Biopsy report in

Steve1961

Everybody knows my story, but if you don’t prostrate cancer five years ago, 3+4 radiation treatments plus the breakytherapy booster. Now five years later PSA dropped from its lowest point of 0.9 up to 1.9 but here are the results. Very confusing. I do have a follow up visit on November 8, looks like it’s 4+ 4 this time but then again they’re saying it’s so small I can’t really tell very confusing I guess the good thing is I caught it early and it is very small and hopefully it looks like it’s still contained but maybe you can have a look . I guess I’m going have to definitely treat it again.

COMMENT:

In this case we note prostatic adenocarcinoma with no treatment effect

in parts D and I for which Gleason score has been provided. In addition

there are scattered foci of prostatic adenocarcinoma with radiation

changes; this is seen mostly as discontinuous single cells and single

glands. Gleason score is not applicable in treated carcinoma, and as

such Gleason score is not provided for treated tumor. Lastly, radiation

changes are seen in benign prostate tissue. 

In part I, there is carcinoma with no radiation changes and small

scattered foci of prostate carcinoma with radiation changes. 

In part D, the tumor focus is too small for accurate grading and Gleason

score 4+4=8 is favored. 

Gleason pattern 4 is comprised of expansile cribriform and poorly formed

gland types. 

Slide for part I was also reviewed by Dr Simko at the GU case consensus

conference on 10/25/2023 with agreement on the Gleason score and

interpretation. 

Clevelandguy

Hi,

Maybe Proton therapy, it can be used as a mop up after traditional radiation treatment. Check it out…

https://www.mayoclinic.org/tests-procedures/proton-therapy/about/pac-20384758#:~:text=Proton%20therapy%20may%20be%20used,after%20traditional%20X%2Dray%20radiation.

Dave 3+4

Steve1961

Metting with specialist to see if im a candidate for focal ablasion and with the same radiologist who wants to do brachytherapy again which I’m not fond of because it didn’t work the first time will it work this time really want to remove it but they seem really Leary I wish they would’ve expressed how having surgery after radiation it’s a very last resort.

Rob.Ski

That is disappointing that the docs didn't disclose difficulties of surgery after radiation. I had 2 radiologist tell me to get surgery and come back to see them if I had recurrence.

How is brachytherapy different from imrt with regards to getting a second round of treatment? I've heard and read docs won't radiate you twice. Can you get radiation or proton treatment after brachytherapy?

Steve1961

https://csn.cancer.org/discussion/comment/1710443#Comment_1710443

https://csn.cancer.org/discussion/comment/1710443#Comment_1710443

Its my own fault very first radiologist I saw had his own practice that is all he did. He has his own place just doing radiation only for men with prostrate cancer in women with breast cancer that is it and he told me to get surgery then I decided to see another radiologist and he told me I didn’t need surgery and then the surgeon told me I should have surgery but then he told me if I’m not comfortable with surgery they do radiation yes you just have to treat it. The outcomes are but both the same, I wish they would’ve got on the same page and They both came to an agreement. What was best for me? I have regrets but I can’t go back to answer your question. Yes, you cannot radiate twice breakytherapy they put the needles directly into the prostrate and just radiate that I’m very leery. It didn’t work the first time. Why would it work this time? I really don’t trust that radiologist. He should’ve told me as well to get surgery done but he didnt just hope it all works out. I am on top of it. I’ve caught it very early but at this point, I’d like to just remove it if I have to wear a diaper so be it, but I am going to set up an appointment with a surgeon at UCLA. They actually specialize in doing surgery after radiation. We’ll see what happens. This whole thing just stinks.

centralPA

https://csn.cancer.org/discussion/comment/1710451#Comment_1710451

It’s not true that you can’t do brachytherapy twice. In fact, it is an effective treatment, since they can just zap the localized recurrent cancer focally. Very recent study. HDR brachytherapy, not the permanent seeds.

https://www.tandfonline.com/doi/full/10.1080/21681805.2023.2168048#:~:text=In%20conclusion%2C%20salvage%20HDR%20brachytherapy,low%20acute%20and%20late%20toxicity.