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I have been advised to have surgery. One surgeon thinks I should have open surgery and remove all lymph nodes (he is American trained), another 'normal' Da Vinci. Does anybody know the pluses and minuses?
I am 51, live in London, PSA 4.8, Gleason 8, T1c (poss T2c). Gleeson 8 is 20% (4+4) one core out of 12, but there is Gleason 6 and 7 in anterior 1cm tumour in Transition zone.
I am also looking at Proton Beam, but have seen a statistic that says a 50% relapse rate for a Gleason 8. (Old data though.) Thoughts?
Could you please advise if your lymph nodes are infected with cancer and if it has invaded your seminal visicles?
You can read my story at http://www.yananow.net/Mentors/JohnF3.htm, it is out of date at the moment.
If your lymph nodes are not infected, why does the surgeon want to remove them? As they are a major part of the immune system, if they are invaded then, in my opinion, surgery would not be a good idea. I would go for the Proton radiation treatment.
I was 62 when diagnosed, you are 10 years younger than me, plus there have been a lot of advances in treatments since my diagnosis, so that could be a big reason as to what treatment you decide on. Just don’t be pressured by the medical profession to undergo any particular treatment, until you are comfortable, that, that is the treatment you wish to undertake.
It is very important that you do your research and get second or more opinions on your treatment.
Well the only extra information I have is from a pre-biopsy MRI which showed it to be contained to the prostrate, no indication of any move to lymph nodes or seminal vesicales either. Bone scan clear. The issue is the Gleason 8. I am keen on Proton anyway, but maybe at my age surgery is more sensible?
Simon:
This is not an easy decision.
First: The type of treatment is not of any consequence compared to the experience, success and confidence of the doctor performing any procedure. Find the very best person you can locate and afford and move forward without regret.
Now, to your case; Any G 4 is of concern and you are in an intermediate to higher risk category. This increases the chance that your treatment will require ongoing additions over years, though this may not be so in some fortunate cases. Some men have the luxury of time in deciding their treatment options and pursuing same. Those in your category have less of that commodity. It is possible that an immediate hormone treatment of short duration will provide more time to consider alternatives if you are not ready to move forward.
The whole issue of lymph node removal is likely based on some research that those with more nodes removed had longer time free of detectable disease. Even a few cells may harbor in areas otherwise deemed clean by pathology. These buggers are deceptive. That is likely the view of your surgeon who thus sees you as the higher risk patient you truly are. If the US trained surgeon is using conventional Retropubic open surgery this makes harvesting (yecch) of lymph nodes much simpler than the robotic which has a smaller field.
Others consider surgery less optimal for such cases since the chance of harboring occult disease is elevated. The modern radiologist can produce results vastly superior to his colleagues 10-20 years ago. This is why historical radiology results in our disease are not truly comparable since the disease progression takes so long that improved technology trumps many studies.
Finally, the choice, if you have one, should be guided by the skill of the practitioner, full stop.
That is really helpful thanks. Of course we do not know whether there has been any progression. The fact that I am an in a higher risk group does point towards surgery - unless proton beam has also moved on too? And would they irradiate the lymph glands? Who knows!
If lymhnode involvement is suspected then radiation to the pelvic area is recommended. Since the Combidex scan is no longer available there is no reliable way to determine lymphnode involvement.
Simon,
You are in the highest risk category that surgeons will still work on. I would go with the open surgery asuming you've got a surgeon that has done at least 300 surgeries. Then you can still go onto hormone and radiation if they think you need it (they will). There is a good chance that the surgeon will find your situation worse once they open you up (tell them to take out your prostate no matter what they find). As my radiation oncologist said "waiting never improves your situation". I should have listened to her.
