Once again....

hopeful and optimistic said:

biopsy

Max, if possible look into getting a directed biopsy using a 3T multiparametric MRI for guidance. This is cutting edge. It is done in one of two ways, 1) MRI looks for suspicious lessions; the MRI results are fused to a 3 dimensional biopsy machine that is able to  target any suspicious lessions,  if any.  Cores are taken., This procedure has the  abi;ity to go back to the exact same spot in a futre biopsy.

 

2) cores are taken with a Multiparametric MRI, able to use the MRI machine to back in real time to target cores.

 

These tests are superior to the 99 1/2 percent of the two dimensional ultrasound biopsy machines found in most urologist offices.

Hopeful,

I do not know what imaging they use, but will ask, and ask about if the 3T device is available.

max

Beau2 said:

Enlarged Prostate

You are correct, a large prostate could account for all of the increase in your PSA. 

Before you do a biopsy you may want to talk to your doctor about a few non-invasive tests that might help you understand your condition; 1.) Percent Free PSA, and 2.) Urine PC3 Test.

Best wishes as you move forward.

The urologist mentioned a blood tests that differentiated "bound protein verses unbound" for prostate cancer diagnosis. Is this the same thing as the Percent Free PSA test you mention ?

Living and learning,

max

Swingshiftworker said:

Need Your Biopsy Results

Regardless of the type of biopsy that is done, nothing can really be suggested until we get the pathology report.

Since you've dealt w/cancer before, a PCa diagnosis should not come as such a great shock to you.  My only cautionary note at this point would be to note that, when a PCa diagnosis is determined, many (if not most) urologists are VERY quick -- much TOO quick -- to recommend surgical removal.

I have no problem in saying that for most PCa patients surgical removal of the prostate is absolutely NOT the best choice.  It is an archaic procedure which presents all of the normal risks of surgery (infection & negligence being the greatest) and also present the greatest risk of ED and incontience following treatment for a minimum of 6 months to a year and (in the worst cases) permanently. 

There may be cases in which surgery is the best option (but I really can't think of any) and, given the current technology, radiation (especially CyberKnife SBRT) is a far suprior procedure.  All you have to do is troll the threads of this and other PCa forums and you'll find countless reports of FAILED surgeries that required follow up radiation (usualy IMRT) treatments. 

The first question that I asked myself when I was diagnosed w/PCa was, why should I subject myself to risks of surgery when I might have to have radiation treatment later AND my answer was there wasn't any good reason to do so.   That's why I chose radiation (specifically CyberKnife) and I am now cancer free w/o any side effects and have no regrets in making that decision.

It's undisputed that radiation techniques are now as good as surgery in terms of surviability for PCa and far surpass surgery in terms of minimizing side effects.  So, my word of warning to you is NOT to let your urologist bully you into a surgical solution until you have time to decide for yourself what treatment is best for you.

Upon hearing the PCa diagnosis, too many men just want the cancer gone and naively thing that surgery is the best option.  Surgery MAY be appropriate for your situation but you should do the research to learn about ALL of the available treatment options and then decide which method you want to choose.

Good luck! 

Swingshiftworker,

I checked their web site, and my hospital (which is a teaching facility for a med school also) does IMRT in their radiation department. Is this a new technique, or in common use in most places now ?  The site did not mention IGRT, so I don't know if they have that or not.

max

It is good to hear from you again, Vasco,

I am quite calm and OK with all of this. I do expect a postitive biopsy, but am hoping for a low Gleason, and Stage 1.  I know this disease is very treatable, and sometimes "curable."  I have learned (the hard way) that every type of cancer is very different.  Staging of lymphoma and leukemia, for instance is NOTHING like prostate cancer, and I suspect most organ cancers. In lymphoma, surgery is virtually never used, and radiation is uncommon, so the fact that surgery and radiation are the main tools against prostate takes a little mental adjustment.

Of five friends who are a bit older than myself (I am now 58), and who have had prostate cancer, two died, both after surviving about 13 years or thereabout, and the other three have had no recurrance or problems: two had surgical removal immediaely at around age 60, and ten or more years later are fine today, and the other, 72 now, has had nothing but "watch and wait," and is symptom free, and his PSA hardly changes at all from year to year.  So, the track record for men I have had direct familiarity with has been a survival rate (mostly without any symptoms) of at least a dozen years or more.   The future looks promising, at least for now, and new drugs are coming out all the time,

max

Old Salt said:

Very significant?

I don't agree that the increase in PSA from 3.7 to 4.6 is necessarily 'very significant'. Could be significant, but PSA tests depend on a lot of variables. Bike riding, recent sex, different labs, etc. PSA bounces without clinical significance also occur.

Nevertheless, getting a biopsy is the right approach to take and I hope that the results will be favorable.

As mentioned, I am having a biopsy in mid-October. I began asking a few questions regarding treatments to my urologist and she (rightly) said I was getting too far ahead. I tend to be a "fast study," but am amazed as how much complex detail so many of you have learned in the course of your treatments.  As I also mentioned to Vasco, lymphoma is NOTHING like any organ cancer -- a whole new world.  It is as if everything I learned over five years is useless in the context of prostate cancer. My college "science" was biology, which helps a little, and I did electonics in the Navy for years, which also helps a bit (I worked around nukes, and have been trained in radiation health a little, but not in a therapeudic context).

Shiftworker: You mentioned "SBRT/CyberKnife" above. Are these one and the same treatments ? My oncology group does "SBRT", so is this "Cyberknife"?   They also do daVinci prostate surgery. Again, is this something different? 

Headed to Barnes & Noble this week for some prostate cancer books !

max

max

Swingshiftworker said:

IMRT, IGRT, CK & other EBRT Technologies

IMRT is one of the most commonly available radiation technologies and it is often used for follow-up treatment following failed PCa surgery.  IMRT can used as a 1st option for PCa treatment but it is not the most precise method of delivery currently available (lack of precision can lead to some side effects) and requires 4-8 weeks of daily treatments (20-40) in order to complete the treatment program.  However, many men have been treated w/IMRT successfully.

Apart from IMRT, you should also look into low vs high dose brachytherapy (BT), proton beam therapy and CyberKnife (a form of SBRT - sterotactic body radiation therapy) as other alternatives.

CyberKnife is currently the most precise and advanced in terms of radiation delivery (which results in the lowest risk of side effects) and only requires 4-5 treatments over a week.  BT involves the temporary  HDR (high dose rate) and permanent LDR (low dose rate) placement of radioactive seeds in the prostate but problems can result for improper mapping, placement and/or movement of the seeds.  There are also PBR (pulse dose rate) and IG (image guided) BT which are attempts to "improve" the basic BT procedure but they require specialised equipment that is not generally available.  In initial studies, CK was most often compared w/HDR BT in terms of results and efficacy, becase they both involve the treatment of PCa with very high, temporary radation dosages within the entire protate capsule. 

Proton beam therapy (PBT) uses protons (rather than x-rays) to treat PCa but requires the use of a linear accelerator (ie., cyclotron) in order to generate the protons, which substantially limits the availiable treatment sites and greatly increases the cost of treatment.  Like IMRT, PBT involves a 4-8 week (20-40/day) course of treatment but also requires the patient to be fitted in a body cast to prevent movement and the insertion of a water ballon in the rectum to prevent damage to it during each treatment.  So, while apparently effective, it is also the least comfortable and convenient treatment of those mentioned.

IGRT involves the reimaging of the prostate w/ultrasound (or other methods) before each treatment is given.  3D CRT (conformal radiation therapy) maps the prostate in 3 dimensions prior to treatment but at only one point in time before treatment.  CK involves the imaging of the prostate during treatment (like IGRT) and 3D mapping of the prostate (like 3D CRT) but it does both of these things in REAL TIME during treatment.  So, it is a significant advancement beyond these and the other external beam radiation technologies (EBRT).

Swingshiftworker,

You seem to have studied the RT initial response to PCa especially well. The following question is therefore submitted to you, but ANYONE with information is asked to submit their thoughts.

Are you familiar with NORVALIS IMRT treatments ?  I think it is mostly a bunch of bragging about proprietary equipment, which does not readily appeal to me, but it is (as best I can tell) a high-quality IMRT; a highly-contoured RT delivery device.  I just learned that my local center has it, and admit to not having researched it much yet.

Again, anyone who has gotten feedback regarding it from their oncologist is asked to share what they have heard, good or bad.

max

Old Salt said:

Novalis

The Novalis instrument is from Varian. This company has been in the radiation/cancer oncology business for quite some time and equipment such as the Novalis system needs FDA approval (sigh of relief).

Looks nice to me (but pay no attention to my personal opinion): http://www.novalis-radiosurgery.com/clinical/prostate-radiotherapy/

A Radiation Oncologist should be able to give you a much better answer; mine is not based on even a superficial survey of the field. !

 

PS; Here is a link to a (2008) comparison between CyberKnife and the Novalis (could be outdated!)

http://www.kumed.com/~/media/Imported/kumed/documents/novalistx_comparison.ashx

(much of this is beyond my pay grade!)

Old Salt,  I read your provided links. Thank you.  It seems Novalis may be an improvement in RT, but it is hard to decide what is a sales pitch verses independent evaluations. Everybody is wanting to sell their wares, whether it be surgeons, rad oncologists or medical centers.   Some impressive treatment centers have bought Novalis, but who knows what else they have, or how many of their doctors like it. According to the articles MD Anderson, UCLA, Duke and Vanderbilt all have them. Another complication is that there systems 'are used against tumors all over, and a machine useful against brain tumors might work less well on the prostate.   I know I am getting way ahead, but don't want to be totally uninformed when I get the biopsy done in a  few weeks.   I do not have the funds to globetrot for the best treatment on earth, and will need to know how to ask for the best treatment options at my local hospital group, which is also a teaching hospital, fortunately.  I suspect that since they have Novalis they will  try to sell me on it if I decide on RT.

Again, anyone who has used Novalis is asked to share their  experience.  

Max