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Re: Surgery or Proton Beam?

Bill,

I have a few questions before I would want to fully comment on you decision.

1) Is your cancer organ confined?

2) What is the highest gleason score for your samples e.g. (4+4)?

I will comment about ADT since I had 16 months of it. I tolerated it very well. It is very important to exercise during the treatment and I think you should do it before and after the treatment. You want to do weight bearing exercises and some upper body weight lifting. I was able to maintain my upper body strength for about 10 months and then I started sliding downhill. I also think it is very good for avoiding depression. It looks like your radiation doc would only have you on ADT for a max of 12 months. Most men recover their testosterone after this period of time, so the symptoms should resolve.

You might consider asking your surgeon if you are a candidate for nerve sparing. That is an important factor in determining your long term ED risk.

Fred

Re: Surgery or Proton Beam?

Hi Fred,

I appreciate the reply!

Organ confined? How do I know for sure? I am T1c. Completed an MRI and CAT scan at Scripps which showed no apparent extra-capsular activity. Johns Hopkins nomograms see it as 67% likely it is contained (Partin sees that as 59%). 30% chance of extracapsular extension (5% chance of seminal vesicle invasion and 2% chance of lymph node involvement). As to Gleason scores, being on the fence between 7 & 8 the slides have been read 4 times - but Johns Hopkins being perhaps the most credible at 4 + 4 = 8.

Legacy Health Johns Hopkins Bostwick Labs MD Anderson
Right apex 3 + 4 = 7 4 + 4 = 8 4 + 3 = 7 4 + 4 = 8
Right mid - - Suspicious Suspicious
Right base 3 + 3 = 6 3 + 4 = 7 3 + 4 = 7 3 + 4 = 7
Left apex - - Suspicious Suspicious
Left mid - - - -
Left base 3 + 3 = 6 3 + 3 = 6 3 + 2 = 5 3 + 3 = 6


On nerve sparring the surgeon makes no commitments – he makes the call when he’s in. Ridding the cancer he rightly points out is first priority.

Does an "8" kick me over the fence and into RP?

I appreciate and value your statements on ADT and exercise. I am trying to use the time now to crash course in getting fit no matter which path I take.

Re: Surgery or Proton Beam?

Bill,

Sounds like you have really done your homework. You said your gut tells you to do the proton radiation. I wouldn't argue with your gut. I'm curious if Scripts offers the exact same technology as MD Anderson or have they gone to true IMPT. Getting no exit dose and a lower entrance dose seemed very attractive to me. I think the cure rate with ADT added is just as good as surgery but I'm no doctor.

Good Luck,

Fred

Re: Surgery or Proton Beam?

Tough decision.
I was Gleason 6 pre. op. upgraded to 7 post op. Surgeon felt cancer was confined. I also was 58 and very healthy and physical. The surgeon found cancer got out of the prostate into the fatty tissue around organ. This caused some nerve damage to remove. Everything else was clear. After surgery my incontinence went away very quickly. About a week after catheter was removed I was 70% good. 100% after about a month. ED started getting better after a year. 1 1/2 years post surgery PSA started going up. Had salvage radiation and ADT therapy for 6 months. Radiation was easy with no complications. ADT was difficult. I stayed active but still gained weight and libido was totally gone. Mental ability was compromised. Hot flashes lasted 6 months after my treatment was over. 2 years later my libido and ED is just starting to come back although not as it was before ADT. I would have been very happy with my decision to have surgery if the cancer had been confined. Even though I tolerated ADT pretty good I hope I never have to go back on it. If I knew the cancer escaped I probably would have opted for radiation. But how do you know.
PSA is still undetectable. Good luck

Re: Surgery or Proton Beam?

Hi Bill,
As you said, it really is your call but let me share my experience with you. I was 57 when diagnosed (64 now), 3+4, T2B. I chose EBRT with 9 months Neo Adjuvicant ADHT. The reason for my choice was as follows;
- I was close to an 8 thus the chance of extra capsular penetration was high.
- I did not want to be incontinent nor impotent.

Bill my post treatment PSA's (March 2008) have all been in the order of 0.1 (+ or - 0.02). Radiation coupled with ADHT has certainly exceeded my expectations. My quality of life is excellent.

Good luck with your research. Choose wisely.
John

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