PROSTATE CANCER

[hinx]

Recently diagnosed with prostate cancer and am struggling with a decision for the best treatment
for a cure.Can you please help?
AGE:67
HEALTH:good
PSA:3.7
GLEASON:3+3=6
PROSTATE VOLUME:21.27
twelve needle biopsies   one showed cancer

[HeinrikMD]

Hi,
Since you are only 67 (and estimates are, in the absence of any other disease - you are expected to live another 15 years),  you have 3 choices. There is no clear evidence to favor one over the other.
The first is to monitor and if progression of disease is imminent, then intervention would be done.
The other option is to intervene with either surgery and radiation.
Try to find out how localized is the disease. If the disease extends beyond one lobe of the prostate - then observation would not be equivalent with radiation or surgery in terms of outcomes. There would be some differences with post-therapy complications. These complications will vary from procedure to procedure (there are a number of surgical options, there are open, laparoscopic, and robot-assisted) and machine to machine (different radiation modes of delivery), so it would be best to find out what is available to you and then make a decision.

[hinx]

Do you agree with Dr.Glenn J.Bubley,M.D. that your chances of long term survival may be equal regardless of which approach you choose?For early stages of prostate cancer treatment,the medical literature does not categorically show that one treatment is better than another.Dr. Bubley is aswsociate professor of medicine,Harvard Medical School and director of genitourinary oncology,Beth Israel Deaconess Medical Center.If this is true why would anyone have major surgery for early stage prostate cancer?I am searching for the option with the best cure rate.This is really confusing.

[Artdude]

Hello.  I am 48 and was diagnosed with prostate cancer in August after taking antibiotics during the summer to bring my PSA down.  It did go from 6.8 to 2.9, but my urologist was unsatisfied with the results and a biopsy was scheduled.  I had 22 or 24 samplings.  Gleason was 3+3. I chose surgery based on longevity of life and quality of life.  I was fortunate to have had robotic surgery and the recovery went well.  Though you are almost 20 years olders surgery also is performed on men your age.  I learned that with other therapies there were too many possible side effects that could happen 10-12 years down the road.  For me surgery was the best bet.  Now of course, I am presented with another challenge.  You can read about that in my profile.  What i learned is that if I have a reoccurence, I have more options with fewer difficulties based on my decision.  Perhaps because you do have 20 years on me, seeding with external beam radiation might be the best bet.  I would consult with more than one doctor and weigh the facts, making sure you are comparing comparable statistics.  all the best for the journey ahead.

[HeinrikMD]

Hello again,
On equivalent outcomes: Yes, I agree with Dr Bubley that there is no proven advantage for going for intervention over a wait and see approach.
On reasons why some men prefer to go for treatment:
As I said before it will all come down to a value judgment. The advantages of the wait and see policy is that you avoid any complications of the interventions. The disadvantage is that, in the event that disease progresses - it may progress to a stage that is no longer curable, surgery may be harder to perform, radiation would involve larger fields - so there may be more complications with the intervention. Currently, there is not enough data to determine which patients will fail on a wait and see policy.
As I posted before, the decision calls for a personality assessment. Some patients take on risks more than others.
Hope this helped.

[hinx]

I am not considering watchful waiting.My point is that if Dr. Bubley's statement is true.Why should you choose surgery over radiation?Can you give me a definitive answer?I can't imagine anyone choosing major surgery over seeds or direct radiation if the cure rates are the same for early stage prostate cancer.I am struggling big time with a decision?What is your opinion of Robotic surgery?

[HeinrikMD]

Issues you need to consider:

Blood loss – surgery can be associated with much blood loss, hence radiation would mean avoiding transfusion related risks and side-effects.  Robotic surgery is associated with less bleeding, so there may be no advantage with radiation.

Anesthesia complications – surgery will require anesthesia, so would seed implants/brachytherapy, it would be avoided by external beam radiation.

Erectile dysfunction – this is hard to evaluate. Radiation shows short term preservation of erectile function – but the risk of dysfunction actually increases over time. For surgery, if the nerves are included in the dissection field – dysfunction would be evident soon after recovery from the surgery.

Bowel and bladder complications – almost 50% of patients undergoing radiation have symptoms during treatment, for surgery this is not a large issue, though problems with bloody urine do occur during the recovery period.  

Treatment period – external beam radiation usually takes several weeks, whereas surgery and seed implants can be done in one day.

Institution volume – here is a tough one to evaluate. OF course, surgeons who perform a high-volume of prostatectomies would perform the surgery better than other surgeons. If the hospital is known more for its surgeries than its radiation facility, then surgeon skill wouldn’t be an issue. The radiation doses are generally planned and delivered depending on the machine, so there is little if any variation present. Put another way, while there is evidence that there is equivalence, surgery would be inferior if the surgeon is not very experienced.

Others: try to find out if you are indeed a candidate for seed implants. Your prostate is fairly small and there may be more urine/voiding problems if you take this option.

Re robotic surgery: robotic surgery is fairly new, my main concern here is the experience of the user. If your surgeon is more used to performing open prostatectomies, then this may be the way to go.

[hinx]

Thanks very much.

[HeinrikMD]

You're welcome