Treatment options
I am 72 years old and was diagnosed in 11/2022 with Prostate cancer. My biopsy results indicated a gleason of 7 ( 4+3), intermediate unfavorable risk group. My PSA was 5.31 prior to my biopsy. Based on various tests, my cancer is confined to the Prostate. Since January, 2023 I have been on Bicalutamide as a bridging therapy. My PSA has been at 1.6 for the past year. I am currently considering alternatives for more definitive treatment and am considering radiation therapy options. The Medical and Radiation Oncologists that I have been seeing locally are recommending: 28 treatments of photon VMAT-IMRT, placement of a Barrigel Hydrogel spacer as well as fiducial markers, and 4-6 months of ADT, either Lupron injections or Orgovyx.
I recently went to Mayo Clinic Rochester, MN for a second opinion and their recommendations were quite different. They recommended: Proton or Photon SBRT in 5 treatments, 4 months of ADT, either Lupron injections or Orgovyx and also the SpaceOAR hydrogel spacer as well as fiducial markers. A 20 fraction regimen of IMRT treatment could also be used, but the standard of care at Mayo for the past few years has been the five treatment SBRT approach.
I would like to get some feedback from other community members on their experiences, pros and cons, with a few of the options that I will need to decide on in the near future. These would include:
1. Proton vs. Photon therapy
2. The 20 or 28 IMRT treatment regimen vs. the 5 treatment SBRT approach.
3. ADT options including Lupron injections vs. Orgovyx oral med
4. Barrigel vs. SpaceOAR hydrogel spacer
This is a great forum, I have learned alot from all of you during the past year that I have been dealing with this disease. Thank You!
Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
It is best viewed on computer or just print it on paper. Not so viewable on phone.
To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.
Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.
And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Many of them are more dangerous than the cancer.
Also on the spaceoar gel.
One doc had an interesting take on it.
-on one hand.. it reduces rectal symptoms of radiation
-on the other hand, if you suspect micro mets in that area, it might just move them away from getting bathed in lovely radiation. LolI had the SBRT 5 sessions with the SpaceOAR and fiduciary markers. My last treatment was 24 days ago. The SpaceOAR caused zero discomfort right from the start. My treatments went smoothly. I did experience some urinary discomfort and was prescribed Flomax when I reviewed my symptoms with my oncologist. I was pretty tired during treatment. The days following the treatment were the most difficult and the day following the 3rd session was the hardest and frankly scared me a bit. But, that was on a Friday and I had an extra day until the Monday treatment and I felt much better.
About 3 days after the final session I woke after a good nights sleep and it was like a fog had lifted. I stopped Flomax about a day or two later and started regaining my energy and stamina. 3.5 weeks out I’m my normal self, including good sexual function.
I want to take this opportunity to thank the great people that run this forum and also everyone who posts. The information I found here led me to my treatment choice and helped me stay positive as the treatment approached.
I started with a Gleason of 4+3=7 (intermediate stage but aggressive) in only 1 core of 12 samples. Because of earlier BPH issues I’ve been monitored closely for many years. It wasn’t always pleasant but it’s why my cancer was found early.
For those who it is an appropriate option, SBRT with SpaceOAR can truly be a modern miracle.Mike
Did you also have ADT as a part of your treatment, if so, what kind and for how long? Thanks for your response, very much appreciated!
