Radiation or Surgery?

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Radiation or Surgery?

by Bizzione on Wed Jul 20, 2005 12:00 AM

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I am 68 years old and I was diagnosed with prostate cancer just about month ago. The tumor is very small and Gleason score is 6. I am reading all the info I can find, hoping that it will help me to make the correct decision which tratment I will eventually choose. I am otherwise very healthy and am enjoying life fully. Can somebody/anybody give me some information about personal experience with radiation and also surgery? Thank you.

Radiation or Surgery

by John_S_4 on Wed Jul 20, 2005 12:00 AM

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I'm 62 years old and had prostate surgery about 2 years ago. I too had a Gleason 6 score and I explored all the possibilities. My brother recently died from prostate cancer after having previously elected to do the seeds (6) years earlier. For me, the surgery was the best of all options so both my wife and I researched and cross checked surgeons who performed this type of surgery on a regular basis. After getting several referrals from different people we interviewed (2) of the doctors which were mentioned at least (3)times and chose one. I appear to be totally free of cancer now with my PSA at 0 for my last 4 checkups. I am continent and my sex life is pretty good for 62. If you need any information on my experience, just email me back.

Radiation or Surgery

by Bizzione on Wed Jul 20, 2005 12:00 AM

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Hello John! Thank you for your prompt reply. I am living a turmoil of emotions these day. I want to make the decision of treatment within 2 weeks so you can imagin my concerns. I am very interested in your personal experience with the surgey. Please, share with me as much as you can! Thank you again, Erik

Decision

by Bud622 on Thu Jul 21, 2005 12:00 AM

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I am recovering from a Radical Prostatectomy. I had surgery July 18. Have seed or external beam with IMRT, even if you have to travel to find treatment. I wanted Brachytherapy , my prostate was too large, then I choose Radiation with IMRT The cat-scan showed problems, my huge prostate had grown into the bladder. There was also kidney and bladder problems. Everything was complicated by the Lupron I had received to shrink my prostate.Lupron makes the outside lining of the prostate thick and sticky. This makes the nerves harder to find. I have talked to a lot of men who had Seed, External Beam Radiation or a combination of both, they do great. Surgery is rough, some people do OK, but why put yourself through it when the cure rate is the same. I also would not ever have hormons except in advanced stage, there isn't enough proof that it helps to be worth the side effects. Good Luck, James K.

Many Options

by Badge414 on Thu Jul 21, 2005 12:00 AM

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Hi Erik, Don't panic, prostate cancer is never an emergency! You have many options, especially with your Gleason score of 6. I had the radical prostatectomy in December 2003 for a 13 cc tumor, Gleason score of 9. I ruled out radiation because it was fast growing and aggressive. It had not spread to lymph nodes or bone, but there was 1 cc on the margin, and my PSA was 0.71 four months after surgery. I had four months of chemotherapy with weekly Taxotere IV which reduced my PSA to 0.21. I lost all my hair and fingernails, but it grew back. Then I was on hormone therapy for six months, Lupron injection with daily Casodex. In just one month my PSA went from 0.21 to 0.01. Two months after the Lupron wore off, my PSA went to 0.41. I will check again in 4 months and repeat the Lupron & Casodex for 6 months if the PSA continues to rise. I wear a diaper, I leak when I cough or strain, an erection is not possible since the nerves could not be saved. I wish I had tried hormone therapy first to reduce the tumor size, but that was not wise with the fast growing Gleason 9. Surgery can not be done after radiation therapy, it makes a scarred mess and can also have side effects. In your case, I suggest hormone therapy, or even seed implants. Jim

Many Options

by Bizzione on Thu Jul 21, 2005 12:00 AM

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Hello Jim! Thanks so much for all the info you delivered to me in your post. I am amazed how much can be done for PC in any stage. I admire you for your courage to go through all of that "hooplah" and still be so positive. I have to learn a lot in that "department" yet. Never before I faced any, and I mean ANY health issues so this diagnose came as a thunder. I had all the available scans and testing done and no sign of cancer anywhere besides the prostate. My urologist was never able to find any lump in my prostate when the rectal exam was done. It was my wife's insistence that made me and my urologist go for the biopsy. It was the RIGHT choice uderwise my cancer would grow and grow and then?? So, here I am, still getting as much of info as I can and will make my final decision in a few days. Thanks again and wish you the best, which in "our" cases is H E A L T H !

Options

by Badge414 on Fri Jul 22, 2005 12:00 AM

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Hi Erik, What lead you to have the biopsy, was it a high PSA? What is your PSA now? I am now 67, and it was in July 2003, two years ago when my PSA was about 4.8, up from the prior year at 2.8 or so. Then in October it was around 7.8, and the digital exam indicated an enlargement. Then I had the biopsy to confirm cancer, all 13 samples were positive, Gleason score of 9. My urologist considered hormone therapy to shrink the tumor prior to surgery, but he decided against that since it was so fast growing, no time to wait. I have been told from many sources that surgery can not be done after radiation because that causes too much scar tissue. I have not heard of any negative impact from hormone therapy causing thickening of the prostate capsule or causing stickiness as reported here by another person. Most likely that was the result of radiation. My doctor could not see the nerves to spare them at time of surgery, the right one was taken on purpose because of the size of the tumor there. I spoke with another patient of my doctor whose nerves were spared, they peeled off the prostate just like they should, and he had no erection problems. His tumor was smaller. My cancer doctor who administered the chemotherapy is also directing the hormone therapy, and the plan is to do six months of therapy and then six months of nothing so that the body can recover. It is possible that radiation could cure the cancer, but it has too many side effects such as burning holes in the colon and nerve destruction. I still suggest hormone therapy, surgery can still be done if needed, and hopefully the two nerves needed for erection can be spared. What does your doctor say? Jim

Options

by Bizzione on Fri Jul 22, 2005 12:00 AM

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Hi Jim. Thank you again for giving me inside look at your personal problem. And we do have a problem, don't we? Some more serious then others but still.. problem. My PSA was rising by the years. Not much but still rising. In the last 4 years it went from 1.0 to 4.2 and then 4.6. My wife insisted on more testing but my urologist did not feel is needed. Thanks to my wife's insistence, I finally had the rectal exam (2 months ago) but the urologist could not feel any tumor at that time. So again.. my wife demanded the biopsy and there it was. Small tumor (T1). 12 samples were analysed and only one had evidence of cancer. The urogogist (just few days ago) gave me a prescription for Casodex 50MG and if I decide for radiation I should start to take this hormone once a day. I am still undecided though and trying to read and talk to other men as much as possible. Most of my friends (3 of them physicians) are suggesting the radiation. They said that surgery would be recommended if I were much younger but at age of 68 and the size of my tumor I should be doing just fine with the radiation. On the other hand I read some quite positive articles about the surgery. I now realize that I am dealing with very confusing controversy and my head is spinning. You are right! I did not hear nor read anything similar to the other poster's info on the undesirable problems from the hormone therapy. Actually all I heard is quite positive. I met two man (in the doctor's office)and they both are receiving their injections of hormones for several years after their surgeries and radiation. One was diagnosed 18 years ago and the other 15 years ago. They both are doing very well and that is encouraging. I found two additional urologists/oncologists and asked for their opinions or suggestions. Both inclined for radiation. They explained that there is a new method of External Beam Radiation which is aiming precisely at the tumor so the collateral damage is much lower then it used to be even a year ago. So, go figure! Now you know why my head is spinning. BTW Did you hear or read if the radiation can cause additional cancers like colon or rectal?

Options

by Badge414 on Fri Jul 22, 2005 12:00 AM

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Hi Erik, You have some good numbers, the low PSA and the low Gleason score of 6, so you have lots of time to decide on a course of treatment, even nothing, the so called watchful waiting. One treatment you can rule out at this time is the chemotherapy. That works only for the fast growing cancer, Taxotere attacks ANY fast growing cells, cancerous or not. That is why I lost hair and fingernails, those cells are fast growing. Your cancer is not fast growing, so chemo would not work well for you. The least invasive would be hormone therapy. As you know, prostate cancer initially depends on testosterone to thrive, so Lupron is given by injection to cause the brain not to deliver the signal to the testes to produce testosterone and thereby starving the cancer. The adrenal glands sitting on the kidneys also produce testosterone, and they don't get the signal from the brain not to produce. That is why the daily Casodex is administered, to block what testosterone is produced from binding with the cancer. Casodex is expensive, about $14.70 per pill in the US, but I got mine for $7.33 from a Canadian pharmacy, $220 per month rather than $441 per month US. I have no direct knowlege about radiation, maybe you can find someone who has had that treatment. No, I have not heard of any cancer being caused by the radiation treatment, and the beam is more focused on the tumor to avoid collateral damage. Jim

Radiation or Surgery?

by Badge414 on Fri Jul 22, 2005 12:00 AM

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Hi, I was diagnosed last October. I am also 68. My Gleason was 7. I went on hormones right away. My PSA dropped from 5.3 to 0.3 in six weeks. Radiation was to start in January and last eight weeks. Being as how we live in Ottawa, Ontario and have a nice place in Florida for our winters, my oncologist agreed that I could stay on hormones until the Spring and start the radiation then. That is exactly what I did. I have now had 35 treatments with just three to go. I finish on Wednesday. By April my PSA was 0.1 and my testosterone was 0. There is no reason for you to rush a decision. Your cancer isn't going anywhere. I am very pleased to have chosen my treatment plan (actually my oncologist did not give me options except to say that surgery was unnecessary). There are side effects to all options. In my case, I would say that mine are mostly mild and tolerable although annoying at times. The actual process of doing the radiation is simple and painless. I go in the afternoon and they schedule me for late afternoon on Tuesdays which is my golf day. My treatment crew of radiation technologists say they don't want to run my life just save it. I will see my oncologist on Wednesday and I believe that I will see him next in 6 to 8 weeks. At that time he will probably do a PSA test and every 6 months after that. He has already given us the green light to go to Florida on October 22nd until next April. I volunteered that I could get my PSA tested in Florida at the 6 month interval but he said that that would not be necessary and that 7 1/2 months would be fine. "This stuff works months and years, not days and weeks" Take care and let me know how you are doing. My best wish is that you do as well as I have. Bob T.
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