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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 42869
Experience:  Board Certified Physician
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Prostate. I have been diagnosed with a Gleson 6 prostate cancer

Customer Question

Prostate. I have been diagnosed with a Gleson 6 prostate cancer after biopsy. The result shows it is in one side of the prostate. I have enlarged prostate which is also obstructing my uring flow. I am told I have to have a scrapping done to increase the urine flow and 3 mothis after that procesure I willhave the Brycheraphty done. What is life expectancy after Brycheraphy treatment.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.

Dr. David :

This is Dr. David

Dr. David :

brachytherapy treatments for prostate cancer are highly successful in treating and curing prostate cancer,

Dr. David :

however, the procedure needs to put 10-20 needles into the prostate to deliver radioactive seeds into the prostate which give off radiation for about 2 months so you can't be close to other people or babies or pregnant women in those two months.

Dr. David :

and the procedure itself causes substantial more swelling of the prostate gland which can make urination more difficult. and if you have difficulty with urination at this point, some doctors would say this is not the right treatment for you

Dr. David :

some doctors would recommend external beam radiation to your prostate gland for 7-8 weeks of radiation as this causes less problems with temporary swelling of the prostate and urination problems.

JACUSTOMER-ydtksjg9- :

WhaT about the Lucrin therapy which the Uroplogist says Ineed to have every three months and am reluctant to have it because of the side effects.

Dr. David :

because if the swelling gets too bad and you can't urinate, they will have to put a foley catheter into your bladder through the prostate gland to empty your urine and this can lead to infection risks.

Dr. David :

you probably mean lupron therapy which is an anti-testosterone hormone shot which can shrink the prostate slightly

Dr. David :

this is not needed for gleason 6 prostate cancer treatment

Dr. David :

it is used with radiation for more advanced prostate cancers like gleason 7-10 prostate cancers

Dr. David :

just using it to shrink your prostate is not a great use of it.

Dr. David :

and it does take away testosterone for 3-4 months at a time which will take away your libido and erections for that period of time.

Dr. David :

usually the testosterone comes back 6-12 months after the lupron shots wear off

Dr. David :

I would opt for not the brachytherapy, but for the external beam radiation if possible for your prostate cancer.

Dr. David :

I am a radiation oncology cancer doctor in the USA

Dr. David :

let me know if you have other questions.

JACUSTOMER-ydtksjg9- :

What about the Lucrin injection theraphy that the Urologist says I need to have for three months which I am reluctant tohave becuase of the maney side effects. Can you advise on this please.

Dr. David :

Lucrin injection are called lupron injections in the USA.

Dr. David :

they are the same thing. leuprolide injections which take away the body's testosterone level for 3 months.

Dr. David :

did you see what I wrote about them above.

Dr. David :

lucrin are not needed for gleason 6 prostate cancer treatment.

Dr. David :

they are used with radiation for gleason 7-10 more advanced prostate cancers.

Dr. David :

just using lucrin injections to try to shrink the prostate can be done, but not a great use of the medication.

Dr. David :

it does take away testosterone for 3-4 months at a time which will take away your libido and erections for that period of time

Dr. David :

usually the testosterone comes back 6-12 months after the lupron shots wear off

Dr. David :

I would opt for not the brachytherapy, but for the external beam radiation if possible for your prostate cancer.

Dr. David :

I am a radiation oncology cancer doctor in the USA

JACUSTOMER-ydtksjg9- :

I have done bone scan and CT scan of the pelvis areas and both are negative.I have enlarged prostate and this is causing obstruction of the urine flow and inconsistence as I cannot always empty the bladder. The Urologist recomemnd that I do a scrapping of the urethrea and part of the prostate to increase the flow of urination and then do the brachytherapy three monhts after the scrapping procedure.Your advise please

JACUSTOMER-ydtksjg9- :

I am waiting for your reply about the scrapping of the urethrea and part of the prostate to increase the urine flow wich the Urologist recommends I need to have

Dr. David :

did you not see my reply above?

Dr. David :

oh.

Dr. David :

you can have a scraping procedure.

Dr. David :

this is called a TURP or trans urethral resection of prostate tissue.

Dr. David :

where the urethral path is widened inside of the prostate to allow for easier urine flow.

Dr. David :

this is the proper procedure for you to have to improve your urination.

Dr. David :

also have your doctors analyze the prostate tissue cut out from the center of the prostate and see if there is prostate cancer in the tissue cutout.

Dr. David :

they could also find prostate cancer gleason 6 cancer in the scrapping prostate tissue.

JACUSTOMER-ydtksjg9- :

He has told me that the tissues from the scrapping will be further analysed. The tumor is 1.2mm in size. Is Gleason score 6 a low risk or intermetdiate risk and is is slow growing or fast..

Dr. David :

1.2mm in size is super super super super small

Dr. David :

gleason 6 is low risk.

Dr. David :

what is your PSA level?

Dr. David :

gleason 6 is slow growing at your age

Dr. David :

at age 70 your testosterone levels are naturally declining.

Dr. David :

and this will cause your prostate cancer to grow slower.

Dr. David :

I would not be worried about this gleason 6 prostate cancer.

Dr. David :

some doctors would say that you don't even need treatment for this gleason 6 cancer because it is so slow growing and so small.

Dr. David :

and that watching the prostate cancer is an option as well.

Dr. David :

did your doctor talk to your about just watching this prostate cancer?

JACUSTOMER-ydtksjg9- :

My PSA has been as follows recently : May 2013 6.78 ; December 2013 9.62 ; Jan 2014 8.59 ; Feb 2014 was 17 and another one at 11.7 three days after the 17 level; March 2014 10.32. I also had an ultra sound in February and the size was given as 65x46x57 . In the lab report after biopsy in the left prostate one of the eight cores submitted is involved by a 1,2mm focus of moderately differentiated invasive adenocarcinoma gleson score 6 (3+#) no perineural permeation by tumour is seen. The right side of prostate features are those of begign fibromauscular and adenomatous hyperplasia and chronic prostatitis - no invasive malignacy is noted in these cores ( there were nine cores)

Dr. David :

I see.

Dr. David :

still sounds low risk and slow growing.

Dr. David :

your prostate is quite large.

Dr. David :

it will be difficult to do brachytherapy on a large prostate.

Dr. David :

and doing brachytherapy will cause a lot worse short term swelling of the prostate which will make urination more difficult.

Dr. David :

I would not do brachytherapy with such a large prostate.

Dr. David :

if you want your prostate cancer treated, I would opt for external beam radiation therapy after your TURP scrapping procedure.

Dr. David :

does this make sense?

JACUSTOMER-ydtksjg9- :

It does based on your advice. Do you recommend prostactectomy in this situation in view of the enlarged prostate and what are the risks at my age. I amotherwise a healthy person who is reasonably fit as I exercise four time a week and jog for approx 6 km and my average heart rate is about 145/144 and maximum over 150/165 when exercising. Normal is about just about 72. This diagnosis has an impact on my life and that of my family and I need to do all possible to find a cure for it though difficult I think.. .

Dr. David :

no, I would not recommend prostatectomy.

Dr. David :

this can damage your sexual nerves and can cause urinary incontinence.

Dr. David :

I would recommend external beam radiation

Dr. David :

again, you have to realize even if you are in excellent shape, that a small gleason 6 prostate cancer at your age most likely will not cause you to die and will not impact you in your lifetime most likely

Dr. David :

and it is your choice to treat this cancer or to simply watch it.

JACUSTOMER-ydtksjg9- :

What are the chances of the cancer reocuring afer external bean radiation therapy and the rate of success of exterbnal beam radiation therapy.

Dr. David :

because it is so slow growing and non consequential.

Dr. David :

external beam radiation has a 90%+ long term cure rate.

JACUSTOMER-ydtksjg9- :

I am sometime getting a sediment ( sperm like) before I urinate what is this and cause of it.

Dr. David :

this is most likely semen or seminal fluid coming out before you urinate.

JACUSTOMER-ydtksjg9- :

What supplement do you recommend that I can take ,if any avaialble, to shrink my prostate size

Dr. David :

there are prescription medications like finasteride (proscar) and avodart which can shrink about 5-10% over time.

Dr. David :

it can take several weeks to months to slowly shrink with these prescription medications.

Dr. David :

you can talk to your doctor about them.

Dr. David :

best of luck to you

Dr. David :

let me know if you have other questions

Dr. David :

if done for now, please leave positive feedback below the chat box

Dr. David :

you can always reach me as Dr. David if you have other questions.

JACUSTOMER-ydtksjg9- :

Thak you for your time and advice which is greatly apprecaited.

Dr. David :

you might have to scroll down to see the ratings area

Dr. David :

you are welcome

Dr. David :

http://www.justanswer.com/medical/expert-dr-david/

Dr. David :

is my personal website

JACUSTOMER-ydtksjg9- :

sorry for typo errors .

Dr. David :

where you can reach me again if you have other questions.

Dr. David :

that is ok.

Dr. David :

best of luck to you

Dr. David :

thank you for using JustAnswer.com

Dr. David :

don't forget to leave positive feedback below.

Dr. David :

thanks.

Dr. David :

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Dr. David :

hello?

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