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This forum is for the discussion of anything to do with Prostate Cancer.
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Which treatment to choose

Hi all,
I am a 63 y o male, who was diagnosed with prostate cancer following a biopsy several weeks ago. The biopsy showed “evidence of a carcinoma in the biopsy material in five of twelve biopsy regions of both sides with a total dimension of ca. 5 mm.” My Gleason Score is 3 + 3 = 6. Stage T1C. Having done a lot of research on top clinics, decided to go to John Hopkins and met with one of the surgeons there to discuss my radical prostectomy, who said that I have a 100% of full recovery. Having said that, I can't help wonder about all the side effects such as incontinence and erectile disfunction that might come with this full recovery. Also, I wonder whether a surgeon can objectively propose a better option for my case whether it is a prostectomy, radiation or active surveillance (which I believe is not really ideal for my parameters). The more I read, the more confusing it gets...

Thanks for any perspectives you may add.

Re: Which treatment to choose

Michael:

As part of your research effort you may find the following book by Bob Marckini helpful: "You Can Beat Prostate Cancer..." His chapter on the advantages and disadvantages of several methods of treating PCa is usually of particular interest to the newly diagnosed. This book is readily available, an easy read and well worth its modest price. Although this book is nearly ten years old at this point much, if not most, of the information remains relevant.

In general the more research you undertake at this point( be sure to include up-to-date material) the more likely you will be to make a good decision for yourself. Your research will also enable you to ask good questions of the various clinicians you are bound to encounter as you proceed.

Best wishes Don O.

Re: Which treatment to choose

Thx

Re: Which treatment to choose

Michael,

5mm of gleason 6 cancer is something that does not need immediate treatment. You are wise to do your own research. When the surgeon say's you will have 100% recovery, you should ask him if your sex life and urinary function will be as good as his after the surgery. Surgeons need to be more truthful about the side effects from a RP. You don't say what your PSA history is and that can be part of this decision. I would suggest getting a 3T-MP-MRI and if that is negative for a higher gleason tumor then you could safely go on AS.

If your sex life and urinary function is important to you, delaying treatment can potentially give you several more years of normal function. I think a consultation with Dr. Snuffy Meyers or Robert Leibowitz could give you additional treatment options.

Fred

Re: Which treatment to choose

Thank you Fred.
My PSA in 2012 was 3.9, in 2014-4.5, in 2015 5.5.
The doctors mentioned are oncologists or urologists?

Michael

Re: Which treatment to choose

Michael:
Both Dr. Leibowitz and Dr. Myers focus on the treatment of prostate cancer consequently each is far more specialized than your typical medical oncologist. There is reams of material on-line for both of these clinicians.
To find out more on each, see below:
1. Google Dr. Liebowitz at Compassionate Oncology Group.
2. Google Dr. "Snuffy" Myers by name as shown here.
You might also benefit by knowing Dr. Liebowitz is located in California and Dr. Myers is located in Virginia.
Regards Don O.

Re: Which treatment to choose

Hi Michael,
I really feel for you and empathise - so many treatment choices and each practitioner suggesting that theirs will result in a cure. If you check my blog then you will see that I chose HIFU and it worked for me so I would always visit that treatment as my first port of call and then widen out to others if it is not suitable for you.
Good luck and with best wishes.
David Mansfield.

Re: Which treatment to choose

Hi Michael and welcome,
I, and I am sure many others of here, could write a novel on "which treatment to choose". The problem with that is, no treatment option is an absolute standout over another. The other issue is that PCa is a disease that can take very different pathways among men. For instance, I know men with high grade PCa that have done well. Sadly I also know men with low grade PCa that have done poorly. So the point I am trying to make is that each of us old PCa warriors arrived at our decisions to seek particular treatment options after doing the appropriate research. This website has many survivor stories of men in a similar circumstance as yourself. Have a good read of their stories. The site also hosts a paper, which I wrote earlier this year, that provides an analysis of member stories in terms of treatment options chosen and disease progression if any. You will find that paper on the resources page, paragraph 3 of what men chose to do.

Rather that having us write an essay in broadly answering your concerns, it would be much easier if you pose specific questions.

You are quite correct, expert medical opinion if mostly correlated with training. Surgeons like cutting things up, Rad Onco's prefer to fry. That is not to say the advice is not valid, it is simply consistent with their training and what they perceive is in your best interest. In terms of possible complications from treatment, most talk is about percentages, but in reality for the patient complications either happen or do not. So perhaps it is more of a 50-50 call.

best wishes
john

Re: Which treatment to choose

Michael,

This sounds so familiar I suppose since I asked the same question in in 2010. I was diagnosed by DRE because my PSA was very low. My urologist recommended the same thing they did for my father in 1985. Surgery followed radiation followed by hormones followed by death. Sorry to say that is just how he explained it. That's exactly what my father did and he lived until 1997 when he died of bone cancer. He had suffered from a variety of side effects over the years and none were very pleasant. If your surgeon is giving you a 100% guarantee I would be concerned. That is like a financial planner giving you a guarantee of a 12% return. You should know that if you choose radiation first you can't go back and do surgery later. Just FYI.

As for me I chose Proton Beam Therapy at Loma Linda. You can find all the details in Bob Markini's book. I have no side effects from the procedure. I worked and did whatever I wanted during the treatment and today my PSA has been holding steady at 0.3. As everyone has mentioned "your results may vary". Bottom line is you have got to do what you feel comfortable with because you have to live with your decision not the doctor or anyone else.

The outcomes for all the current procedures are about the same it is just the side effects that vary. Also, you need to know what your insurance will cover. Mine only would cover surgery even though I was in a "good" PPO.

Good Luck,

Greg

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