Hello just diagnosed and very frightened

Steve1961 said:

Okay

so when I show up for the mri hopefully they will. Be using the apron but if not what then get up and leave or should I call to find out first 

If they tell you to prep for the MRI by taking an enema before your appointment, they are planning to use an ERC.  If you ask if there is any prep required and they say no, then they probably are planning to use a phased array pelvic coil.  That was my experiene

Steve, I'm not sure you can ever get a perfect clear gleason score since to some extent it is subjective depending on the pathologist. However, I believe that the most accurate  gleason can only be attained if the pathologist  has your prostate in hand. I had 3 biopsy 's before they found my cancer and the last biopsy revealed  a gleason 7 (3+4).

I opted  for surgery  and once my prostate was removed and evaluated my gleason was upgraded to 8 (4+4). So yes it it is very possible that your gleason score can change.

Message from Steve1961,

" 

hello i am the pain in the butt lol that has quite a long thread going..it seems that you my friend are very knowledgeable about alot of treatment.... I.want YOUR opinion because i respect all of your opinions i have read.....i have seen 4 quacks so far and didnt pay any attention to anything they had to say except they all said that i will be fine and most likely cured  which is good....so i did go to Stanford and met with RP surgeon that has 1200 under his belt....he highly stated that i wasnt a candidate for Brachytherapy because i am intermediate..Also he said that with brachytherapy  there really is no plan B if it comes back...hmmmthats the only comment i didnt go for....so this week met with a surgeon from UCSF   26 year veteran has over 1200 open and around 500 robotic ..this man said i am an candidate fro brachy and cyberknife..he explained it all to me  and he even said that surgery is invasive and that should be the last resort  and in  my case he felt strongly i should
have one of the radiation therapies...he said at my stage the outcome are all the same for a cure in the 90% with any treatment i choose...today met with CK specialist that did swingshiftworker 6 years ago....so my stats are 3 cores positive  3+3  3+4 3+4  20 % 60% 70%  low psa 8.1 DRE clean i guess where they were located and all this put me at the lower end of the intermediate risk which makes me a candidate......so this ck  has been around for a while but only has 10 years of stats.....which are good...they use the same radiation as the other methods  and expect the same outcome...my question is should i believe them ... this method seems way to easy and effortless ..can i be soo lucky to have this simple procedure done  and be free of PC for ever...also i will be going to stanford again to their ck clinic because they pioneered it back in 1990  and have made MAJOR advances  and apparent have done over 7000 treatments  so they say..oh also waiting on Stanford to re look over my
pathology slides  hopefully all will stay the same or even better i..thanks for your time   and input i cant say how much all u people have helped me thru my journey..i hope i can figure out a way to give back..sure has been a tough ride  making a decision  i think the treatment part will be easier  thanks again..just wondering what u think about ck and everything i have said...also going for a brachy consultation with an expert lol  but i have some existing urinary problem that may cause me major problems with brachy that i dont need will discuss that with him at appointment  thanks  again.....man i hope my insurance will cover consultations"

Dear Steve,

I wonder, did you have a T3 MRI yet. This image test is needed for any type of treatment that you will have so you will be able to better quantify if the cancer has or has not escaped the prostate. Eash of these institution likes to do their own MRI, so if for example you are treated at UCSF they will want to do the MRI and probably will not except the results from certain other institutions.

With reguard to SBRT, of which cyberknife is one of the machines that deliver.

You mention that you were told that Stanford did 7000. Well that number is high and probably includes all SBRT's done to include treatment for parts of the body other than prostate...ie brain, etc, etc. They probably have done 500 to 700 tops for prostate cancer treatment.

Yes Stanford pioneered cyberknife for prostate cancer, however the doctors who originated cyberknife for prostate cancer  with them ,have since switched to other organizations. 

Here is a nine year study of SBRT done with cyberknife by a doctor Katz in NYC, who I believe has treated the most prostate with cyberkife.

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

Nine-year outcomes after treatment with SBRT

While it’s tempting to conclude that neither the higher dose of radiation, with its greater toxicity, nor the addition of ADT conferred any incremental benefit, that can only be proved with a randomized clinical trial. Until so proven, it must be understood as only a good hypothesis to be discussed by patients with their radiation oncologists. It is also worth noting that these data reflect the outcomes of one very expert practitioner. There is an SBRT registry currently collecting data across many treatment centers.

The reported outcomes are nearly identical to those reported at 7 years (see this link,this link, and this link), indicating very stable control and no additional late-term toxicity with longer follow-up. In light of that, its low cost, convenience, and the fact that the standard of care, IMRT, has only one more year of follow-up on a much smaller sample size, it’s difficult to understand why some insurance companies still balk at covering SBRT for low- and intermediate-risk patients. Medicare does cover this.

Editorial note: This commentary was written for The “New” Prostate Cancer InfoLink by Allen Edel.

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Steve, please note that in this study for men  with intermediate prostate cancer, there is a 89 percent cure rate; the perimeter of the radiation can be easily expanded immediately outside the prostate.

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SBRT is given in four or five sessions, depending on the preference of the doctor administering. 

I cannot comment on which institution, Stanford or UCSF will provide a better outcome. with sbrt. They are probably very similar. You will have to do your research in order to select one over the other.

The side effects with sbrt are minimal. Generally, you can go on with your normal activities the days that you are treated.

For the most part you will not be able to ejaculate after sbrt.

It takes a while to reach nadir. Quite often 18 to 2 months out , there is a radiaition bump, then the psa reading continue to lower levels. Generally you want the PSA to go under 1.

SBRT is a very precise radiation treatment, as far as I know the most precise, more so than IMRT.

The cure rate is very similar to IMRT.

The cure rate is also similar to surgery, but with less side effects

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Brachytherapy

Not an expert about brachy, but with intermediate cancer , some seeds will also have to be implanted outside the prostate.I think that these seeds need to have less radiation. The seeds have a 3 mm range. It may not be as effective outside the prostate....I am not an expert, just making a laymans guess. I suggest that you speak with a radiation oncologist who specializes in brachy.

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SBRT (cybernife) was invented at Stanford. Prostate cancer was successfully treated there. SBRT given by  cyberknife and other machines such as varion is widely used at major institutions of learning, that are centers of excellence. Did the radiation oncologist at stanford who told you this had a different specialty that he wanted to sell you?

https://stanfordhealthcare.org/medical-treatments/c/cyberknife.html

Once again here are nine year results of this treatment type. These results look pretty good to me.

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