What are the other ways of managing my prostate cancer at 58?

Question

Hi doctor,

I just got my biopsy results, and I am really scared. I am 58, and they found cancer in six out of 12 samples with a Gleason score of 7. My PSA jumped from 3.2 to 8.4 in one year. The urologist is pushing for immediate surgery, but I have read horror stories about incontinence and erectile dysfunction. I am recently remarried, and this is affecting my relationship.

My father died from prostate cancer at 72, but his disease was more advanced. The surgeon mentioned robotic surgery and radiation as options, but I do not know which one is better. I run a small business and cannot afford to be out for months recovering. I am also worried about the cost because I have high-deductible insurance.

I am wondering if there are less invasive treatments. How quickly does this type of cancer spread? Should I get a second opinion? What is the difference between surgery and radiation outcomes? My new wife is supportive, but I can tell she is scared, too.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I completely understand the fear your family is experiencing, especially since you have been diagnosed with prostate cancer and your father also had the same condition. But I want to reassure you that your Gleason score is not high. This places you in the intermediate-risk category, which means your cancer is not expected to progress aggressively or in a frightening way.

I also want to reassure you that your PSA (prostate-specific antigen) is not extremely high, which gives us the opportunity to choose from several effective treatment options. In your case, radiotherapy is often the best option. We usually do not prefer surgery because, as you know, its side effects can be significant, including erectile dysfunction, incontinence, and urinary symptoms that may persist. This is why we often recommend radical radiotherapy instead.

Insurance generally covers this treatment, especially given your family history. Radiotherapy does not require a long recovery period. The treatment typically involves a few sessions, depending on the size and location of the tumor, and you can continue working without difficulty. After treatment, we will reassess your cancer cells. If they are hormone-sensitive and your PSA remains high, we can add hormonal therapy. If not, you will continue with regular follow-up.

Radiotherapy usually preserves sexual function, and your relationship with your wife should remain unaffected. I also want to reassure you that, in terms of cancer control, both surgery and radiotherapy offer similar outcomes as radical treatment options.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.