treatment?

It would also be interesting to know your prostate's TRUS volume, your age and general health.

Best regards,

Henk Scholten, Haarlem, The Netherlands

Re: Deciding my PCa treatment

I'm 59 and in great health.

But, I think this needs to be treated due to the size of the tumor and the Gleason 7 score.

Although I'm worried about the side effects of all the treatments (especially after reading some of the personal stories at this site), Watch and Wait is probably the only option that I'm not considering, at this point.

What has been your experience?

Regards,
Rick

Re: Deciding my PCa treatment

I personally feel that DaVinci is fine for simple low grade cases. May have some limitations however for more complicated ones which may be best tackled by using the "very" "very" best surgeon available and the Radical method. Good luck, I'm sure whatever route you choose to go will be the right one for you.

Re: Deciding my PCa treatment

I was not given the choice of no treatment. I was rushed into surgery very quickly. All of the info I have is here:

http://www.yananow.net/Mentors/PaulA2.htm

Re: Deciding my PCa treatment

Thanks for replying, Paul

I read your story - It's been quite a journey for you.

It sounds like your PSA is under control now, so I hope all your struggles have been worth it.

I also hope my surgeon is as good as he seems.
(At least he's done over 400 da Vinci operations.)

Thanks again for posting.
-Rick

Re: Deciding my PCa treatment

Like you, once I had heard the "C" word, watch and wait was not an option for me. Cancer runs in my father's family, and Dad had prostate cancer.

I finally narrowed treatment options down to three: IGRT (Image Guided Radiation Therapy), brachytherapy, or radical prostatectomy. Because cancer runs in my family and because radiation treatment would make surgical solutions to any future cancer in the lower abdomen difficult if not impossible, radical prostatectomy seemed to be the best choice at this time. Once we knew we were doing RP,we went looking for the best da Vinci surgeon we could find in a reasonable travel and found Luis Anglo here in St. Louis who did 300 tradition open procedures before moving over to the da Vinci robot, where he has done over 500 surgeries, now including mine.

I can't give you a recommendation of what the "best" answer is in your case. Ultimately we are left to make very personal decisions on how to treat our cancer. Continue to research, read, talk, and get recommendations. Hold out until you are absolutely satisfied that you have the best solution possible at the time. And then be at peace with your decision.

Re: Deciding my PCa treatment

Rick
I'm currently doing the Hormone therapy and Radiation treatments. I was 48 yo when I was diagnoised in September of 2008 and had a PSA of 158. Seven months ago I had a Radical performed in which they took the prostate, both seminal visicles, and over 40+ lymph nodes. The Radiation and Hormone therapy that I'm currently doing is a clean up that I opted to go with. As far the sex life and incontinence good luck. I know each person is different, so remember no one will be able to predict your true out come. Read and educate your self that will hopefully help you make a better well informed decision. I just wanted to pass along my situation, that I'm currently dealing with. Reading others experiences has helped, but I've found that each person is different and especially when you bring in the Doctors.

Re: Deciding my PCa treatment

Hi Rick,

My cancer was a T4 grade with spread to the seminal vesicles and pelvic floor. I was very lucky though, in that there was no spread to bones or lymph nodes. I had HT plus 37 RT treatments in 2005 and it seems to have been very successful. Here's the link to the story so far...

http://www.yananow.net/Mentors/GeorgeH.htm

Whatever you decide, may I wish you the very best of luck.

George

England

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