Newly diagnosed
Age=73; good health and good physical condition. GS is 3+4 from biopsy; PSA 13); right SV invasion on MRI. I am considered high risk doe to the SVI. I have reviewed over 100 journal articles and as my docs (surgeon, radiologist and a med oncologist) the effectiveness is comparable. As expected when put on the spot "What would you do" the radiologist said "slightly lean to radiation"; the surgeon favored surgery for the reason that salvage RP is a more difficult surgery; the med oncologist was slightly in favor of radiation + ADT. Thoughts from anyone? Thank you!
I had similar numbers. Took the surgery. Margins clear. Six months later PSA was .2. Concerned, I asked the Urologist/Surgeon about radiation. He said, we can do that if you want to. I didn't. 5 years later PSA was 1 and I had it done but it wasn't where they thought it was, ie, the prostate bed. Today, I take Casodex to keep it down, alternating month on/off.
I guess Im suggesting to have both. Cut out andWhat has your experience with Casodex been?
Hi
. Sorry to hear about the diagnosis, but glad to hear you have been doing your homework. Each case is different and, for your protection, we cannot give medical advice over the internet. One of the things you are definitely experiencing is the phenomenon of specialists thinking their area of expertise is best - surgeons want to cut and radiologists want to radiate. I don't think there is anything nefarious about this, just human nature. A couple of questions for the doctors do come to mind. One is, how does the seminal vesicle invasion change the equation? By this I mean things like the likelihood of needing radiation following surgery. Also, have different types of radiation been discussed, such as Cyberknife or proton therapy? Have other potential therapies been discussed, such as cryotherapy? Hopefully others who may have had similar circumstances will weigh in with their experiences. Please feel free to keep us posted. Best, Richard (ProstateCancer.net Team) Sneakers100,
Hello I was 63; in working with a local urologist at a smaller community hospital the following was determined: PSA had crept up to 5.6, worst case biopsy sample was 5+4 = 9.
At this point I can appreciate what you are doing in seeking 2nd opinions - good for you! I live in the Chicago area, and switched gears to one of the national Cancer Institutes, Northwestern University Medicine for 2 - 2nd opinions. Of course surgeon preferred surgery. However; the radiation oncologist was very good, explained that they have different flavors of radiation including Proton. However after looking at my records and hearing my story he said: "Off the record you are healthy enough, therefore you should strongly consider surgery" (He may be the most honest medical expert I will ever talk to!).
When I asked him why, 2 things resonated with me:
1) He suggested if you have radiation first and if you were to have a recurrence, surgery is no longer a practical follow-up. I have since learned (true or not?), that apparently it is very difficult to operate thru tissue that had been previously irradiated. His comment was why take 2 cards off the table by doing radiation first if you are healthy enough for surgery first?
2) He also said that radiation goes hand-in-hand with ADT/Hormone Therapy, and for some men it can be very hard to tolerate.
Yes I did get surgery and am not looking back. Just sharing what went into my decision to have surgery, everyone is different, being your own advocate by researching and getting 2nd opinions is key. Wishing you the best with whatever you choose!
