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Prostate Cancer Treatment Options

Prostate Cancer Treatment Options

Posted by Bills10 on Feb 20, 2019 12:51 pm

Hi,
I am 65 years old and was recently diagnosed with prostate cancer (Feb 2019).  I have grade 2 cancer, (3+4 = 7, Gleeson), my urologist tells me it is at an intermediate stage, in addition, my prostate is about three times the normal size.  5 of 12 biopsies specimens were abnormal on a growth on the left side of my prostate. I had a CT scan and a bone scan and they were negative.  I am currently scheduled to have surgery, but am having second thoughts.  Does anyone have any information to compare the success rate between traditional surgery and radiation? Radiation seems less invasive, although it is much more time consuming.  Any thoughts or experiences would be helpful.

Regards,

Bills10

Re: Prostate Cancer Treatment Options

Posted by Aly on Feb 20, 2019 2:18 pm

 Hey Bills10‍ , I am going to tag WesT‍ into this conversation who has experience with prostate cancer.

Re: Prostate Cancer Treatment Options

Posted by WesT on Feb 20, 2019 4:43 pm

Bills10‍ Sorry to hear of your diagnosis.  Yes radiation is less invasive than surgery.  But, if you have radiation and there is a recurrence, surgery is not an option at that point, only more radiation and chemo.  If you have the surgery and there is a recurrence, then radiation and/or chemo can be given.

Both options have the potential for long term side effects.  Some doctors may even tell you that radiation may alter your cell structure in the cells surrounding the area of treatment that may actually cause other various types of cancer down the road.

The choice is up to you and you should take the time to educate yourself on the options available, the side effects and success rates of each. 

During my journey I compile a list of helpful resources available here....

https://cancerconnection.ca/discussions/viewtopic/73/59292

I highly recommend  the following book which was written by the doctor that came up with the surgery procedure.  He compiled data and statistics as well as detailed explanations of each option.

Dr. Patrick Walsh's Guide to Surviving Prostate Cancer - Fourth Edition
by Patrick C. Walsh, Janet Farrar Worthington
https://www.chapters.indigo.ca/en-ca/books/dr-patrick-walshs-guide-to/9781538727478-item.html?ikwid=Dr.+Patrick+Walsh&ikwsec=Home&ikwidx=0

If you have questions, compile a list to talk to your medical team to get the specific answers.  Don't be afraid to ask them the "hard questions" about their experience and success rates.

Good luck and keep us posted on your decision and progress.

Wes
 

Re: Prostate Cancer Treatment Options

Posted by Tim1961 on Feb 21, 2019 7:58 am

Investigate Brachytherapy. I just had this treatment, it is the implanting of radiation seeds into your prostate. My cancer is contained within my prostate, no metastasis. I was a 6/7 Gleason (PSA 5.6) & am 57 years old. I felt it had a very high success rate & was much less invasive than surgery. Tim

Re: Prostate Cancer Treatment Options

Posted by WesT on Feb 21, 2019 9:20 am

Tim1961‍ What was involved with your treatment?  Something similar to a biopsy only leaving the seeds behind?  Was there anything else involved?

Re: Prostate Cancer Treatment Options

Posted by Tim1961 on Feb 21, 2019 10:22 am

I am in the province of Quebec, so I went to see Dr Eric Vigneault at the Hotel Dieu in Quebec City. He is recognized as leader in the Brachytherapy treatment field.
It is a day surgey. They insert rods between your rectum & scrotum & through these they implant the seeds. For me it was a total of 39 seeds, I have the x-ray of the seeds & looks like they go for full coverage of the prostate gland. The procedure took about 90 minutes & then about 2 hours in recovery. I was black & blue for a week or so but have healed up pretty good. They put me on Flomax immediately, this is to help you with urinating as it opens up the blood vessels etc. The Urethra runs through the prostate as you well know so in the early stages after the procedure they want to give you a bit of help. Have not experienced any ED but the literature does say that the side affects of ED & Incontinence can present down the road. The seeds are active for about 10 to 12 months so during that time they are killing the cancer cells & healthy cells as well. So if there is damage to the healthy cells then ED or Incontinence may present later. I had my treatment Jan 25th. Tim
Forgot to mention that I am 57 years old.
My Dad was diagnosed at age 68, PSA in the 12s - he chose to do Hormone Therapy & I think he stuck with that into his late 70s
He lived to be 87, died from Heart failure
Tim

Re: Prostate Cancer Treatment Options

Posted by WesT on Feb 21, 2019 10:50 am

Tim1961‍ Thanks.  So you just on hold right now waiting for the radiation to slowly do it's thing?

How does your follow up work?  Check in in six months or so and then do a PSA test after a year or so?

Just not having to deal with a catheter for two weeks makes that sound appealing!

Keep us up to date on your progress.

Bills10‍ this is definitely another option for you to investigate!

Re: Prostate Cancer Treatment Options

Posted by Tim1961 on Feb 21, 2019 11:04 am

I have my first follow up this Monday Feb 24th with Dr Vigneault. They will do another X-Ray to check that the seeds are all still good & then yes it is a waiting game for the radioactive seeds to do there thing. Moving forward it is a constant measuring of the PSA level, the goal is for it to decrease back to zero. I am not sure how often they will do the PSA measurement will know on Monday.
I will post any new info I get from my Monday appointment.
I have been going to the bathroom to urinate more frequently & there is a little burning & my stream is not quite as strong as before & sometimes a full empty is a bit harder to achieve 
And a bit of fatigue
But overall 3 1/2 weeks out things are pretty good
Tim

Re: Prostate Cancer Treatment Options

Posted by WesT on Feb 21, 2019 2:49 pm

Great Tim1961‍ it will be good to hear of your progress and then others considering the same treatment will be better informed when making their decision for treatment.

Thanks
Wes

Re: Prostate Cancer Treatment Options

Posted by Tim1961 on Feb 21, 2019 4:59 pm

Just to share a bit more of what I learned during my investigations.
Brachytheraoy has 2 options Low Does Radiation (LDR) which is seed implantation & High Dose Radiation (HDR) which is delivered the same way but it is multiple sessions of Radiation into the prostate for aprox 30 minutes but no seeds. My Doctor said that he has a group going now on HDR but the PSA scores after the treatment have not been as good as the LDR treatments group.
I believe that Sunnybrook Hospital in TO is doing Cryotherapy where they using freezing. I think been around longer in Europe, newer to North America so not sure that they have as many statistics for this treatment procedure. I think they deliver the freezing the same way they deliver Brachytherapy treatment.
Thanks - Tim

Re: Prostate Cancer Treatment Options

Posted by Charles on Feb 21, 2019 6:49 pm

A reasonable (unbiased, I think) source for "Which treatment is best for my situation?" :

pcri.org

Brachytherapy has "cure rates" equal to, or better than, surgery.   And its side-effects tend to be less severe, judging from what I read online.  It's a "single-treatment" process -- once the seeds are implanted, they just sit there, killing tumor cells (and some other cells as well).

If you have surgery, you should expect to have serious problems with ED.  You might be lucky, but most patients (IMHO) aren't.  Those problems are treatable, for lots of men.    I had a prostatectomy in 2007, and have learned a lot about ED and incontinence since then.  You might want to get a copy of Mulhall's book:

"Saving Your Sex Life:  A Guide to Men with Prostate Cancer"

and read up on what can happen, and how it can be treated.

"Secondary cancers", caused by radiation treatment, have been a bugbear since radiation treatment began.  I suspect that the surgeons over-state (without lying, because a doctor would never lie) how often they happen.  Get some data, and decide if you care enough about the slight increased risk to affect your treatment decision.

Oh yes --

. . . . What's your PSA ????

.     Charles
 

Re: Prostate Cancer Treatment Options

Posted by WesT on Feb 24, 2019 12:20 pm

Thanks to Charles‍ and Tim1961‍ for your comments and information as well as Aly‍ for tagging me into this discussion.

Bills10‍ there is a great discussion going on in the Prostate section with more information on some available options and comments on the side effects you may be interested in reading about here;
https://cancerconnection.ca/discussions/viewtopic/73/60779?post_id=290885#p290885

At your convenience, take a read though if you like.

Wes

Re: Prostate Cancer Treatment Options

Posted by Bills10 on Apr 14, 2019 8:54 pm

Thanks everyone for your advice, my Dr. didn’t inform me about the implants. My PSA was 7.9. I have a Timor on my Prostate and it is enlarged as well. He says it is three times the normal size. 

Re: Prostate Cancer Treatment Options

Posted by WesT on Apr 15, 2019 9:13 am

Bills10‍ Has you medical team and you agreed on a path forward at this point?

Re: Prostate Cancer Treatment Options

Posted by Bills10 on Apr 15, 2019 2:19 pm

Hi Wes,
i have had a bone scan and a Ct scan, the cancer has not spread. I also met with an oncologist at the London Regional Cancer Centre in London ON. His recommendation was that surgery was my best option, my wife and I discussed it and agreed on the radical prostatectomy surgery. I am now scheduled for Surgery on May 1, 2019 by my urologist. I’ve met with the Cancer Navigator and Anaesthesiologist at the hospital and am ready to go. I’ve had an opportunity to speak with a couple of guys I know that have had the surgery with my Urologist and received positive feedback. 
Thank you for your interest. 
Bill

Re: Prostate Cancer Treatment Options

Posted by WesT on Apr 15, 2019 2:36 pm

Bills10‍ Great news.  I am not sure if they mentioned it to you when you met with your team, but do everything you can not to get sick!  Catching a cold may postpone the surgery.  I work in a school and that was sooooo hard with everyone sick.  In ended up taking a few days off before my surgery because some many people were sick.  At the last minute (morning of) my surgery got bumped up because the person scheduled ahead of me got sick the day before.

Start working on your Kegal exercises to strengthen your pelvic floor muscles and sphincter muscles.  Don't overdue it though.....

Good luck, the next few weeks will be interesting with the emotional ups and downs.  Reach out if you need reassurances.

Wes

Re: Prostate Cancer Treatment Options

Posted by Bills10 on Apr 15, 2019 8:23 pm

Thanks Wes, I just got over a cold I had for over a month. I am hoping to stay healthy until my surgery. 

Re: Prostate Cancer Treatment Options

Posted by Al_XB on Apr 16, 2019 7:48 am

Unfortunately Bills10,  there are different threads to look at for advice on prostate surgery or radiation. With a large prostate, pellet radiation may not be an option.  
I found the thread where I posted my situation and my interview synopsis, recommendations with a diagnosis similar to yours.
MrFido, Jackwb, Wes T and Charles provided good advice.  
https://cancerconnection.ca/discussions/viewtopic/73/59334
I found some other links below.  Find more posts on Discussions/Cancer types/Prostate. I am coming up to my 6 month check-engine light in May.
https://cancerconnection.ca/discussions/viewtopic/73/60779?post_id=289634#p289634
https://cancerconnection.ca/discussions/viewtopic/73/59232?post_id=293229#p293229
https://cancerconnection.ca/discussions/viewtopic/73/59232?post_id=293181#p293181

Al

Re: Prostate Cancer Treatment Options

Posted by Jackwb on Apr 16, 2019 3:01 pm

WesT:

Start working on your Kegal exercises to strengthen your pelvic floor muscles and sphincter muscles.  Don't overdue it though.....

Good luck, the next few weeks will be interesting with the emotional ups and downs.  Reach out if you need reassurances.

Wes

 
+1...but do the Kegels with a vengeance, you have only a few weeks so you'll need to to strengthen them to regain control after surgery. I had 3 months to do the exercises and was able to crush a walnut in my butt however i needed a pad for only a week after my catheter was pulled.

Hi Wes...I'm back from Florida and just got my 12 month post-op results:

PSA <0.008...A1c: 5.1, and my average 3 month BP: 118/74 

They haven't been this good in 15 years.

Sadly, I've been in contact with my oldest friend while I was away, he was having difficulty peeing and was resisting his doctor's advice to get a TURP. Based on my experience I was able to talk him into it and he had the procedure on March 26'th.
Yesterday he got the news...Stage D2 prostate cancer, he started hormone therapy right away, and is in for more tests next week. This caught everyone by surprise as his PSA has always been very low, even the most recent tests. His situation is very complicated as his wife has advanced alzheimers and he is her sole caregiver, they live in a small town and he has to travel for treatment but can't leave her alone.

He gets his prognosis on he 25'th.

Re: Prostate Cancer Treatment Options

Posted by WesT on Apr 16, 2019 3:12 pm

Jackwb‍ Welcome back and great news!  Those blood pressure numbers are great.  Mine were in that range but since my diagnosis 15 months ago have been elevated just outside of the optimal range.  Not high but no longer optimal.

My next PSA is a month away.  My family doctor is sending me for some screening tests to make sure my cancer hasn't manifested itself elsewhere close by.  That test is in a couple of weeks....

Sorry to hear about your friend but it sounds like at you're insistence it has been caught early.  Hopefully the hormone therapy will keep it under control.

Re: Prostate Cancer Treatment Options

Posted by Jackwb on Apr 16, 2019 4:03 pm

Keeping our fingers crossed but apparently there's no cure at this stage, his doctors are just hoping that it hasn't moved into his spine, that would be a problem. The funny thing is that his PSA was fine for years, still is, which as got me thinking of some questions for my urologist when I see him next. My numbers are great...but are things really OK down there?

How do I know if I can't trust the PSA?

Also, I edited my post...his TURP was on March 26'th and already he has the news and treatment has started. At this point the urologist gave him about 8 years, he'll know more in a few weeks...if it's reached his spine it's only 1% that he'll last 5 years. He's going nuts worrying about how to look after his wife. She refuses to go to a home but needs constant supervision and care, she needs help even going to the bathroom.Getting old is not fun (he's 73, she's 68).

Re: Prostate Cancer Treatment Options

Posted by Charles on Apr 16, 2019 6:19 pm

>>>
How do I know if I can't trust the PSA?
<<<

In a small fraction of tumors -- 1%, 2%, something like that -- the tumor cells have mutated so far from "normal" that they no longer secrete PSA.   Those cases are often not diagnosed, until they become metastatic and cause symptoms:

. . . The PSA test isn't a perfect screening tool -- it has both false positives (a lot of those) and false negatives (1% - 2%).

A bone scan (which relies on tumors collecting more radioactive stuff than normal cells) _will_ catch such tumors.  But nobody uses a bone scan as a routine screening tool.

So, if you've had a bone scan, and it indicates that you don't have any metastatic tumors, there's a good chance you have "organ-confined" disease.  But the bone scan has limits to its sensitivity, so it will miss very small metastatic tumors. 

That's why no surgeon should ever say, after a prostatectomy:

. . . "We got all the cancer."

After surgery, you're as "cured" as your next PSA test.

If this makes you feel nervous, and at the mercy of chance --

 . . . join the club.

.     Charles

Re: Prostate Cancer Treatment Options

Posted by Jackwb on Apr 17, 2019 8:58 am

Thanks for the info, I'll pass it on, although I think that he's into information overload. After the TURP he was told that he has "a bad, spreading type of cancer", that he is at Stage D2 (Stage IV?), and that tomorrow he's in for more tests (he thinks that it's a CAT scan and something else). He expects to hear the results on the 25'th. His PSA was never over 2.5, even today. His only symptom was that he had problems peeing, very slow and weak stream. Because his PSA was low his urologist put him on Flowmax which didn't work very well, recently he doubled the dose which still didn't work. If not for the TURP, they still wouldn't know he has cancer. He's in a tough spot...living in a very small town with limited medical resources and is his wife's sole support person.

When I was diagnosed my PSA was at 9.6, after 3 months on hormone therapy it dropped to 0.2, and after surgery it's <0.008. My urologist says that I'm now "cancer free" but not "free from cancer"...still told to take calcium and vitamin D supplements as osteoporosis is still possible.

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