Treatment Options

Don Larson, this is from 6/2016, but many of the questions still apply today.

1. What threshold of PSA is there for absolute need to treat my situation? What is the negative in waiting to treat until PSA gets larger, if it ever does?

2. What are the different treatments that can be used? Cyberknife, internal and external radiation, hormone therapy, ADT, Bemer magnetic, etc. Pros and cons of each? SIDE EFFECTS and how can you reduce?

3. Will hormone therapy help with the success of radiation?

4. What are the chances of success for someone with my stats?

5. Is there any way to narrow down and therefore lessen the side effects of radiation?

6. Are there different intensities with radiation? Less times to administer if higher intensities? How close can you pinpoint on the cancer? Pros and cons?

7. Percentage of radiation cases that cause other cancer?

8. PET scan possibility? Other ways besides PSA to find the cancer?

9. Hormone treatments? If suggested, are there different types? When is it done? Does one need to go thru hormone treatments at the same time as radiation? If at the same time, how would one know what is working?

10. How can I know the expertise of the Dr. that I may choose to do the treatments? Are there ways to check? How many of these kinds of situations have you done?

These are just suggestions above, expand as you feel comfortable

PROSTATE QUESTIONS Before Decision on how to treat, after confirmed positive biopsy

It is recommended that you interview (get second opinions) with several Drs. before you make the decision how to treat your cancer. Every situation is different, and doctors will “sell” you on their specific speciality, like radiation, surgery, seeds, drugs…

Make a list of questions and make sure to ask the same questions of each Dr. If you do not do this, one questions asked differently or not asked will sway your interview one way or another. Be consistent.

Here is my list that I used. It is several years old, so add whatever questions you feel you want to, this is only meant as a START.

Will the treatment options change if I had a more up-to-date MRI done? (I had a 1.5T-MRI on 10/6, perhaps a 3T-MRI is better?)
2. Are there other tests that should be done to determine what treatment is best?

3. How urgent is the need for treatment? What are my risks for waiting until March 15?

4. How do I get other professional opinions on the Gleason score/stage, and also treatment options? Do you recommend any? (I understand 3+4 is much different from 4+3 and that score is subjective per the pathologist)

5. If I go with surgery, what is the soonest I can get in, and would you recommend; robotic or retropubic and why? Hormonal, external, or radiation seeds therapy? Why or why not? Combinations of more than one perhaps? If robotic, does your current robot use a 4th arm? What are the recovery time and risks?

6. How many of these operations have you performed, per year and lifetime? What is the percentage that lose their ability for erection, have incontinence, and/or orgasm feeling? How do you know this information?

7. If I choose RP, will hormone or any kind of radiation therapy before I can schedule the surgery be of any benefit?

8. What is the significance of the location and volume of my prostate for treatment selection?

9. Should another PSA test/MRI be done before deciding on treatment? What other tests would help to make a best decision?

10. I have read there is a unusual form of cancer. It is will cause high PSA’s, but be unnoticeable in DRE and hard to diagnose because of many negative biopsies because of the location in the transition zone. Can this be me? (Pg 204, Dr. Walsh cancer book.)

11. Free PSA? I do not believe I have ever been tested for this. Should I be?

12. Proton radiation Therapy. New technology? Consider for me?

13. Am I a candidate for Focal Therapy?

14. New PMSA technology, is it only for recurrence cancer or can I be a candidate?

15. NEW technology (now used only for BPH) using steam ablation. Can I get on a clinical trial for this?