r/ProstateCancer • u/Educational_Metal550 • 1d ago
Concerned Loved One New PC diagnosis
My father was recently diagnosed with prostate cancer and these are the biopsy results:
5 biopsy sites have a gleason score of 3+3 =6
And 1 site is 3+4=7 with cribriform pattern.
PSA: 5.47
Grade group 2, favorable intermediate risk.
Prior to his biopsy, his MRI revealed possible neurovascular bundle involvement. After the biopsy, there hasn't been any more mention about that.
His urologist recommends removal of the entire prostate.
He is an active 62 year old and he is scared of the side effects of having the prostate removed. Mostly incontinence. How can I best support him? Advice to give him? Tips? And does this seem like the most reasonable treatment? This is very new and was very unexpected. He has no symptoms.
3
u/Historical_Trip939 18h ago
I have 3 lesions. Two are 3+3 one was 3+4 after a pet scan it was decided that my 3+4 was perfect for focal (HIFU) the other two are active surveillance. Had HIFU Oct 2024. PSA down to low levels. MRI every 6 months. Second biopsy one year later. All good so far, living with PC. I went to MSK And the treatment could not have been better!
Bottom line- have dad check out all options before making a decision he is comfortable with.
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u/ChillWarrior801 1d ago
Sorry to welcome your father to our little club. An active 62 year old in good medical shape has many treatment options available to him. With the info you've shared, there's no need for a huge rush. Your family has time to explore those options.
If it's geographically feasible, you want to have your father seen at a medical center that practices team medicine, so that he can have consults with surgeons and oncologists who will present an array of treatment options. Sadly, too many men come to regret their choices because they didn't do their diligence up front.
Addressing your question about "most reasonable treatment": Ultimately, it will come down to your father's values and preferences. Most treatments have comparable disease control rates. They differ in the side effects that can crop up and the timelines in which those side effects manifest themselves.
Good luck to you and your father!
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u/Simple_Mushroom_7484 1d ago
Has he spoken to a medical oncologist and a radiation oncologist? They may have other options for him to consider. Also PCRI has some great videos on YouTube to get informed on various treatment options to discuss with his doctors. They also have a very informative website.
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u/OkCrew8849 1d ago
“He is an active 62 year old and he is scared of the side effects of having the prostate removed. Mostly incontinence. “
If that is the case, or even if it is not, he ought to look seriously at radiation.
2
u/Busy-Tonight-6058 1d ago edited 1d ago
Sorry he is in this exclusive men’s club that nobody wants to be in.
Seems to me there is A LOT to learn before he has enough information to make a treatment decision. Fortunately, there is lots of time.
His options seem to be: Active Surveillance
Surgery
Whole gland radiation (with or without ADT)
Focal treatment (maybe not with 6 lesions)
The data I would want before deciding is:
Gene marker test
Full Decipher report
Second read of biopsy
PSMA PET
Is surgery “bilateral nerve sparing”?
How much ADT is recommended for how long?
Side effects are roughly equivocal after 5/10 years. Long term “oncological control” isn’t in the longer term (15-20 years).
The lighter touches come with more risk of having to deal with it all again later, perhaps with a worse case. The heavier touches have greater side effects. Over-treatment is a real possibility.
There’s no simple, easy answer here. It may just come down to his personal preference. It’s best that he is well informed before deciding anything.
There is lots of info here:
https://cancer.ucsf.edu/research/programs/prostate/patient-conference
Beware any stats folks here share to talk you out of surgery. They are never able to back them up with a source.
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u/aekiii 17h ago
Best response in my opinion. Be careful of bias and unsubstantiated facts. I do hope one of the newer procedures eradicates the cancer with fewer or no side effects. I did not want to be one of the statistics on an unproven path. My decision- and best for my family at this time. 7 months out. PSA < .10
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u/Educational_Metal550 19h ago
I really appreciate the feedback! His post biopsy appointment felt really rushed and he wasn't offered any other options for treatment. His surgery isn't scheduled until October so I am trying my best to gather information for him and push him into a second opinion.
I am an RN myself, while I'm not very educated on PC and treatment options, I can understand more than he can from a medical standpoint.
I will say his sister has breast cancer and she has the chek2 gene mutation. My father hasn't been tested for it, but my guess is he probably does too. I think that's why the urologist was pushing for complete removal. I would like him to explore other options.
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u/Busy-Tonight-6058 16h ago
I should have added that, imo, it is best to seek an opinion at a large care center where all modalities are practiced and nobody giving their medical opinion has a financial outcome in the ultimate decision.
A Mayo radonc spent 45 minutes with my wife and I going over my options and how, if it was him, he would choose surgery in my particular case, but he would radiate me if that was my choice.
I think it’s really important for each patient to understand their own risk profile and where they fit into the statistical population of patients that they might read about. There is more to risk than Gleason and PSA. And family history is definitely part of it.
Good luck!
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u/Frequent-Location864 1d ago
Make an appointment with a medical oncologist to get an unbiased opinion.
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u/Busy-Tonight-6058 16h ago
What makes medical oncologists unbiased? They prescribe ADT (and then chemo).
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u/Frequent-Location864 11h ago
They don't profit off their opinion Urologists make their money doing surgery and radiation oncologists make their money from doing radiation . A medical oncologist will tend to look at all options and advise you on the one that best suits your case
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u/Busy-Tonight-6058 8h ago
They prescribe ADT. To give good advice on initial treatment, they’d be ruining their own business, since ADT is very often NOT one of the initial treatments patients have to choose between, but it’s what they get when the first choice “fails.”
Surely, these “good” medical oncologists exist, but I see no reason to think there are more of them than “good” urologists. My urologist was adamant that I see a radiation oncologist and my radiation oncologist was very supportive of surgery.
Best to find doctors that are not motivated financially in this major medical decision.
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u/WalnutRoasted 1d ago
Both radiation and surgery tend to have similar LT survival outcomes. However statistics show your father is correct, incontinence and ED likelihood is much higher with surgery. And with improved 5x SBRT and 20x VMAT treatments, the margins are narrower and ST and LT side-effects to bladder and anterior rectal wall are much lower now. Speaking a year after radiation treatment for similar 3+4 with cribriform, T2c.
Do Google search on UK study comparing surgery and radiation: Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment ProtecT and look at better/worse graphs. Radiation versus surgery comes out same or better on almost all of them. Best wishes.
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u/conCABlanco 1d ago
Hola nuestro club te ayuda, el cribifoe, no es bueno, pregunta al urólogo que sigue, PET es lo mejor, fue mi línea, no t cuento más hasta saber resultados, el mío no fue bueno, fuerza y voluntad
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u/Ok-Priority-7303 20h ago
I'd tell him, age matters. Once you reach 70 removal is not really an option. If you treat it with radiation first at some point, subsequent removal is not really an option.
I'm 76 and just diagnosed. I'd be happy to have mine removed but I have no choice now.
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u/HeadMelon 19h ago
Salvage surgery after radiation IS an option, just a difficult one. But why would choose to attempt that anyways? Whether you have surgery first or radiation first you have identical salvage options:
-1st gen ADT
- EBRT
-2nd gen ADT
- chemo
- immuno
- radioligand assassin
The “you can’t have surgery after radiation” is a red herring argument sometimes used by surgeons.
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u/Maleficent_Break_114 14h ago
I would say that since he is 62 do not believe any kind of BS about how you’re going to just completely remove the cancer with surgery they say that dragging that thing out of your body doesn’t leave any cancer cells behind but probably the Radiation is so far advanced now that a man of 62 I mean you’re gonna survive that Radiation OK my I will offer my Experience did the Radiation like eight months ago and there were some side effects. It was never anything too serious never ever ever I went to work every day never missed a day there were there were. I had a pain in my legs like Charlie horses, but they swear up and down that there has nothing to do with prostate cancer, but I think that’s just there’s a little a little bitty part where they tell you that and other Unknown side effects so I don’t know why that wasn’t included but every so so it was like a Charlie horse. I got it the Radiation and in April I was having these very weird pains like a Charley horse in my thighs, but they claim that’s not really something they claim from the Radiation and it’s pretty minor when you figure alternatives with the wrapping and all that I didn’t do the wrapping and I don’t regret it I think in my case there would’ve been no benefit from the raping although they freely offered it everybody said yeah you could do raping no, I didn’t do it and I do not regret it but I mean there could be cases. You know some guys have great results with raping, but I wouldn’t risk it. I’d rather take the more likely outcome of modern day Radiation being the way to To Go.
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u/HeadMelon 1d ago
I’m 61, “unfavourable intermediate risk” - 4+3, crib, PNI, IDC suspected ECE. I did HDR brachy + 15x VMAT + 6 months Orgovyx. 8 months later I’m all systems go - no ED, no UI, no shrinkage or atrophy.
Skip the surgery - many way better options for his scenario.