Jim,

At one point you mentioned interest in a partial gland ablation. Here is a study that I came across that addresses this. As you can see, the outcomes were not the best.

https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/98184-partial-gland-ablation-versus-radical-prostatectomy-comparative-analysis-of-partial-gland-ablation-and-radical-prostatectomy-to-treat-low-and-intermediate-risk-prostate-cancer-oncologic-and-functional-outcomes.html

Intermediate-risk Prostate Cancer: Oncologic and Functional Outcomes.

To analyze oncologic and functional outcomes of partial gland ablation (PGA) compared with robot-assisted radical prostatectomy (RARP) for patients with low-and intermediate-risk prostate cancer.

From July 2009 to September 2015, 1883 patients underwent RARP and 373 had PGA. From those, we selected 1458 participants (1222 RARP and 236 PGA) who have Gleason score 3+3 or 3+4, clinical stage ≤T2b, prostate-specific antigen(PSA) ≤15ng/dl, unilateral disease and life expectancy >10 years. Propensity score matching analysis 1:2 was applied on the overall RARP sample selecting 472 patients for between comparison. As PGA, 188 men underwent high-intensity focused ultrasound (HIFU) and 48 had cryotherapy. Oncologic outcomes were analyzed in terms of the need for salvage treatment. PGA failure was defined as any positive control biopsy after treatment. Functional outcomes were assessed with validated questionnaires.

Matching was successful across the two groups, althought men treated with PGA were older (p <0.001). Mean follow-up in PGA group was 38.44 months. PGA failure was observed in 68 (28.8%) patients, 53 (28.1%) with HIFU and 15(31.2%) with cryotherapy. PGA was associated with higher risk of salvage treatments (HR 6.06; p <0.001) and complications were comparables between groups (p=0.06). RARP was associated with less continence recovery and lower potency rates at 3, 6, and 12 mo after surgery (p <0.001).

For selected patients with organ-confined prostate cancer, PGA offered good oncological control with fewer adverse effects requiring more additional treatments. Potency and continence appear to be better preserved with PGA.

The Journal of urology. 2017 Aug 17 [Epub ahead of print]

Silvia Garcia-Barreras, Rafael Sanchez-Salas, Arjun Sivaraman, Eric Barret, Fernando Secin, Igor Nunes-Silva, Estefania Linares-Espinós, François Rozet, Marc Galiano, Xavier Cathelineau

Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: raersas@gmail.com., Memorial Sloan Kettering Cancer Center, New York, USA., CEMIC University Hospital, Buenos Aires, Argentina., Hospital Universitario La Paz, Madrid, Spain.

PubMed http://www.ncbi.nlm.nih.gov/pubmed/28823768

Jim,

Thank you for finding and updating this thread.

You did your due diligence and researched the ability to continue with Active Surveillance. The medical professionals that you contacted feel that now is the time to select an active treatment. One a specialist in HIFU, did not believe that you are a candidate for HIFU.

You have had 3T MRI which did not show extracapsular extension, however the prediction nomogram estimates a 27 percent chance of extracapsular extension.

The two major active treatments that are available are surgery and various forms of radiation.

Surgery is a localized treatment option that can have major side effects. The side effects in fact are age related, so at age 74 or 75 as you are, this would be a very poor choice since a doctor can perform surgery on a patient that is 50 and have excellent results and then perform the same surgery on a man of 75 with poor results; greater chance of erectile dysfuncion and incontinence. Additionally if the cancer is somewhat outside the prostate, additional treatment will be necessary. Surgery does not cure any cancer that is outside the prostate.

Radiation....can treatment the prostate itself, and the perimeter of the treatment can be expanded to go outside the prostate so any cancer immediately outside the prostate will be treated as well. Not say that the radiologist will think that it is necessary to extend the perimeter of the treatment since the radiologist may feel that it is contained...you will have to discuss this with the radiologist.

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. This will be my choice if and when I will need to seek an active treatment. ....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/

Best

I cannot suggest which treatment is right for you.  However, I can strongly encourage you to find a doc you can talk to and trust.  So go doctor shopping.  The more I lean into the decision process, I am on the verge of decision making, probably on 11/13 when I meet with my rad oncologist and Uro Oncologist.  For me it is critical I have faith in their opinions, their expertise and their ability to communicate with me.  I am not a medical doctor, so at some point I need to trust the one I choose. a trust is a powerful tool.  As to AS, water under the bridge.  Stay in today and focus on finding the right doc!   Be well, Denis

mcin777 said:

Thank you old Salt.  You

Thank you old Salt.  You suggest that I have ample time to consider all modalities.  The three Urologists that I have met with all seem to think that I am a ticking time bomb or that the bomb may have already gone off.  This is based on the prognosis of left lateral inferior abnormality consistent with tumor, possibly with focal capsular disruption. PI-RADS 5.   If I knew for sure that i was okay for a little longer (4-5) months, I would have another biopsy of the T5 tumor to see if it is infact benign or cancerous.  If is was benign then I would opt for HIFU by having my prostate roter rooterd, and then wait it shrinks to the size it needs to be at for a successful HIFU procedure.

Because the MRI and Biopsy were in conflict with each other, I get the real sense from the Urologists that I should not wait any longer to get treatment.  

It's been stated over and over on this and other prostate cancer forums, Urologists are surgeons and they typically recommend removal of the prostate. But one major point to consider is that you are over the 'typical' age limit for surgery (70). 

Like several others who have posted in this thread, I highly recommend that you discuss your options with a good radiation oncologist.