Surgery or Radiation therapy treatment
Hi, colleagues!
Let me explain shortly my story: I am 65 years old. During the last 20 years I have the prostate adenoma which slowly increased in size ever Year. Now is around of 60 ml volume. Because this problem I monitored every 6 month PSA level during all years. In 2017 I have noticed that PCA is too High for my age (about 4 ng/mL). I did RMI investigation, where two suspect zones were found. After Biopsy (done in Gronau Prostate center (Germany) in 2018 I have got the Prostate cancer with Glisson score=7a (3+4) with recommendation of radical prostatectomy surgery. I decided to have an alternative treatment in Germany (IRE irreversible electroporation) in June 2018. After surgery and Biopsy analyses no cancer sells was founded. PCA level was at 2,3-2,6 levels. After 2 Years , in January 2020 I decided to check my status and did again Biopsy in Anadolu Medical Center in Istanbul. No cancer sells was found. In 2022 I saw that my PCA level starts to increase. Now is 3,9. I went to Istanbul again and did PCMA Pet CT screen with Ga 68 contract. PSMA PET showed PSMA uptake in one focus in the prostate and minimal activity in the pelvic lymph nodes. Due to the slow increase in PSA, without distant metastases was recommended to be evaluated for Radiation therapy. Now I have a headache. If I have Radiation therapy, then my urination problems will not disappear any way, due to the large prostate Adenoma. I would like to have more information from patients who passed trough Radiation Therapy. What are the side effects after treatment? If I will have the surgery, there are a lot of side effects, such as incontinence and others. Thank you very much for your opinion. Hope that your opinion will help me to take the most comfortable decision. Thank you in advance and sorry for my English. I am not English speaking guy.
I underwent radiation in 2018 for a returning prostate cancer after surgery in 2013. I will say my anticipation over radiation was worse than the actual 40 treatments over 8 weeks. Today my PSA is 0.02. I had few to no side effects from radiation other than some hemorrhoid issues for a few weeks near the end of treatment. That all went away in 4 weeks after treatment. I was able to drive my self to treatment every day and other than feeling tired the treatment was uneventful.
If the cancer has escaped the prostate gland you may want to ask if surgery is still the best option. Here the surgeons typically will not operate if scans show the cancer has spread too far. If spread is discovered during surgery they remove the prostate and suggest hormone therapy combined with follow up radiation.
None of this is easy and there are no one size fits all solutions. At this point my psa is 0.02 and I have full control of my urine and do still enjoy sex
Dennis (ProstateCancer.net TEAM)Thanks a lot for your reply. So in my case having PC inside of the gland better will be to do surgery now? I red some articles that in case of recurrence after radiation terrapy the surgery after radiation
Most likely you had micrometastatic disease in your lymph nodes to begin with. Having a robotic surgery for an Extended Pelvic Lymph Node Dissection, first, *might* be a possibility as it could lower the cancer burden, and possibly even be curative if cancer has not spread outside your pelvic lymph nodes. The may be a novel approach though. The main rule to remember is in general, surgery isn't an option after radiation but the other way around is. Also with radiation, I'd go to a center that offers the latest realtime MRI Guided SBRT. Any Radiation Oncologist that is at the top of the game should be aware of it. It allows them to be even more precise to contour around the tissue to be preserved to minimize side effects.
https://www.newswise.com/articles/mri-guided-radiotherapy-appears-to-lead-to-fewer-side-effects-from-treatment-for-prostate-cancer
In the US it's called Viewray MRIdian, and in Europe they use primarily the Tesla Elekta Unity although Viewray is being introduced more in Europe I believe.Thanks a lot for your opinion. I had Ga 68 PCMA Pet CT scan in April, and no metastases was found in other parts of the body yet. Only in the mid-zone of Prostate some active cancer sells was detected. The doctors council recommended the local treatment (radiation therapy). My concern was that after the therapy (in case of recurrent of the disease) the surgery will be difficult to do. I am afraid of Radiation, because in My Family line (Father in low, My Mother and he brother) all had the cancer and died before 60 years old. Radiation more often can cause cancer return.
