New Prostate Cancer Dx

when hearing the word (prostate) cancer for the first time. However, the results from your biopsy suggest that a favorable outcome is likely.

You have many options. With only two clinically significant spots on the left side, Active Surveillance is an option. Alternatively, several radiation therapies are available to attack these lesions. Personally I would consider CyberKnife (SBRT) first, and IMRT second.

Surgical removal of the prostate would be way down on my list of options.

My best wishes with the decision process; you have time to study all the options!

Ron,

With the others I welcome you seeking information here.

I had my prostate removed just over a year ago, when 58 years of age.  All things otherwise equal, and knowing what I know today,  I would NOT have surgical removal at the age of 67.  I was considering IMRT/ IGRT at the time.  Recovery following surgery varies for every man, from minimally troublesome to horrible. The older the patient, the more surgical recovery tends toward the latter end of the spectrum.

If you have no cardiac or respiratory issues, you are certainy young enough for the surgical route if you decide on it.  Be certain to demand removal of the seminal vesticles, and for the surgeon to do erectile nerve sparing when possible, but these practices have been pretty much universal for many years now. Undoubtedly they are standard proceedure at a place as highly regarded as San Francisco.

As noted by others, your numbers are not that bad, and you should anticipate full remission of the disease following whichever route you decide upon.

max

RonJT said:

Rx Options

Thanks H. for your response.  I did not see anything else in the pathology that looked significant.  I do see that the 4-3 core was 7 of 12 mm or about 58%.  It did not indicate what percent was 4 vs 3.  Is that what you were referring to?   I agree that I am not likely a candidate for active surveilance at this point.  I guess technically I have already been there. For the last 10 years my PSA has been drawn every 6 months and has slowly risen from 4 to 7.5 over 10 years.  Had one other negative biopsy in 2004.  

I have certainly been doing a lot of reading on the topic recently.  I like my urologist and he too thinks the 4-3 finding requires some intervention.  I will definitely seek a second opinion on the pathology report before I act on this.  I know that I will also need further imaging studies (MRI, CT others?) before making my choice.  My understanding (so far) is that RT and Surgery have very similar outcomes in terms of mortality.  My first appointment is with the Radiologic Oncologist next week. The amount of information out there is pretty overwhelming.  I wish I had done better in my speed reading course in High School.  

Except for rare exceptions, the Gleason score is comprised of   the most prevalent pattern graded as primary, and the worst pattern (even if it is third-most prevalent) is graded as secondary, so a Gleason 4+3=7 is more aggressive than a 3+4=7. In your case the pathologist found 58 percent of the core to be cancerous. Basically, the percent of cancer in each of your cores is an indication of the extent of the cancer found, and might give an indication if there is extracapsular extension.

When one has a prostate biopsy, the pathologist may also determine  information other than the Gleason score that will give an indication of where you stand, and provide more input.

http://www.pathologyoutlines.com/topic/prostategrading.html

http://www.cancer.org/treatment/understandingyourdiagnosis/understandingyourpathologyreport/prostatepathology/prostate-cancer-pathology

A T3 multiparametric MRI uses the most powerful magnet (T3) in clinical use. The CT scan does not provide the definition that the MRI does. The MRI may show if there is extracapsular extension, that is if the cancer has a escaped the prostate, and will affect your treatment choice....if you wish , you may click my name to the left side...I believe that I wrote about the MRI.

There are also other image tests such as PET Scans. There are different PET scans that are available that you may wish to discuss with you doctor, and if it is appropriate to have one. Some are better than others. I would first pursuethe T3 multiparametric MRI.

I am an outspoken opponent of surgery (either open or robotic) for the treatment of PCa.

Although it is still commonly recommended by urologists (because it's what they know how to do), there are a lot of very good reasons not to choose surgery -- mainly the risk to your quality of life. 

I won't bore you with a litany of reasons NOT to choose surgery here.  You can find any number of posts that I have made in this regard and it is easily researched on Google but, if you request, it I'd be happy to provide my standard warnings against surgery to those new to PCa.

When I was faced w/the choice of treatments just over 6 years ago, I quickly ruled out surgery because of the risks.  I was with SF Kaiser at the time and the only choices offered to me were daVinci surgery or Low Dose Rate Brachytherapy (LDR BT). 

After doing my own reearch, I also decided against LDR BT and discovered Cyberknife (CK) stereotactic body radiation therapy (SBRT) which was and still is a major advancement over IMRT or IGRT which are the common radiation techniques (other than (LDR BT) offered for PCa treatment.

I chose to receive CK at UCSF over 5 years ago and have effectively been cured of the disease.  I was a Gleason 6 w/a PSA of around 9 at the time of treatment.  CK has also been used successfuly to treat patients rated at Gleason 7. 

I strongly recommend (as has already been suggested) that you consider CK instead of IMRT and surgery for your treatment. CK is covered by Blue Shield of California.  Not sure about other carriers. 

Even though CK was available for the treament of other cancers at SSF Kaiser, it was not offered for treatment of PCa at the time of my diagnosis (which compelled me to switch to Blue Shield) but I am told that is is now being used at Kaiser to treat PCa as well.

The major benefits of radiation over surgery is the minimization of negative side effects -- most commonly incontinence and impotence.  The major benefits of CK over IMRT are the degrese of accuracy of CK in the delivery of the radiation to the sub-mm level which further minimizes the possibility of negative side effects AND the fact that treatment w/CK takes only a week (usually 3-4 treatments every other day) while IMRT typically will take 8 weeks of treatment -- 5x's a week -- for a total of 40 treatments.  Both methods have had good reported success over time w/IMRT reportly slightly more side effects.  So, all things being equal, CK has proven to be superior to IMRT in terms of effectiveness and convenience. 

The name of the head of the CK Department at UCSF is Dr. Alexander Gottshalk; Gottschalk was my RO.   UCSF of course also offers ALL other available treatments for PCa -- be it surgery, IMRT, CK, low and high dose BT, active surveillance, etc.   Dr. Pete Carroll and Dr. Eric Small are 2 other well-known physicians at UCSF who specialize in the treatment of PCa and have been often mentioned in PCa research literature.  Dr. Carroll led the development of the active surveillance program at UCSF.

UCSF has apparently opened a new Prostate Cancer Center in MIssion Bay.  Drs. Gottschalk, Carroll and Small are all named as staff members.  You can find info about the new center and them here:  https://www.ucsfhealth.org/clinics/prostate_cancer_center/.

Feel free to contact me by private mail here, if you'd like to know more about my experience at UCSF.

Good luck!

RonJT said:

UCSF

Thanks H,

                Yes have been a member 2009 when my PSA was rising enough to warrent a biopsy.  It was negative at that time. This week I have seen one surgeon at UCSF and have an upcoming appt with radiation oncologist hopefully next week.  Bone scan and CT are scheduled.  Has anyone seen a radiation oncologist there or have a recommendation for one?  I have posted my decision making process so far on my blog here:

http://csn.cancer.org/user/138408/blog

Hopefully it will be useful to others.

See my post to you below dated 3/8/16.  It goes into great detail about my experience as a patient at UCSF.

RonJT said:

UCSF radiation oncologist

Saw a second radiation oncologist this week. This one from UCSF. He is scheduling a 3TMRI for later this month. Apparently it has to be at least 6 to 8 weeks after biopsy for best interpretation of results. Depending on the 3TMRI results he thinks a combination therapy would be best. Gold seed implant then eight weeks of external beam RT with 4 month of ADT. Depending on the results there would then be a boost RT using either brachytherapy, cyberknife or IGRT. I did not realize how many different radiology treatments were possible.  I assume  I would need to do the 3tMRI prior to starting the ADT.

 

Ron: What is the name of the radiation oncologist you saw at UCSF?

RonJT said:

UCSF

I saw Mack Roach.  The 3t MRI will be done by Dr Shinohara.

I have viewed lectures by Dr. Roach, mainly from Prostate Cancer Research Institute (PCRI). He is very experienced, and considered aoung the very best in the world.

Ron,

I would assume your IMRT will be at around 3 Gray per application. By itself, IMRT usually has to be for a total of over 70 Gray to be regarded as reasonably curative. When combined with other modalities, this number might be lowerable; I don't know.

I too was T2a at beginning of treatment (which for me was RP).  A biopsy is more authorative in determing the aggressivity of a cancer, but for that particular piece of tissue only, which is usually generalizable.  The MRI is better at judging extent of the disease outside the capsule, for which a biopsy can yield only little information (volume of diesease; sometimes will indicated perineural involvement, etc.)

Your MRI results luckily do not sound too bad, and so I hope you quicly get to fully curatve results with as few side-effects as possible,

max