is psa 84 high

Before advancing with any treatment option you may check if the clinical stage (t3 nx m0) is proper. The high PSA and extent in 12 out of 12 positive cores makes me think that extracapsular extensions are present. I wonder how the M0 (far metastases) were diagnosed. Did you have any image exam?

Traditional CT or MRI can miss detection if the tumour is small in size (less than 1.2 cm) or if you got a case of micrometastases. Higher PSA levels are typical in micrometastases cases. The best to verify any spreading status (including the lymph nodes Nx) is to get a PET scan. PSMA tracer in PET also checks for metastases (M1) in bone. In any case, the importance in such specific exam is to determine if you are prune to become systemic, in which cases cure is difficult to obtain. Can you tell what is the Gleason score? What about any symptom?

CyberKnife (or IMRT) and surgery are very effective when the cancer is contained (whole inside the gland). If metastases are present both would not treat you for good. It all depends where the bandit exists. Surgery can be done with the intent of debulking the biger cancerous portion (the whole gland). Metastases should be treated with radiation or chemo depending on how advance and far such extraprostatic extensions are found. However, all treatments involve risks and side effects that you should know before deciding. Get second opinions on the the various options from specialists. 

Here are some materials to help you understanding about the disease;

http://www.ccjm.org/index.php?id=105745&tx_ttnews[tt_news]=365457&cHash=b0ba623513502d3944c80bc1935e0958

Best wishes and luck.

VGama

titortrt said:

Old salt,Vgamma,

Old salt,Vgamma,

Thanks for the replys.

Urologist recommends prostatectomy, ADT treatment ASAP.

 

Had bone scan, was negative.

Here is the  is the mri numbers:

prostate size:54*50*49

lesion: 33*32

no swollen lymph nodes

 

Tito

 

 

titortrt,

Your PSA and involvement in all 12 cores indicates serious, possibly aggressive disease.  As Vasco noted, escape for the gland is LIKELY, which strongly suggests in most cases a choice of IMRT over surgery.

Your gland is very large. It is possible that the surgeon wants to debulk (again, as Vasco theorized), and at the same time prevent stricture (collapse of the urethera), which restricts the ability to urinate.  These are reasonable concerns.  But ask him why he has not suggested radiation in the mix as well. ADT will beat back the disease, but is not curative, whereas radiation in most cases is curative.

I highly recommend that you see a radiation oncologist for a second opinion,

max

Sorry about that result. But you can fight back, if you are so inclined. From the limited information provided, it's difficult to judge if prostate removal is the way to go. Whatever, a multi-pronged approach is likely in your future, with hormone therapy (androgen deprivation therapy) as one of the modalities. Please report back to us and we will respond.

PS: What were the Gleason scores? This is relevant for estimating the likelihood of the cancer having escaped the prostate.