On The Bubble-question

Hello Jude 

Interesting post - however I think you need to think about where you are with this and what you want moving on.

* To get a true PSA you need to be at least 48 hours free from from vigorous exercise or sexual activity. 

* I would say 5 weeks post biopsy is fine - however a PSA test is only an indicator. The Gleason Score and MRI are the true indicators.

The choice between Radiotherapy, Surgery or Proton Beam therapy is a very personal choice and you need to establish how each treatment and the side effects would affect you and your family - write a list of the pro's and con's doing your research from trusted sources, Macmillan, Prostate Cancer UK and Cancer Research UK. (not Dr Google).

Feel free to ask the Community any questions. I can't comment on DNA testing although I would advise you to ensure your children (male and female) are tested for the various cancers.

I do hope this helps.

Best wishes - Brian.

Thank you Brian for your thoughtful response.  New to this, of course.  

I am somewhat overwhelmed with information, after my oncologist gave my wife and me a 70 minute presentation on options.  It was well presented, yet I'm trying to sort through it all.  You mentioned the MRI as part of the puzzle.  He did spend some time on it and I need to revisit that with him.  Thank you for that pearl of info.  

My GP mentioned something that had me walk away with more questions.  He indicated he believed the robotic prostatectomies were overrated comparatively to radiation.  Gave his reasons that were subtle and I have stumbled on some of the articles and discussions that deep dive the numbers.  One area I read was on the Health Message Board Claimed, Mistaken Advantage 5-"Surgery Provides the Best Rate".  Thoughts are welcome

Hi Jude 

There are always going to be some who prefer surgery, particularly surgeons, which is understandable I suppose.

I did read some time ago that surgery was considered 'old hat' and the latest Radiotherapy was the way forward.

Probably the best points about Radiotherapy are less likelihood of long term side effects and no major op.

The one downside with RT is if cancer returns surgery near impossible, ok the other way round Radiotherapy after surgery.

Just my opinion by the way, doesn't mean it's right 

Best wishes 

Steve 

HiHello Jude . If you are looking for numbers then NICE have issued some guidance on short and long term side effects for things like ED and incontinence when comparing AS, surgery and radiotherapy- see section 1.3.7.

https://www.nice.org.uk/guidance/ng131/chapter/Recommendations#localised-and-locally-advanced-prostate-cancer

It's limitations are that it is retrospective, techniques have improved and it doesn't address the newer focal therapies.

In the UK there is little experience of Proton Therapy wheras it is more widely available in the USA so I am not sure whether you will get much of a response on this option.

Brian has mentioned the Gleason and MRI but the PSA density and initial PSA also play into the algorithm for determining which initial treatment to choose.

Genetic testing can be useful if you have a family history of breast or prostate cancer. There are certain gene defects with things like the BRCA, BRCB which can increase the likelihood of developing cancer and this can have implications for family members. Genetics and genomic testing is being looked at to better understand the different types of prostate cancer and so design the best treatment strategy for individual patients. There are immunotherapy drugs which have been found to be more effective if some gene defects are present but these therapies are currently used if other therapies have failed or if you have a particularly rare form of prostate cancer which doesn't respond to normal treatment. 

Thank you so much for this information Grundo and Alwayshope.  It really helps me learn more about realities and expectations.  

Jude