Newly Diagnosed - Gleason (3+4)

JoeDoe said:

Treatment Center Video (NYC)

Treatment Center Video (NYC) which discusses why Cyberknife affects less of the surrounding tissue (less margin than other radiation therapies).  Somewhat balanced presentation in that he talks about various treatments but still seems to be pushing Cyberknife. 

https://www.youtube.com/watch?v=XsGmMtCGptk

Fox News Video with Dr. David Samardi (Surgeon) claiming new meta-study suggests surgery outcomes twice as good as radiation for long term longevity.  Would love some opinions on this. 

https://www.youtube.com/watch?v=-AxdBgtGnCI 

Dr. Oz talks about options.  (1:35) Study shows no difference in outcomes between RP, Radiation, Watchfull waiting.  This seeems misleading. 

https://www.youtube.com/watch?v=ENHJrf1JmtA&t=230s

 

It is really hard to know the right treatment when there is so much conflicting information out there.  I don't think Doctors are intentionally pursuing a conflict of interest but it does seem that everybody argues for what they personal do as a service.

Joe,

I have not yet watched the YouTube regarding supposed superiority of surgery over RT as regards long-term suvivorship, but as hopeful and optimistic noted, numerous factors that must be known in evaluating such a work.  USUALLY, however, a study will clearly explicate its methodology, and what sorts of subjects were utilized, allowing a fairer interpretation of what was written.  

How current was the RT form or forms employed ? Were Gr levels equivalent to those used in the US ? What stage were the patients at ?  Were the RT and surgery patients at the SAME stage ?  Did the RT patients or the surgery patients receive any forms of anxillary or supplemental treatments ? (BT, HT, etc. In other words, compare apples to apples.)   Know also that "long-term" in oncology usually means ten years or more, whereas general discussions of survivorship ordinarily use five years as the most frequently referenced benchmark.  These things must all be precisely and exactly defined.

META-studies are usually compilation studies that glean the data out of all (or at least most) previous studies and then interpret those results with newly-applied statistical analysis.  If that is what Dr. Samardi is referring to, that in general would suggest that the work is more substantial than if it is not.

The sentence referring to Dr. Oz is putatively ridiculous, and I don't think even any of the guys here would regard him as an authoratative sourse for any study on any subject. I know that I do not.

Rakendra is another poster at this forum

My laymans opinion is that Dr. Samandi gave great advice to obtain diagnostic tests T3 MRI and bone scan.

If I was to have surgery, my readings indicate that Dr. Ashutosh Tewari is the best of the best for surgery. He is also located in NYC.

Above I referrenced a nine year study by Dr. Alan Katz, He is located in Flushing Queens. He delivers SBRT via a Cyberknife platform. He probably did the most Cyberknife procedures in the world. I recommend that you consult with him.

http://www.flushingros.com/our-practice/our-doctors

Swingshiftworker said:

Yes it does . . .

All methods of radiation used (CK, IMRT, BT, etc.) are programmed to kill ALL of the prostate tissue not just the tumor.

Lots of obvious reasons for this but primarily the fac that if you try to localize just the cancerous tissue and you miss some, it will continue to grow.  Better to attack the entire prostate as delimited by the capasule lining which can be easily identified in scans.  This has essentially the same effect as removing the prostate physically and is just another reason why radiation is preferably to surgery taking into the account the greater risk of temporary and permanent side effects following surgery.

..with more aggressive cases, the perimiter of the radiation given can be expanded beyond the capsule lining, so that there is a better chance of cure versus surgery, with less possible side effects.

Kicken,

I am sorry for your diagnosis.

First, you mention Gleason 7...there is a difference between a Gleason 3+4=7 and a Gleason 4+3=7; the Gleason 4+3 is more aggressive.....(the first number shows the cancer that is most prevelent.............which is yours? It is important to know, please share. If the Gleason is a 4+3=7 , a bone scan might be considered since each of the cores that is positive shows significant volume....( the american urological association does not recommend a bone scan for those with less than a gleason 8 except when it may be appropriate because of significant volume).

Did you have any other diagnosis tests?, digital rectal exam (finger wave in rectum) results, any image tests (results?), etc.

There have been significant improvements to radiation since the seventies.....radiation now is directed and improved, t and now has success rates comparable to surgery with less side effects than surgery. The radiation treatment of the 70 ties was 50 years ago and the treatment today is simply not comparable to the 70ties.

In your case, there is significant cancer found in the cores that were positive. There is a possibility that the cancer has escaped the prostate. There are image tests that may show if the cancer has escaped the prostate, ie 3T MRI and pet scans.

As you already know surgery can have significant side effects to include but not limited to erectile dysfunction and incontinence. This procedure is localized to the extent of the prostate so if the cancer is outside the prostate additional treatments will still be needed, radiaiton and/or hormone treatment. The side effects of each of these treatments are cummulative.

With radiation as a first (and hopefully the only) treatment, the perimeter of the the radiation can be extended beyond the prostate so that a greater area can be treated with cure. There probably will be less side effects than would occur from multiple treatments or even surgery alone.

One form of radiation, is SBRT. This treatment is done in 4 or 5 sessions with minimal side effects. SBRT is very precise, more so than other radiation treatment modalities. SBRT offers comparable cure to surgery without the major side effects. . ....as any other treatment, I strongly suggest that you find and "artist" who can provide this treatment..find a high volume center with lots of experience.

Here is a nine year study for your evaluation.

https://prostatecancerinfolink.net/2016/01/06/nine-year-outcomes-after-treatment-with-sbrt/

Clevelandguy said:

Your choice

Hi,

Is your cancer a 3+4 or a 4+3? A 4+3 is more agressive than a 3+4.  Your imaging tests should give you a definite location of your cancer.  If it's deep inside the prostate then surgery could be a good option.  If it's very close to the outside edge of the prostate then you could do radiation in it's various forms or surgery. If it's escaped then radiation might be a better treatment.  Study all the info in this post plus other sources and make the decison on your treatment mode.  Don't be afraid to talk to multiple doctors and get different opinions.   Both surgery & radiation have side effects in various degrees.  Some people come out of surgery & radiation with very little side effects, some have more.  Depends on the facility, doctors, and how advanced your cancer is.  I know it does not sound very incouraging, but man it's cancer.  In my opinion you have to attack it with one of the various tools available today.

 

Dave 3+4

The MRI fusion biopsy showed it is a is a 3+4 on the outside. 

When i had just had the scatter-shot biopsy they thought I was a Gleason 3+3. I had/have absolutely no other symptoms (PSA was 4.8) I went to an open surgeon known as THE best in my city. Has done thousands. He did my brother’s. After 15 minutes I had scheduled surgery that he said I should do within a few months. No imaging, good health, PSA <10 all my life. PSA tested for six prior years always below 3. 

I canceled about a month before the surgery because I thought I needed more information. 

Now I know more yet pulling the trigger is more difficult. Maybe this doc knew mine would progress like my brother’s but could not violate doctor/patiemy confidentiality?

Or is it the surgeon’s mantra: Steel to heal. 

Hopeful, Cleveland and AS are on point about researching other forms of treatment, especially SBRT. Oh - and that includes second and third opinions. And while there is value in a Dr's experience, I don't care how many "procedures"  Dr. X has performed - if I feel he or she is morphing into a hungry car salesman - I'm heading out the door.

Regards - CC