New CA Diagnosis
Comments
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Dave, Keep in Mind
AS is not a lifetime guarantee, so I have been researching treatments for myself for 15 years. That involves many in-person suppport meetings, a dozen or so websites like this one, five Facebook PCa support groups, and now various Zoom gatherings. So, I have heard from thousands of men who have had a spectrum of treatments. I've probably posted 8,000 comments on various forums. You need to understand that my strong opinions did not come from reading studies, they came from all the first-hand accounts I was told by men who walked those walks. The boomarking of hundreds of studies came later, to reinforce that there was easily cited facts to support my views.
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Well ASA I guess we can agree
Well ASA I guess we can agree to disagree on how bad surgery is.
Dave 3+4
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OverallASAdvocate said:Dave, Keep in Mind
AS is not a lifetime guarantee, so I have been researching treatments for myself for 15 years. That involves many in-person suppport meetings, a dozen or so websites like this one, five Facebook PCa support groups, and now various Zoom gatherings. So, I have heard from thousands of men who have had a spectrum of treatments. I've probably posted 8,000 comments on various forums. You need to understand that my strong opinions did not come from reading studies, they came from all the first-hand accounts I was told by men who walked those walks. The boomarking of hundreds of studies came later, to reinforce that there was easily cited facts to support my views.
AS, your demeanor and approach to the PCa issue is what is termed in classical logic (Aristotelain logic) "the appeal to authority."
Cleaveland's posts, as always for him, were never snarky or rude -- observations I wish were attributable to you as well.
I admire the value you bring to the discussion, in knowing so well Best Practices protocols for AS generally. But millions, I suspect even tens of millions, of men have been treated and or cured of this disease with both surgery and various modes of radiation worldwide. No one has ever been 'cured' via AS. Stop gnawing on the hand that feeds.... And I agree with Joseph that this tit-for-tat is inappropriate and hopefully has run its course. But no one appointed me Hall Monitor.
There have been occassional doctrinaire writers here over time: men for whom radiation is good, surgery evil, or all other possible responses to a diagnosis. This is childish and can never claim overwhelming empirical support, given the millions sucessfully treated in the many ways available. Your level of obsession, as indicated by the number of groups you are involved with, suggests to educated laypeople that you may have issues that are not wholly PCa in etiology. There is interest, there is due diligence, there is persistence, and then there are responses way beyond all of these.
My thoughts here may seem to you judgemental, but they are in fact the opposite: an insistence that all mainstream medical responses are potentially good, when supervised by a doctor. I have never denigrated AS, radiation, proton, or sugery. I have posted often praises of AS in fact, given that I have a close friend for whom it has worked wonderfully. It is you who tend toward judgementalism and narrowness.
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While reading thru this treadClevelandguy said:Data plus real world experiences
Hi Hopeful,
You and ASA can spout all the studies you want and they are fine backup reading when you are trying to make a decision. But its not the only thing I considered when I decided on my treatment plan. I also wanted to hear first hand from men who have either had surgery or radiation. As any learned person knows there is text book learning and real world knowledge and both are very valuable. I would think Steve 1961 would differ with your accounts on the bebefits of radiation as MK 1961 had a lot of problems after his prostate surgery. I did choose surgery but is it right for everyone, no, based on your unique set of circumstances. So what's the point? The point is use the data plus first hand accounts to help guide you to your decision. Its not fair to condem one treatment over the other and a lot of people on this forum have had great success with either radiation or surgery so lets give both a fair shake. Let the new cancer patient decide on facts which include data plus first hand knowledge and not someones personal bias when they have not walked the talk. It hard enough to make a decision when faced with the big C. And by the way Hopeful, Apple pie can be mighty tasty with a side of vanilla ice cream.
Dave 3+4
While reading thru this tread, I see I was mentioned as bad surgical outcome.
And this is throught. I had very bad surgical outcome.
Was dx with prostate cancer at age of 51. I was very healthy in excellent physical shape, not on any medicatio, was very active, excercised 4-5 times a day, and on weekends, officiated lots of soccer games for last 12 years. Just to mention; I am non smoker, non drinker and not overweight.
Had RARP on 11/02/2016. I reached continence in about 5 months but still I have stress incontinece on any physical strenous movents and also with snizing, while coughing and leaking during sex.
After RP I tried everything possible to recover my erectile function with no success at all. I used Cialis, Viagra, VED, TRIMIX, BIMIX and nothing worked excpet partial erections 60-70% with TRIMIX but TRIMIX was so extremely painful that I could not stay engaged in intercurse longer then just a few minuets with pains and aches in my penis for 24 hours post injecting.
Almost 4 years after and I still regret having RP. RP ruined my life for the rest of my life.
The only success so far is that my PSA is <0.006.
MK
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Met with Surgeon
I met with the surgeon yesterday and he was very helpful. He did not try to convince me one way or another. He felt very confident that the risk of incontinence with RP is very low 2-3% for his patients. He guaranteed that I will have a greater challenge with impotence. I was concerned that because my prostate is on the larger side (90cc), it may me more problematic for removal and possible increased risk of incontenence. He felt treatment with Finasteride 3-4 months prior would shrink the prostate so that surgery would not have any significant increased risks of side effects. He encouraged me to consult with the radiology oncologist regarding the different options for external beam radiation which I am considering and will have that consult in August. My wife was present at the surgical consult and still hears what she want, which is that I can wait for a year before deciding on treatment. The surgeon actually said that where I am on the scale of the disease is intermediate prostate cancer and that delaying treatment 6 months will not have and adverse effect on the outcome of the treatment be it radiation or surgery. Based on the input from all of you above, I should take the time to research all the options and come to a decision in the next 3-4 months. I have also spoken to my two adult children, who are both in the healthcare field, and they understand and sympathize with my situation. Hopefully, my wife will come to terms with the fact that I need treat my cancer with a definitve treatment and not watch it through active surveilence and just hope and pray is doesn't metastasize . I really appreciate the support and information from this group and will use it as I take this journey fighting PCa. Thank you!
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Down the path....
Hi,
Sounds like you are going down the right path by analyzing your options along with your team, wife, doctors, back up data, ect.. When the time comes you should feel comfortable with your choice because you did your homework. Good luck in the future on fighting the beast. When you pick your treatment plan there are lots of good people here to give you their feedback on your choice If you would like the advice.
Dave 3+4
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Doing your homeworkPayneOrtho61 said:Met with Surgeon
I met with the surgeon yesterday and he was very helpful. He did not try to convince me one way or another. He felt very confident that the risk of incontinence with RP is very low 2-3% for his patients. He guaranteed that I will have a greater challenge with impotence. I was concerned that because my prostate is on the larger side (90cc), it may me more problematic for removal and possible increased risk of incontenence. He felt treatment with Finasteride 3-4 months prior would shrink the prostate so that surgery would not have any significant increased risks of side effects. He encouraged me to consult with the radiology oncologist regarding the different options for external beam radiation which I am considering and will have that consult in August. My wife was present at the surgical consult and still hears what she want, which is that I can wait for a year before deciding on treatment. The surgeon actually said that where I am on the scale of the disease is intermediate prostate cancer and that delaying treatment 6 months will not have and adverse effect on the outcome of the treatment be it radiation or surgery. Based on the input from all of you above, I should take the time to research all the options and come to a decision in the next 3-4 months. I have also spoken to my two adult children, who are both in the healthcare field, and they understand and sympathize with my situation. Hopefully, my wife will come to terms with the fact that I need treat my cancer with a definitve treatment and not watch it through active surveilence and just hope and pray is doesn't metastasize . I really appreciate the support and information from this group and will use it as I take this journey fighting PCa. Thank you!
Sounds like you are doing your homework. That is exactly what you should be doing. Remember the decision is yours based on the information provided. There are a lot of questions to ask as you can see from the comments you are receiving. From my experience, and I am around 10 years older than you, be sure and keep quality of life points of interest in front of you. Start preparing by getting in the best shape you can prior to the radiation or surgery treatment. There is a physical side and sometimes a more important point, a mental side. Stay positive. You can beat this with either treatment, radiation or surgery. Your case is unique to you. You are driving this train. If someone told me that they could cure me with radiation or surgery with no side effects, I am certain I would choose radiation. There are a lot of good folks on this site that will feed you with a fire hydrant. Just take your time and absorb it. Your main focus should be what treatment is going to deal this cancer a knock out blow, with minimum side effects, and minimum impact on your quality of life. Good luck on your journey.
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Here are notes that I took from a presentation by mark Schulz, world renowned medical oncologist who only specializes in Prostate cancer. The presentation can be found on YouTube.
radical prostatectomy for basic teal Prostate cancer-Prostate cancer staging guide
the presentation is about eight minutes
Surgery for intermediate
Technology in radiation has advanced, while surgery long considered the gold standard has stayed about the same.
Surgery is an operation and Anesthesia is given. There are studies that indicate long term memory loss with Anesthesia
Radiation provides greater preservation of urinary and sexual function. Surgery scores poorer.
After surgery everyone is impotent, and a minority show improvement. A minority of men of 5 to 10 percent claim that their erections are the same as before surgery.
Leaking urine is fairly non existent with radiation. But the majority of men who have surgery become incontinent right after surgery(the majority recover with fairly good control, however between 5 and 15 percent depending on age do not)
Stress incontinence (laughing, jumping) can occur resulting from surgery....
About 20% of men ejaculate with urine
Advantages with surgery
Patient who has a very large prostate and pre-existing urinary blockage from a large prostate. When you give radiation to a large prostate these conditions can intensify.
More accurate staging
Summary
More side effects
Cure rates no better
Need to have a major operation
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Max, Max. Max....Overall
AS, your demeanor and approach to the PCa issue is what is termed in classical logic (Aristotelain logic) "the appeal to authority."
Cleaveland's posts, as always for him, were never snarky or rude -- observations I wish were attributable to you as well.
I admire the value you bring to the discussion, in knowing so well Best Practices protocols for AS generally. But millions, I suspect even tens of millions, of men have been treated and or cured of this disease with both surgery and various modes of radiation worldwide. No one has ever been 'cured' via AS. Stop gnawing on the hand that feeds.... And I agree with Joseph that this tit-for-tat is inappropriate and hopefully has run its course. But no one appointed me Hall Monitor.
There have been occassional doctrinaire writers here over time: men for whom radiation is good, surgery evil, or all other possible responses to a diagnosis. This is childish and can never claim overwhelming empirical support, given the millions sucessfully treated in the many ways available. Your level of obsession, as indicated by the number of groups you are involved with, suggests to educated laypeople that you may have issues that are not wholly PCa in etiology. There is interest, there is due diligence, there is persistence, and then there are responses way beyond all of these.
My thoughts here may seem to you judgemental, but they are in fact the opposite: an insistence that all mainstream medical responses are potentially good, when supervised by a doctor. I have never denigrated AS, radiation, proton, or sugery. I have posted often praises of AS in fact, given that I have a close friend for whom it has worked wonderfully. It is you who tend toward judgementalism and narrowness.
Thank you for your attempt at psychoanalyis. If you saw my facebook page, you would realize that I have many hundreds of friends and ongoing activities, such as traveling all over the world. PCa is not an "obsession" for me, but I do have free time on most days to check various news, politics, and PCa support sites. I do have strong opinions, as is expected for someone who takes "advocate" for their screen name. The synomym for advocate is partisan.
As far as denigrating treatments, I always can suppport my statements with peer-reviewed studies. But, the opinions were formed by statements of hundreds of men who told me they were unhappy with surgery. I know, the ones who are unhappy are the ones who hang around and gripe, like restaurant reviews. But, I heard what I heard.
At some future point, there will probably be some effective treatment that will not have potentially devasting side effects. Until then, whenever I hear somebody tell a newly diagnosed man to just "get it out", I shall contunue to voice my opinion that surgery is no longer the "gold standard" and that other options should be explored.0 -
Update
Hi All,
My surgery went like this:
Technology in radiation has advanced, while surgery long considered the gold standard has stayed about the same. Surgery has changed over the years from completely open with several days in the hospital to using a robot with five small incisions, hospital stay for me was overnight, no infections or complications.
Surgery is an operation and Anesthesia is given. There are studies that indicate long term memory loss with Anesthesia I had no long or short term memory loss with my surgery no do I know anyone having any type of memory loss with any surgical procedure.
Radiation provides greater preservation of urinary and sexual function. Surgery scores poorer.
Surgery most of the time results in imediate loss of urinary function and sexual function. I regained about 90-95% of my urine control and about 90% of my sexual function.After surgery everyone is impotent, and a minority show improvement. A minority of men of 5 to 10 percent claim that their erections are the same as before surgery. Yes I was impotent after surgery but went back to the about 90% within two years. My erections are more than suffiecient to "do the job" now.
Leaking urine is fairly non existent with radiation. But the majority of men who have surgery become incontinent right after surgery(the majority recover with fairly good control, however between 5 and 15 percent depending on age do not) Same as above with just a slight dribble now during heavy excersize. No leakage just sitting or sleeping at night.
Stress incontinence (laughing, jumping) can occur resulting from surgery.... Can be true, but I don't leak when I laugh or jump. Of course I never jumped much before or after surgery, LOL.
About 20% of men ejaculate with urine Not me
Dave 3+4
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In support of "hopeful " Ihopeful and optimistic said:.
Here are notes that I took from a presentation by mark Schulz, world renowned medical oncologist who only specializes in Prostate cancer. The presentation can be found on YouTube.
radical prostatectomy for basic teal Prostate cancer-Prostate cancer staging guide
the presentation is about eight minutes
Surgery for intermediate
Technology in radiation has advanced, while surgery long considered the gold standard has stayed about the same.
Surgery is an operation and Anesthesia is given. There are studies that indicate long term memory loss with Anesthesia
Radiation provides greater preservation of urinary and sexual function. Surgery scores poorer.
After surgery everyone is impotent, and a minority show improvement. A minority of men of 5 to 10 percent claim that their erections are the same as before surgery.
Leaking urine is fairly non existent with radiation. But the majority of men who have surgery become incontinent right after surgery(the majority recover with fairly good control, however between 5 and 15 percent depending on age do not)
Stress incontinence (laughing, jumping) can occur resulting from surgery....
About 20% of men ejaculate with urine
Advantages with surgery
Patient who has a very large prostate and pre-existing urinary blockage from a large prostate. When you give radiation to a large prostate these conditions can intensify.
More accurate staging
Summary
More side effects
Cure rates no better
Need to have a major operation
In support of "hopeful " I will say that everything you mentioned in your post happened to me.
i have fair amount of stress incontinence some times for now reason, sometimes with reasons mentioned in this post.
i also leak when araused and during sex. Want to add total anorgasmia as another SE which happened to me.
I never recovered erec function. Went into surgery 100% POTENT and ended up 100% IMPOTENT.
ALSO, LOST 2+ INCHES OF LENGTH AND SOME GIRTH.
Was my RP gold standard? Yes, it was GOLD for my doctor but it was and still is MISERY for me.
MK
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Mayo Clinic Risks External Beam Radiation Therapyhopeful and optimistic said:.
Here are notes that I took from a presentation by mark Schulz, world renowned medical oncologist who only specializes in Prostate cancer. The presentation can be found on YouTube.
radical prostatectomy for basic teal Prostate cancer-Prostate cancer staging guide
the presentation is about eight minutes
Surgery for intermediate
Technology in radiation has advanced, while surgery long considered the gold standard has stayed about the same.
Surgery is an operation and Anesthesia is given. There are studies that indicate long term memory loss with Anesthesia
Radiation provides greater preservation of urinary and sexual function. Surgery scores poorer.
After surgery everyone is impotent, and a minority show improvement. A minority of men of 5 to 10 percent claim that their erections are the same as before surgery.
Leaking urine is fairly non existent with radiation. But the majority of men who have surgery become incontinent right after surgery(the majority recover with fairly good control, however between 5 and 15 percent depending on age do not)
Stress incontinence (laughing, jumping) can occur resulting from surgery....
About 20% of men ejaculate with urine
Advantages with surgery
Patient who has a very large prostate and pre-existing urinary blockage from a large prostate. When you give radiation to a large prostate these conditions can intensify.
More accurate staging
Summary
More side effects
Cure rates no better
Need to have a major operation
Potential side effects of external beam radiation therapy for prostate cancer may include:
- Frequent urination
- Difficult or painful urination
- Blood in the urine
- Urinary leakage
- Abdominal cramping
- Diarrhea
- Painful bowel movements
- Rectal bleeding
- Rectal leaking
- Fatigue
- Sexual dysfunction, including diminished erectile function or decrease in the volume of semen
- Skin reactions (similar to a sunburn)
- Secondary cancers in the region of the radiation
Most of the side effects are mild and tolerable. Some side effects may develop months to years later. Serious late side effects are uncommon. Ask your doctor about potential side effects, both short- and long-term, that may occur during and after your treatment.
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Treatment options basic intermediate PCa. Notes
Treatment choices intermediate PCa Scholtz
Web site pcri.org prostate cancer research institute
“Choosing a treatment for intermediate risk prostate cancer/prostate cancer staging guide”. (Notes from this presentation found on YouTube)
Best cure rates...radioactive seed implants ...better than all other treatments to include TIPS which really doesn’t cure prostate cancer but puts in remission
Convenience.....seeds near the top. SBRT aka cyber knife, both treatments are of short duration.
IMRT IMPT can require 5 to 9 weeks
Long term side effects.....hormone blockade or tips have the least side effects All side effects of TIP reverse when the treatment is stopped.
All other radiation side effects are similar (important to go to a quality center)
There is some data that MAY indicate that seeds cause slightly more urinary problems than the others, but research really not that clear.
Surgery has higher risk of impotence and incontinence
All of the above treatments should be considered for basic intermediate cancer, not ones with small amount of Gleason 4 where Active Surveillance is an option or Gleasons 4+3 where combo therapies
Patient needs to make a list of what is important to him in making a choice.
Avoiding bad things is the basis goal.
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USTOO hot sheet, February
Patient-Reported Outcomes Through Five Years for Active Surveillance, Surgery, Brachytherapy or External Beam Radiation With or Without Androgen Deprivation Therapy for Localized Prostate Cancer
Hoffman KE, Penson DF, Zhao Z, et al.
JAMA 323: 149-163, 2020
Importance: Understanding adverse effects of contempo- rary treatment approaches for men with favorable- and unfavorable-risk localized prostate cancer (prostate cancer) could inform treat- ment selection.
Objective: To compare func- tional outcomes associated with prostate cancer treat- ments over five years after treatment.
Design, Setting, and Partici- pants: Prospective, popula- tion-based cohort study of 1,386 men with favorable- risk (clinical stage cT1 to cT2bN0M0, PSA ≤20 ng/mL, and Grade Group 1-2) pros- tate cancer and 619 men with unfavorable-risk (clinical stage cT2cN0M0, PSA of 20- 50 ng/mL, or Grade Group 3- 5) prostate cancer diagnosed in 2011 through 2012, ac- crued from five Surveillance, Epidemiology and End Re- sults Program sites and a US Prostate cancer registry, sur- veyed until September 2017.
Exposures: Treatment with active surveillance (AS; n=363), nerve-sparing radical prostatectomy (RP; n=675), external beam radiation ther- apy (EBRT; n=261), or low- dose-rate brachytherapy (LBR-BT; n=87) for men with favorable-risk disease and treatment with RP (n=402) or EBRT with androgen depriva- tion therapy (ADT; n=217) for men with unfavorable-risk disease.
Main Outcomes and Measures: Patient-reported function, based on the 26- item Expanded Prostate In- dex Composite (range, 0- 100), five years after treat- ment. Regression models were adjusted for baseline
function and patient and tumor characteristics. Mini- mum clinically important difference was 10 to 12 for sexual function, 6 to 9 for urinary incontinence, 5 to 7 for urinary irritative symp- toms, and 4 to 6 for bowel and hormonal function.
Results: A total of 2,005 men met inclusion criteria and completed the baseline and at least one postbaseline survey (median [interquartile range] age, 64 [59-70] years; 1,529/1,993 [77%] subjects were non-Hispanic white).
For men with favorable-risk prostate cancer, nerve- sparing RP was associated with worse urinary inconti- nence at five years (adjusted mean difference, -10.9 [95% Confidence Interval
[CI], -14.2 to -7.6]) and sexual function at three years (adjusted mean
difference, -15.2 [95%
CI, -18.8 to -11.5]) vs. AS. LDR-BT was associated with worse urinary irritative (adjusted mean
difference, -7.0 [95% CI, -10.1 to -3.9]), sexual (adjusted mean difference, -10.1 [95% CI, -14.6 to -5.7]), and bowel (adjusted mean
difference, -5.0 [95% CI, -7.6 to -2.4]) function at one year vs. AS. EBRT was associated with urinary, sexual, and bowel function changes that were not clinically different from AS at any time point through five years.
For men with unfavorable- risk disease, EBRT with ADT was associated with lower hormonal function at six months (adjusted mean difference, -5.3 [95% CI, -8.2 to -2.4]) and bowel function at one year (adjusted mean difference, -4.1 [95% CI, -6.3
to -1.9]), but better sexual function at five years (adjusted mean difference, 12.5 [95% CI, 6.2-18.7]) and incontinence at each time point through five years (adjusted mean difference, 23.2 [95% CI, 17.7-28.7]), than RP.
Conclusions and Relevance:
In this cohort of men with localized prostate cancer, most functional differences associated with contempo- rary management options attenuated by five years. However, men undergoing RP reported clinically meaningful worse incontinence through five years vs. all other op- tions, and men undergoing RP for unfavorable-risk dis- ease reported worse sexual function at five years com- pared with men who under- went EBRT with ADT.
Meaning: These estimates of the long-term bowel, bladder and sexual function after lo- calized prostate cancer treat- ment may clarify expecta- tions and enable men to make informed decision about care
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Biopsy targeted versus random, versus combination
In this thread we discussed the number of cores taken in the biopsy. Here is information that will provide insight
Low-grade prostate cancer (PCa) is associated with a very low risk of PCa-specific death and often does not require treatment; spread with high-grade PCa is much more likely and is responsible for most PCa deaths. “PCa in Gleason grade groups (GG) 3-5 account for a majority of PCa deaths in the U.S. each year. The variation in disease lethality underscores the importance of accurate diagnosis,” noted Peter A. Pinto, MD, head of the Prostate Cancer Section of the National Cancer Institute Urologic Oncology Branch, and colleagues. They found that combined use of magnetic resonance imaging (MRI)-targeted biopsy and 12-core systematic biopsy led to enhanced detection of PCa vs. either method alone among men with MRI-visible lesions. Findings were published online in the New England Journal of Medicine. “PCa is one of the only solid tumors diagnosed by performing systematic biopsies ‘blind’ to the cancer’s location. For decades this has led to overdiagnosis and subsequent unnecessary treatment of non-lethal cancers, as well as to missing aggressive high-grade cancers and their opportunity for cure,” said Pinto in a press release. “With the addition of MRIbetter. There are many ways to lose weight, but finding one that is generally safe, effective, and heart healthy in cancer patients should be given enormous kudos, respect, and attention. I am grateful to all the researchers that were a part of this study. Thank you! Reference: 1. Freedland SJ, Allen J, Jarman A, et al. A Randomized Controlled Trial of a 6-month low carbohydrate intervention on disease progression in men with recurrent prostate cancer: Carbohydrate and Prostate Study 2 (CAPS2). Clin Cancer Res 27 February 2020 [Epub online] targeted biopsy to systematic biopsy, we can now identify the most lethal cancers within the prostate earlier, providing men the potential for better treatment before the cancer has spread.” The most common method for the initial diagnosis and grading of PCa is transrectal, ultrasound-guided, 12-core systematic biopsy. Unlike biopsies for most other types of cancer targeting abnormalities found by imaging, systematic prostate biopsy provides a non-targeted, systematically spaced sampling of the prostate gland. This approach leads to potential inaccuracies with disease grading. Combined Biopsy Strategy Improved Prostate Cancer Diagnosis Combo Biopsy Missed Only 3.5% of the Most Aggressive Cancers MRI-targeted biopsies merge images of suspected cancer taken earlier with real-time ultrasound technology. Studies have shown that MRItargeted biopsies result in a higher rate of detection of high-grade cancers vs. systematic biopsy. However, debate persists about whether MRI-targeted biopsy should be used in place of systematic biopsy or in conjunction with it. In the Trio Study, a substudy of the larger clinical trial, Pinto’s group evaluated the use of MRI-targeted biopsy, 12-core systematic biopsy, or the combination of the two in an attempt to define the most effective method for PCa diagnosis. Men eligible for the substudy had an elevated PSA level or abnormal digital rectal exam and were eligible for prostate MRI. Men with detected PCa could enroll in the study if they consented to prostate biopsy. Of this group, 2,103 men had MRI-visible lesions and were included in the analysis. They underwent both systematic and MRItargeted biopsies at the same center. The primary outcome was cancer detection according to Gleason GG. Clinically insignificant disease was defined as GG 1. PCa with favorable intermediate risk or worse was defined as GG 2 or higher, and GG 3 or higher was defined as cancer with unfavorable intermediate risk or worse. Upgrading and downgrading of GG from biopsy to whole-mount histopathological analysis of surgical specimens were recorded among the men who underwent subsequent radical prostatectomy (RP). Pinto and team found that systematic biopsy alone and MRI-targeted biopsy alone diagnosed PCa in 1,104 and 1,084 men, respectively. However, adding MRItargeted biopsy to systematic biopsy led to 208 (9.9%) more diagnoses, 59 (28.4%) of which were clinically significant (GG 3 or greater), vs. either method alone. The combination strategy also led to upgrading to a higher GG in 458 (21.8%) men. Overall, PCa was diagnosed in 1,312 men (62.4%) with the combination of the two biopsy methods, and 404 (19.2%) subsequently underwent RP. Cancer detection rates with MRI-targeted biopsy were significantly lower than with systematic biopsy for GG 1 PCa and significantly higher for GGs 3-5 (P <0.01 for all comparisons). Thus MRItargeted biopsy detected more clinically significant (GG ≥3) prostate cancers. Among the men who underwent RP, Pinto and team found that systematic biopsy alone underdiagnosed about 40% of cancers, and MRItargeted biopsy alone underdiagnosed about 30% of cancers, while combined biopsy underdiagnosed 14.4% of the cancers. In addition, while systematic biopsy and MRItargeted biopsy underdiag-nosed 16.8% and 8.7% of the most aggressive cancers, respectively, combined biopsy missed only 3.5% of the most aggressive cancers. The researchers acknowledged that results were obtained at only one institution and might not be generalizable to institutions with less experienced practitioners. Use of one physician to perform the systematic biopsy and another to perform the MRI-targeted biopsy is not representative of actual practice patterns, they noted. There was also the possibility of selection bias in the RP cohort, since RP was not performed in all men with a PCa diagnosis. MedPage Today 2 April 2020
Source ustoo, may 2020
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I will keep you in my prayers
A PC diagnosis or ANY cancer diagnosis shakes you to your bones. We went into shock for a few days. I did my crying and then we went into 'fight' mode. Don't give up yet. At your age, and with only 4 nodes, I would suggest external beam radiation. Hubby had successful radiation thereapy and finished late June. His PSA now is >0.1 and other than hot flashes and a bit of fatique from hormonal therapy, still works full time in construction at age 75! He has no incontinence - although does not put off using the restroom like he could prior to all this. I do hope that all will go well for you. The only downside to radiation is that it requries daily, M-F treatments for some time. We had to drive an hour each way. Hubs still worked part time during his treatments. All is not lost. Don't give up. FIGHT!
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Don't wait!
I'd recommend a fast decision. If the cancer is still contained inside the prostate, removal will rid you of it. If it escapes into the surrounding tissue and the lymph system, surgery is no longer going to solve all your problems.
I had eight sites at 3+4 or 4+3 and while waiting for a surgery date , the cancer escaped the prostate leaving me with radiation and brachytherapy (more radiation) as the only option. I'll never be sure whether the cancer will show up elsewhere.
Good Luck!
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colonoscopy before radiationhopeful and optimistic said:All of us go through shock
All of us go through shock and all those negative feelings when we are first diagnosed. This lasts for some months, so it is important to be in positive situations. Spend time with positive people, and, for example, if you attend religious services (by zoom), you want the clergyman to be upbeat and positive.
Let me emphasize that prostate cancer is very slow growing, so you do not have to rush into making a quick decision. You want to do things in a coordinated way to achieive the best results.
You mentioned that you live on the West Coast. I live in So. CA and am very familiar with the best doctors and centers of excelence here, and am willing to share with you, if you wish.. There are other posters who may provide insights about various geographic areas....What ever treatment that you decide on, you want the very best, an artist to handle the various aspects of your case. You also want to strive to be treated in a high volume center of excellence.
I am enrolled in an active surveillance protocol where I receive targeted biopsies using a Tesla 3 MRI and an Artemis three dimensional machine (a competitor of the UroNav machine that was used in your case). T. At any rate my doctor targets the suspecious lesions, then does a stratefied random sample of the rest of the prostate. Generally I receive about 15 sample cores.....
My highest Gleason is a 3+4; I have a small amount of 4 so this is considered appropriate for active surveillance. Since a 3 dimensional biopsy showed this Gleason, I had a follow up biopsy a year afterward that trigulated the area to see how extensive this was. Nothing was found in the area.
Your biopsy also indicates a small amount of 4, however it appears to me that there is a lot of Gleason 6. Now Gleason 6 will not leave the prostate, however when there is a lot of Gleason 6, it is very possible that there can be Gleason 4's hidden in the prostate. At any rate your doctor ordered a Decipher test, the results turned out to be a decider.
FYI
PIRAD ranks potential of significant cancer on a 1 to 5 scale, 1 being least likely and 5 most likely; 3 is neutral
The T3 MRI, does not show microscopic tumors, but the results of the MRI indicate that no cancer was found.
You may wish to visit with a medical oncologist for consultation that is unbiased....he/she may suggest that you have a pet scan to "really, really" make sure that there is no cancer outside the prostate. This might be overkill, but I would get an expert medical opinion. Axium petscan approved by medicare is a good one, however there is an investigational pet scan, PSMA that is the best....there is a $2700 charge for this one...UCLA does it.
Surgery is a localized treatment, and is more likely to have side effects such as incontinence and erectile dysfunction that radiation., shortening of the penis
There are various types of radiation; they all are comparable in outcome. The radiation oncologist can adjust the radiation to extend beyond the prostate; that is treat small cancers that may have escaped the prostate.
One that I favor is SBRT. Stereotactic body radiation therapy delivered by cyberknife, novalis and other machines. It's been around since 2003. It's a technological advance that has improved through image g uidance and development of shapeable radiotherapy beams. SBRT has the ability to to deliver higher dose of radiation in 4 or 5 sessions, over two weeks, and provides similar results to IMRT that takes 8 weeks. The amount of total Gy depending on the doc ranges from about 35 to 40 gys, much less than IMRT. While you are treated you can go about your regular activities.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679773/
Also good idea to have a colonoscopy before radiation.
n
Hi,
Did you hear this from a doctor? Please cite a specific source. What is the reason? That radiation might excacerbate any existing condition? Or is it only to have a baseline? And if anything is found in the colon, then what?
Thanks
0 -
I'm so sorry to hear yourMK1965 said:In support of "hopeful " I
In support of "hopeful " I will say that everything you mentioned in your post happened to me.
i have fair amount of stress incontinence some times for now reason, sometimes with reasons mentioned in this post.
i also leak when araused and during sex. Want to add total anorgasmia as another SE which happened to me.
I never recovered erec function. Went into surgery 100% POTENT and ended up 100% IMPOTENT.
ALSO, LOST 2+ INCHES OF LENGTH AND SOME GIRTH.
Was my RP gold standard? Yes, it was GOLD for my doctor but it was and still is MISERY for me.
MK
I'm so sorry to hear your story. I will certainly take it into account for my decision. Did/do you have any other conditions that might have caused this bad result?
I hope you are able to find other things in life to keep your spirits up.
And by the way - and please excuse me for asking - you say that you have never recovered erectile function, so does that mean that the 2 inches lost are from flacid state, or is that from a semi-erect-but-not-hard state?
Wishing you the very best possible
0
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