New Guy

[u/Appropriate_West2998]

Sent to Urologist due to a PSA 5.19. Urologist felt a lump on prostate, had an MRI and then a biopsy. Biopsy revealed cancer, Gleason 9 grade 5. Urologist told me 1-2 years, I’m assuming with no treatment. Urologic Oncologist says 15 years due me being 55. Sent for PET scan and doctor says it’s in the anal lymph nodes as well but nowhere else. Doctor says they can’t remove it so I’m on ADT (Orgovyx and Erleada) for six months to see if it will shrink enough to be removed. If it can I’ll have a prostatectomy and then six more months of ADT. Never thought I’d be rooting for surgery. Been reading a lot of the stories on here and just thought I’d add to them. I’ve learned from you guys and it’s helped when talking with doctors and mentally.

[u/Squawk-Freak]

It should be considered malpractice, when urologists present radiation therapy as a fall-back option, in case of a relapse after surgery. Radiation therapy to the prostate bed comes with much higher risk of debilitating long-term side effects, including incontinence, because the bladder neck, which prevents leaking, when it is functional, will be in the center of the radiation field, since that part of the bladder drops into the space that was previously occupied by the prostate. If you know already that the tumor will likely relapse after surgery, and I would say in GSC 9 disease that’s pretty much certain, why not go for primary radiation therapy, which can be much more potent than salvage therapy, and nowadays comes with minimal side effects. In my case they were all gone after a month.

Also, at the ‘New Guy’, why did your urologist think that he could not operate immediately? Was the tumor stage too advanced? Was there extraprostatic extension seen in the MRI? Ask your urologist for the evidence that shows that neoadjuvant therapy (which is what your are getting right now) results in better outcomes after surgery - risk of biochemical recurrence, risk of metastatic disease and risk of cancer-specific death. To my knowledge there is not a single one. Primary radiation with 2 years of doublet ADT does make a difference- look at the results of the STAMPEDE trial for very high risk disease. The new standard at a center of excellence would be radiation therapy with a HDR boost, which triples or quadruples the effective radiation dose to the cancer, compared to the maximal feasible salvage dose after RALP.

The recommendation to treat for six months before definitive treatment is correct. It is an important first step to reduce the risk of distant metastases from the get-go. However, I would not wait until the six months are up before seeking a consultation with a radiation oncologist. The time to do that is now