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    Suggest treatment for prostate cancer

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Posted on Thu, 2 Jun 2016 in Cancer
Question: Diagnosed with prostate cancer:
-was not detected by manual exam (several exams)
-was detected due to rising PSA (PSA only XXXXXXX from 4.6 to 6, but because my prostate is so small, PSA score still considered high for relative size)
-Gleason score of 8 on 5/10 biopsy samples, 1 sample was a 7/10 - so agressive
-Cat scan was clean
-Bone scan was clean
-Appears hasn't spread yet, but is aggressive
-Age 72, but healthy 72. No medical issues except taking crestor for high colestrol. Excercise daily and within my proper weight for my age. Non-smoker

Treatment suggested was ADT (Hormone treatment) for 2 years (monthly injections), with 8 weeks of radiation after 2 months.

Question is this:
-Was said that at my age, best not to do surgery to remove prostate. Side effects range and could be worse than side effects of hormone treatment. Do you agree?
-If I do the hormone treatment and it's ineffective, can surgery be done later?
-Hormone treatment is used to starve the cancer cells from testosterone, but it isn't a cure. So what happens after 2 years when the testosterone starts flowing again?
-What is your general recommendation, given what I have told you
doctor
Answered by Dr. Indranil Ghosh 2 hours later
Brief Answer:
both surgery and radiotherapy are good options

Detailed Answer:
Hi
Thanks for your query.

You have intermediate risk prostate cancer which is confined to the gland. Surgery is definitely a good option. I don't think age itself is a barrier. Your general health appears fine to me.

Radiotherapy with hormone therapy is also equally good option. Here radiotherapy is the primary treatment. Hormone therapy is just an adjunct to improve the results. Hormone alone is not curative but with radiation it cures many.

Long term control results of both surgery and radiotherapy are equivalent. Some side effects are different, which you need to discuss with your docs. Options of radiotherapy after surgery and vice versa remain, if necessary.

Hope this helps.
Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Indranil Ghosh 10 hours later
Thanks
Yes Doctor did say that that even with surgery, still a 60-70% chance of needing radiation. So it appears radiation will be in the equation no matter what.

If it the science says that both options are equal in terms of outcome, and that to do surgery versus hormone treatment comes down to side effects, and of course side effects are always different for different people, makes it a very difficult decision to make.

Question: If I start the hormone treatment and do the radiation and I realize that after say 1 year in (post radiation), could I still have the prostate removed? or is this decision final, no turning back?
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
please refer below

Detailed Answer:
If you have done radiation and disease gets controlled, then no question of surgery. Only if PSA starts rising again after falling close to zero, then it can be considered.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1536 Questions

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