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)
