Prostate Cancer Community

You didn't mention what your gleason score was and what percentage of cancer your one positive core was. As you probably already know gleason scores of 6 or less are less aggressive tumors while gleason scores of 7-10 are more aggressive tumors and more likely to spread. As to your options , surgery versus radiation, the ten year survival is the same. Surgery is more likely to cause impotency and urinary incontinence from the get go, while radiation seems to initally have much lower rates of these complications but higher bowel incontinence immediately. 3 years down the road I think the potency levels for the 2 approaches is the same since radiation can eventually damage the nerves. You may ask what is the risk at your age of having permanent impotency? Probably about 50/50. Permanent incontinence probably a lot less than that. Each approach obviously has risks and depending what side effect you are most willing to live with may determine your decision. Some guys are so scared about never having sex again go with radiation, while others who just want to get rid of the cancer go with surgery. One thing to remember is that if the cancer reoccurs and your PSA starts rising after either radiation or surgery you can't really go back and have surgery then. There is a procedure called salvage prostatectomy done by a few md's but it has a very high complication rate including development of fistulas with repeated repair surgeries. A few guys on this board talk about it and it ain't pleasant. So if the cancer comes back you have to move on to the third level of prostate ca treatment, anti-hormonal treatment and then the fourth level becomes chemo. There are other treatments you might consider, like proton therapy, HIFU, and cryo. These treatments have less sideeffects than than surgery or radiation, but the long term effectiveness of these treatments is still not clear. Of course if you have a low gleason score cancer with low amount of cancer in your one core you could just do watchful waiting, where you have repeat PSA's and biopsies every few months to see if your cancer is growing very fast or not. Some cancers go nowhere, of course nobody really knows which ones do or don't. I didn't want to take that chance. I am 52, had PSA rise from 1.9 to 2.85 in one year, negative DRE, second biopsy showed ca in 2/12 cores on R side, 5% cancer one core, 25% other core, clinincal stage T1c. Both had gleason scores of 3+3=6. Both of my parents died of cancer, I am very scared of cancer. Had bilateral nerve sparing robotic prostatectomy on 09/11/08. Pathological stage was T2a, organ contained, no signs of spread (so far!). Both post-op PSA tests have been less than .01. I was continent in 3 months but the ED remains. I have to have penile injections to have sex . I am very unhappy about the result of the ED, due to my age I felt I had shot of getting this back but it doesn't look like that's going to happen. I would do the same thing over again due to my paranoia about cancer but others choose different options based upon what they want to live with the rest of their life........prostate ca survivor

Thanks and my Gleason was 6 and i do not know the details of my 1 in 12 positive biopsy... dennis

Firstly, biopsy readings are subjective: if you havn't already done so have the slides sent to an expert pathologist for a 2nd opinion to confirm where you stand.

With only one of the 36 samples Gleason 6, it would pay to take the time to seek further opinion(s) before rushing into treatment.

If you decide on radiation Anderson in Houston has a proton therapy facility which treats prostate (not prostrate) cancer. It is one of five centers in the U.S. that have the capability. Proton therapy has minmal to no side effects which makes it superior to other types of radiation. I've talked to many men who have had proton treatment, and they are all enthusiastic supporters of it. I just finished being treated at Shands in Jacksonville, FL, and am very glad that I did. I had no incontinence and no decrease in my sex life. My only side effect has been to urinate more frequently, and this is predicted to gradually return to normal.

I agree with AUS and think a second opinion is highly important in your case. Active surveillance for a period is perhaps the best choice for you and the side effects are zero, compared the the other two options you mention. With the biopsy numbers quoted there is NO reason to go directly to treatment without further recommendations and consideration.

Thank you and interesting.... Do you have any links to information or referrals to the proton therapy ... dennis

Dennis, if you google "proton beam therapy" you will find lots of info. Let me know how you make out. Or I can give you more info if you like.

Dennis, another place to google is"proton bob".

Hi Dennis,

I am not going to recommend one procedure over another. If you are close to Houston I would recommend the genitourinary cancer clinic at M.D. Anderson. They have a web site M.D.Anderson.org and a 1-800 number. So far as I know they offer almost any treatment you want to pursue there.

Dave Dx'd 1999, PSA 43, Gleason (4+5=9), T3c, 42-3d-EBRT+ADT2, Int. ADT, salvage RRP

Thank you very much.... dennis

Dennis, You are fortunate to be living close to one of the finest cancer treatment centers in the country, M.D. Anderson. Your Gleason score would be helpful in deciding what option might be best for you. But you should certainly consider the proton radiation option available at Anderson. You mention the hazards of surgery and proton radiation being similar but that is definitely not true. Take a look at: protonbob.com/proton-treatment-homepage.asp. Then talk to a radiation oncologist at Anderson. I completed treatment there a year ago and was completely satisfied. Give it careful thought before letting a man with a knife near you.

Unless you are prepared to give up sex for the rest of your life, never to have another orgasm, erection or ejaculation, then I strongly recommend anything other than surgery. I had what is supposed to be the greatest surgical procedure (RP) robotic prostatectomy in '07 and will regret it for the rest of my life. I was rushed into surgery due to a 1st time test of 19 on psa. The dr's scared me into surgery and have left me devastated emotionally and physically with no support. I tried a cancer support group and found I had nothing in common. They just wanted to hear success stories. What's the use of a support group if they can't help you when things don't go right. Sorry you are now in my shoes and hope you have a better result. Just to be alive is not always the solution. Quality of life after prostate cancer needs to be heavily weighed in making your decision.

Hello, I am a new poster here. I underwent the HIFU procedure the middle of last month and couldn't be happier. You might want to consider this as well. I'm 64, my Gleason was a combined 7 with a PSA of 4.7 and found cancer in all areas of the gland (we'd be watching the PSA rise for some years and did the ultrasound/biopsy after the latest PSA). You might want to do a search for International HIFU since this procedure must be done out of the U.S.. If you have questions I'll be happy to answer them to the best of my ability.