Treatment decision: Diagnosed with Gleason8 at age 51.
I am 51 and have been diagnosed with a G8 PC. I have spent the past two months studying treatment options. I was at first more inclined towards radiation but all three surgeons I talked to (I only talked to one radiologist, they are harder to get hold of) were adamant that at my age radaition is too risky long-term. They all started their talk with « you are only 51…. ».
Radiation would mean EBRT + Brachy Boost + ADT. The literature shows this to be quite effective but there are no long-term survival results. The surgeons’ argument is that radiation will leave tissue intact inside the prostate that can act as a future source of recurrences.
Has anyone pondered the same question or found evidence on long-term survival with brachy boost? I am concerned about an early recurrence after surgery and its additional toxicity. I am very active, pretty much had the life of a 35 year-old. My partner is 35, so I am scared to desth what might happen to our relationship. All advise is welcome.
: None of this is easy, and after being diagnosed in 2012 with a Gleason 9, I feel comfortable saying there are no right or wrong paths to follow. I chose surgery. With an advanced cancer, my concern was that it might return. It has come back 2 additional times. Choosing surgery first gave me the option of radiation as a follow-up option. The reverse is not always as successful.
I have a new partner following the death of my wife of 57 years, and I will say things continue to move along quite well in the bedroom. A lot of this, I believe, has to do with how you and your partner approach life and the many challenges that we face as humans. My advice --- listen to the silent guidance we all have in our heads, make a decision, and never look back. Dennis (Patient Leader)Thanks a lot Dennis, this is encouraging. Eould you feel comfortable sharing more details of your originsl diagnosis and follow-up? I assume the first recurrence was treated with srt plus adt. Was the second time just adt?
I know that one cannot do surgery after radiation. What bothers me that the risk if a first recurrence snd needing salvage is so high that the 5 or 10 year risk of having a second recurrence is not smaller than the recurrence risk after ebrt+bracy boost+adt. The question is, which place is better to be at moving forward, with a second recurrence post surgery or a first one post-radiation.
Hi
. It is good that you are doing your research to make the best decision for you. Considering your age, it sounds like you are considering the long-term implications of treatments on quality of life. Have doctors talked about potential impacts of different types of radiation? I ask because this study on the impact of high-dose-Rate and low-dose-rate brachytherapy boost on toxicity found both to have higher toxicity levels than EBRT monotherapy, but lower levels of recurrence issues: https://pubmed.ncbi.nlm.nih.gov/33279595/. I say this not to advocate for any treatment, just to provide an example of weighing the balance of what is important to you. Dennis mentioned making a decision and moving forward, so I want to share with you this article he wrote on overcoming decision paralysis: https://prostatecancer.net/living/decision-paralysis. I did find this one study that compared the EBRT with brachytherapy to surgery: https://pmc.ncbi.nlm.nih.gov/articles/PMC6943084/. Hopefully this can help inform further conversations with your doctor towards a decision. Best, Richard (Team Member)
Thanks Richard! I am pretty certain that the radiation option would be EBRT + HDR Brachy Boost + ADT (RTmax) Surgery has a high probability of needing SRT, which has higher toxicity. My main concern with RTmax is the risk of long-term recurrences (past 15 years). Not sure if one is better-off after RTmax or SRT overall. All the surgeons tell me very strongly that RT has a higher long-term recurrence risk or eorse recurrences as it leaves the prostate in the body which may still harbor cancer.
Hi
. I've also heard before that radiation has a greater long-term risk of recurrence and, therefore younger men are often encouraged to go the surgery route. A decent amount of the research seems to point in this direction. That said, I'm always a little leery when specialists advocate for their specialty. In addition, the research is retrospective - by necessity it is looking back across time at how the treatments played out. It often can't take in to account how rapidly the treatments for PCa have advanced. I know you mentioned having trouble speaking to a radiation oncologist, but wondering if you can get one to explain why they think that their treatment would be the way to go - potentially on top of quality of life in the shorter term. Feel free to keep us posted on the decision process and how you are doing. Best, Richard (Team Member)
Will do. Will see a radiologist in two weeks. But I am getting used to the idea of surgery. Momentarily mainly dealing with regret issue, but trying to focus on the present and what’s ahead.
