Prostate cancer options

[Ben Zioner]

31 minutes ago, Ben Zioner said:

I'd second that. For localised PCA the "Regret rate" for those who have chosen surgery or radiotherapy is twice as high as for those who elect active surveillance. The gain in life expectancy of prostatectomy patients is about 3 months.

 

I am now in the 7th year of active surveillance.

 

"Results showed that after five years, 279 of the men (13% of the entire group) had regrets about what they had chosen. The surgically-treated men were most likely to voice unhappiness with their decision; 183 of them (13%) felt they would have been better off with a different approach. By contrast, regrets were expressed by 76 (11%) of the radiation-treated men and 20 (7%) of men who chose active surveillance. Men in the low-to intermediate-risk categories were more likely to regret having chosen immediate treatment with surgery or radiation instead of active surveillance. The men with high-risk cancer, however, did not regret being treated immediately."
 

[Yellowtail]

It 

3 minutes ago, Ben Zioner said:

 

"Results showed that after five years, 279 of the men (13% of the entire group) had regrets about what they had chosen. The surgically-treated men were most likely to voice unhappiness with their decision; 183 of them (13%) felt they would have been better off with a different approach. By contrast, regrets were expressed by 76 (11%) of the radiation-treated men and 20 (7%) of men who chose active surveillance. Men in the low-to intermediate-risk categories were more likely to regret having chosen immediate treatment with surgery or radiation instead of active surveillance. The men with high-risk cancer, however, did not regret being treated immediately."
 

I am amazed that the percentage of people that regretted a particular course of treatment five years later is that low. 

 

 

[Ben Zioner]

3 hours ago, Yellowtail said:

It 

I am amazed that the percentage of people that regretted a particular course of treatment five years later is that low. 

 

 

I think it matches largely the toxicity of the chosen treatments.

[newbee2022]

On 10/12/2024 at 8:35 PM, sidjameson said:

In the UK at the moment. Mid 50's. Had a couple of PSA tests. 3.9 and 3.6 Then an MRI which showed a 12mm lesion. Went for the biopsy, getting results on Tuesday 15th. The Dr already said that given my age and health (generally pretty good) he would recommend a prostatectomy!!!!

 

Haven't had results yet, but preparing for the worst. Would appreciate others experiences. Willing to have treatment here on NHS or pay back in Thailand.

 

Just want the best decision based on survival and quality of life. This is part of my research. Thanks.

Get the biopsy results and go for a 2. or 3. opinion.

[helloagain]

On 10/12/2024 at 8:35 PM, sidjameson said:

In the UK at the moment. Mid 50's. Had a couple of PSA tests. 3.9 and 3.6 Then an MRI which showed a 12mm lesion. Went for the biopsy, getting results on Tuesday 15th. The Dr already said that given my age and health (generally pretty good) he would recommend a prostatectomy!!!!

 

Haven't had results yet, but preparing for the worst. Would appreciate others experiences. Willing to have treatment here on NHS or pay back in Thailand.

 

Just want the best decision based on survival and quality of life. This is part of my research. Thanks.

Why pay in Thailand if you can still get it free there. And if you can't have sex anymore why come here.

[TigerandDog]

On 10/13/2024 at 11:54 AM, Sheryl said:

At your comparatively young age, and assuming a localized cancer,  main choice would be between prostatectomy and radiation.  And within thise categories there are additional choicese.g. conventional vs robotic surgery, widebeam radiation vs. Implants (brachytherapy).

 

Precise biopsy findings would help guide this. And indeed since you don't yet have biopsy result, possible you do not even have cancer. 

 

If results come back malignant suggest you get more than one opionion in UK. Note that possible to get consultation  privately, you don't have to limit yourself to NHS for that. (Indeed, even private treatment in UK is similar to costs of private care in Thailand.) 

 

Where in UK are you? 

 

 

If the biopsy comes back malignant, even if the cancer is localised within the prostate the OP's PSA readings are too high for Brachytherapy. My PSA readings were in range but also around the same as the OP's and Brachytherapy was immediately ruled out by my urologist as an option on that basis alone. For me the choice was conventional radical prostatectomy (robotic wasn't available when I was treated) rather than radiation.

[StraightTalk]

1 hour ago, helloagain said:

And if you can't have sex anymore why come here.

That's quite a prejudiced comment.

[saintdomingo]

On 10/21/2024 at 12:45 PM, Jonnapat said:

Had a protastectamy here in Thailand in 2008 followed by radiotherapy. Still here to tell the tale. Would strongly recommend Siriraj government hospital  who have all the best equipment and surgeons.

 

 

 

Have da vinci robot also to assist. Excellent treatment for 16 years

Also had mine in 2008, at St Thomas in London but I went for the radiotherapy.

16 years later all is well last psa check gave 0.254, it did once go to 0.4 but only the once. Reminds me I must be due for another.

[nana kid]

From experience I would say that Prostatectomy should be your very last choice.  Good possibility of no sex and diapers 

[Ben Zioner]

47 minutes ago, nana kid said:

From experience I would say that Prostatectomy should be your very last choice.  Good possibility of no sex and diapers 

Near certainty during the first year following the treatment. Prostatectomy should only be offered to patients with more than 15 years of life expectancy. And then it has become even more questionable with the advent of SBRT.

[wolf81]

On 10/12/2024 at 8:35 PM, sidjameson said:

In the UK at the moment. Mid 50's. Had a couple of PSA tests. 3.9 and 3.6 Then an MRI which showed a 12mm lesion. Went for the biopsy, getting results on Tuesday 15th. The Dr already said that given my age and health (generally pretty good) he would recommend a prostatectomy!!!!

 

Haven't had results yet, but preparing for the worst. Would appreciate others experiences. Willing to have treatment here on NHS or pay back in Thailand.

 

Just want the best decision based on survival and quality of life. This is part of my research. Thanks.

 

You should research alternative treatment options, such as using Ivermectin, Fenbendazole, Mebendazole, ...

 

Various studies (e.g. lab studies on mice) have shown success when treating cancer with this medication. Also people have successfully treated themselves. These are just a couple of such studies, many more can be found online.

 

- https://pmc.ncbi.nlm.nih.gov/articles/PMC7962607/#:~:text=Fenbendazole was also cytotoxic against,mebendazole (36–38).

- https://www.researchgate.net/publication/260343692_Effects_of_fenbendazole_and_vitamin_E_succinate_on_the_growth_and_survival_of_prostate_cancer_cells

- https://www.worldwidecancerresearch.org/news-and-press/news-and-press/game-changing-treatment-for-prostate-cancer-could-become-available-to-patients/

[wolf81]

P.S.: see also this: 

 

[Ben Zioner]

On 11/18/2024 at 8:55 AM, wolf81 said:

P.S.: see also this: 

 

Yet another propeller head...

[erectem]

On 11/15/2024 at 6:50 PM, Ben Zioner said:

I'd second that. For localised PCA the "Regret rate" for those who have chosen surgery or radiotherapy is twice as high as for those who elect active surveillance. The gain in life expectancy of prostatectomy patients is about 3 months.

 

I am now in the 7th year of active surveillance.

No, not all outcomes are the same.  All diagnoses are not the same.  IDC, PNI, , LNI.  Active surveil that.  Active treatment the only option.

And still local.   

 

[Sheryl]

Indeed, oristatd cancers fiffer markefly in thrir aggresdivrnesd.

 

Active surveillance is an option only gor slower growing types.

 

For aggressive prostate cancers surgery if done in time is literally  difference between life ( decades of life in the case of men under say 60-65) and death.  

 

 

[Ben Zioner]

8 hours ago, Sheryl said:

Active surveillance is an option only gor slower growing types.

Which are the vast majority, especially with elderly patients. 

[Sheryl]

5 hours ago, Ben Zioner said:

Which are the vast majority, especially with elderly patients. 

80%.

 

Which stilll leaves 20%  -- 1 in 5 --  that are aggressive. 

 

Nowadays diagnosis distinguishes between "clinically significant" (aggressive ) snd nonclinically significant (slow growing) prostate cancers and surgery or radiation considered only for the latter.  For whom it is potntially life saving. 

[No Forwarding Address]

On 10/21/2024 at 12:41 PM, jgm005 said:

Yes there are side effects. As noted in the post above mine. 

Erection issues

Get up to pee at night more frequently.

It took, for me, to stop occasional dribbling.

Sorry, I should of noted them.

Nightly self cathetering thru penis is necessary for my brother to save the mattress - he learned to live with it.

But in hindsight, he would have gotten the removal surgery years before he did.

[Ben Zioner]

9 minutes ago, Sheryl said:

80%.

 

Which stilll leaves 20%  -- 1 in 5 --  that are aggressive. 

 

Nowadays diagnosis distinguishes between "clinically significant" (aggressive ) snd nonclinically significant (slow growing) prostate cancers and surgery or radiation considered only for the latter.  For whom it is potntially life saving. 

 

Yes but this fact must be well published. Only one in five men diagnosed with prostate cancer will benefit from immediate radical treatment, the others can get on with their normal lives for 5 to 20 years. They will probably die with their prostate cancer, from some other ailment.

 

And as this is now reluctantly accepted by the medical profession on may wonder about about the millions of men who have been unduly mutilated.

[Sheryl]

2 minutes ago, Ben Zioner said:

 

Yes but this fact must be well published. Only one in five men diagnosed with prostate cancer will benefit from immediate radical treatment, the others can get on with their normal lives for 5 to 20 years. They will probably die with their prostate cancer, from some other ailment.

 

And as this is now reluctantly accepted by the medical profession on may wonder about about the millions of men who have been unduly mutilated.

Perfectly well published and accepted. No reluctance involved. 

 

It us just relatively new, due to recent advances in diagnosis. 

 

 

[Ben Zioner]

6 minutes ago, Sheryl said:

Perfectly well published and accepted. No reluctance involved. 

Well, I was offered a choice of HDR brachytherapy or laparoscopic radical prostatectomy for a Gleason 3+3 of a size of 1% of my prostate. 

[Sheryl]

3 minutes ago, Ben Zioner said:

Well, I was offered a choice of HDR brachytherapy or laparoscopic radical prostatectomy for a Gleason 3+3 of a size of 1% of my prostate. 

When? 

[Ben Zioner]

21 minutes ago, Sheryl said:

When? 

2018.  It was in a private hospital in Bangkok. I knew this wasn't right so I contacted Pr. Stricker at Sydney's St Vincent's who confirmed that AS was the only sensible way to go.

 

Also PCa risk assessment remains based on Gleason and PSA at diagnostic, which is preposterous as baseline PSA will vary significantly from one man to the other, for instance I have BPH and chronic prostatitis, so it was 15 at diagnosis while it was 3.6 at my last visit, after a course of Levofloxacin. But they still consider me as "Intermediate risk"... Some doctors privilege PSA density in their assessment but it isn't widespread.

 

[Sheryl]

1 hour ago, Ben Zioner said:

2018.  It was in a private hospital in Bangkok. I knew this wasn't right so I contacted Pr. Stricker at Sydney's St Vincent's who confirmed that AS was the only sensible way to go.

 

Also PCa risk assessment remains based on Gleason and PSA at diagnostic, which is preposterous as baseline PSA will vary significantly from one man to the other, for instance I have BPH and chronic prostatitis, so it was 15 at diagnosis while it was 3.6 at my last visit, after a course of Levofloxacin. But they still consider me as "Intermediate risk"... Some doctors privilege PSA density in their assessment but it isn't widespread.

 

Actually  risk assessment now includes the PSA ratio not absolute PSA. The ratio is quite helpful in distinguishing PSA  elevations related to BPH.  The PSA trend over time is also considered.

 

 

International Gleason groupings were revised in 2014 and it typically takes several  years for new criteria to be widely known and employed, especially  In Thailand. Under the 2014 revision your score was indeed low risk but obviously whomever uou condulted in 2018 was still referring to older criteria. 

 

 

[DaLa]

3 hours ago, Ben Zioner said:

 

Yes but this fact must be well published. Only one in five men diagnosed with prostate cancer will benefit from immediate radical treatment, the others can get on with their normal lives for 5 to 20 years. They will probably die with their prostate cancer, from some other ailment.

 

And as this is now reluctantly accepted by the medical profession on may wonder about about the millions of men who have been unduly mutilated.

And if you are 1 of those 20% then you don't 'wonder' for more than a second about the options. After that decision you (I) will never know which treatment would return the best outcome. I'll never know whether I should have opted for active surveilance or the other treatments, but I'll also never know if I escaped a painful and shortened life. The problem with 'going on with their normal lives' is like me, you take your health for granted and miss the opportunity to catch it early.

 

I was fit as a butchers dog when my biopsy returned a Gleeson of 4+5.  I had to make a quick decision and thankfully Siriraj in Bangkok had the equipment and experience to deal with it. Radiotherapy had some side affects that I could have lived without , but I'm here 18 months later and reasonably healthy. My s3x drive has diminished but  I put that down to the female hormone injections...2 more to go and then I'm hopeful I'll be back in action.. There's a slight issue with bladder/bowel control, but certainly not requiring pads, mainly the interrupted   sleep from multiple bathroom visits.

 

Good luck to anyone suffering from this, hope it works out well for you.

[Ben Zioner]

9 minutes ago, DaLa said:

I'll never know whether I should have opted for active surveilance

Definitely not. 

[Sheryl]

43 minutes ago, DaLa said:

And if you are 1 of those 20% then you don't 'wonder' for more than a second about the options. After that decision you (I) will never know which treatment would return the best outcome. I'll never know whether I should have opted for active surveilance or the other treatments, but I'll also never know if I escaped a painful and shortened life. The problem with 'going on with their normal lives' is like me, you take your health for granted and miss the opportunity to catch it early.

 

I was fit as a butchers dog when my biopsy returned a Gleeson of 4+5.  I had to make a quick decision and thankfully Siriraj in Bangkok had the equipment and experience to deal with it. Radiotherapy had some side affects that I could have lived without , but I'm here 18 months later and reasonably healthy. My s3x drive has diminished but  I put that down to the female hormone injections...2 more to go and then I'm hopeful I'll be back in action.. There's a slight issue with bladder/bowel control, but certainly not requiring pads, mainly the interrupted   sleep from multiple bathroom visits.

 

Good luck to anyone suffering from this, hope it works out well for you.

A Gleason of 9 (4+5)  is a high risk, aggressive cancer.  No responsible doctor would recommend active surveillance for this. It is (hopefully, was) life threatening.