Prostate cancer Please help

My husband (55) was diagnosed with prostate cancer October of 2017.  His initial pathology showed 4 +3.  He had two previous MRI guided biopsies before the big biopsy. We consulted with Dr. Joseph Busch in Chattanooga, TN for his MRI's, and Dr. Busch performed the guided biopsies.  At that time, we discussed possible ablation if Jim's biopsies came back with positive findings.  After his 3rd biopsy which took 14 core samples, it showed Gleason 7 (4+3) with two areas testing postiive.  A little more agressive than your dad's but still within guidelines for successful ablation. We talked with Dr. Busch's preferred ablation specialist in the Netherlands - Professor Jurgen Futterer.   His assistant's email is Solange.Estourgie@radboudumc.nl.  However, I would probably contact Dr. Busch for a consult -( jbusch1@epbfi.com.  423-622-7212 - Jeannie is his gatekeeper)  Everything is out of pocket for Netherlands procedure.   

There are two ablation study programs going on the US now.  One at Memorial Sloan Kettering in NYC, and one at Mayo in Rochester.  All paid for including expenses.  Contact for Memorial Sloan Kettering is Kathy - 1-646-497-9068.  The contact for Mayo is Deb 507-284-2511.   The doctor heading up the study at MSK is Dr. Behfar Edhaie.  He is an oncologist and surgeon.  The doctor heading up the study at Mayo is Dr. David Woodrum.

We actually went to MSK to apply for the study.  Was accepted.  They ran my husband's biopsies through their own labs, and his Gleason Score actually came out higher - 4 +5. Not what we wanted to hear. Sent pathology over to Johns Hopkins - they concurred with Gleason score of 9.

This put us out of the ablation program in the US.  We could sitll have it in the Netherlands, but the thoughts of a Gleason 9 and ablation just didn't add up for our choice. 

My husband did months of research, and all roads led us to Dr. Edhaie at Memorial Sloan Kettering for his treatment.  He is also a patient of Dr. Mullhall at MSK who is the leading ED specialist in the world.  He had nerve sparing robotic surgery on 1/30.  All lymph nodes removed, prostate removed.   We were blessed with excellent pathology report past surgery.  Downgraded his Gleason to a 7 - lymph nodes clean, nothing outside the prostate, margins clean.  I cannot say enough good things about our experience with Dr. Edhaie and his staff at MSK. 

You will have to weigh your options - which you have.  Just take your time.  Even with my husband's gleason score of 9, we didnt' rush to surgery.  He took time for healing after the biopsies which takes a minimum of 12 weeks.  This helped with nerve repair, and with the nerve sparing part of his surgery.  He lost 50 lbs, got in the best physical shape of his life (walking helps with bloodflow to key areas that are affected by surgery - 5-7 miles daily for us) and he is doing so good post surgery.  For him,  he will tell you he didn't have pain from the surgery.  Cathater was awful!  Recovering from surgery has been tougher emotionally than physically. 

We just returned from his follow up visits this weekend in NYC.  PSA is undetectable!   He's in the top 15% for recovery, ED issues are improving - in fact he's doing great there.  Bladder issues have finally turned for the good, and he's improving daily now.  It's a process that takes time, but he's so thankful for the skill of his surgeon. 

A friend of ours had ablation last July in Miami.  His latest followup test last month showed some areas that were missed.  PSA rising.  He's weighing options on what to do.  Thougth I would throw this out.  I would apply for ablation at either MSK in NYC or Netherlands if you dad's biopsies are confirmed to be a 3 + 4.    My opinion - Get your dad's biopsies reviewed at MSK and Johns Hopkins (Dr. Pollack) - Dr.Busch can help with coordinating these as well. 

That's my two cents worth on your question.  Good luck.  Just don't let fear direct your decisions.  Removing the prostate is a life changing event - but teaming with one of the best mdical groups in the world providing us with phenomenal outcomes.  We are lucky!

Hi,

Sorry about your father's prostate cancer diagnosis. His numbers are very close to mine. I was diagnosed five years ago with prostate cancer. My prostate was three times the normal size and the doctor had a hard time finding cancer. After three sets of biopsies in six years he finally found the cancer. First biopsy was 9 cores. The second was 16 cores. The third was 21 cores and done under anesthesia. My Gleason score was 7. 3+4.

I had the DiVinci procedure to remove it four and one half years ago. I have been going for PSA blood tests every three months since surgery. My last test was six months ago with a reading of .001 non detectable. The surgery took seven hours with very little side effects. This was a nerve spareing procedure and everything works a before but no prostate. The doctor that did my surgery was extremely skilled and was an expert with DiVinci.

Tom

 "but he's so thankful for the skill of his surgeon. "

 "The doctor that did my surgery was extremely skilled and was an expert with DiVinci."

 Thank you, graycloud and Thomas for sharing your experiences. Regardless which treatment or procedure , the skill and experience are paramount. 

It is a very difficult venture, but the professional you choose is every bit as crucial as the treatment you choose. What Max said is so true... you have to feel at peace and "comfortable" with your professional. If you read far into these archives, the successful treatments  give credit to skilled and experienced professionals. The worst nightmare scenarios almost always involved novices or inexperienced professionals who are trying to overachieve or "bite off more than they can chew" .

Aloha,

I just had the procedure, (focal laser ablation) performed March 20th 2018 in Houston (Dr. Karamanian Prostate Laser Center). I could not be happier with both the treatment and the results. Like your father, I too, had a Gleason of 3+4=7 That's the short and sweet. For all the details please see my blog. Simply google "magicsparkes wordpress" (note the e in Sparkes).

Peace and blessings to you and yours!

Doug

Jess4566 said:

Pathology

Ok guys, I have the pathology report. Tell me what you think. 

Left lateral base: Gleason score of 7 (3+4) grade 2. Less than 5 percent of tumor in core. Perineural invasion present. (How do they know they there is PNI? How do they see its tracking a nerve?) No ENE or lymphatic vascular invasion.

 

Left base: Gleason score of 7 (3+4) grade 2. Tumor involves approximately 20 percent of the core. PNI present. No ENE or lymphatic vascular invasion.

 

Left lateral mid prostate: Gleason of 6 (3+3). Group 1. Tumor involves 20 percent of the core. No ENE, PNI, or lymphatic vascular invasion present. 

 

Left mid prostate: Gleason score of 6 (3+3) group 1. Tumor involves less than five percent of core. No ENE, PNI, or lympharic vascular invasion.

 

The right side looks good, no tumors found. The left lateral and apex also have no tumors. All the tissue is white and soft. Is that good? Does that mean somewhat healthy?

The doctor discussed with him his options: active surveillance, radial prostatectomy, radiation therapy, cryoablation, and HIFU. My father is looking at laser ablation or the nanoknife. I know the doctor didn't say those...

Hi Jess,

Crikey, your father and I are very similar with regards to prostate cancer. Last summer I talked with four prostate cancer experts, including a major Urology Professor at UCLA. They all said due to my young age (58 being relative) that I did not qualify for the radiation treatment (pellets or radiation bombardment). They all also shot down HIFU and cryoblation as being very unreliable ... The funny thing is not one mentioned laser ablation whatsoever. In my very jaded opinion, (hey, I can admit that I am jaded), the whole industry is bent on having men go through having a "Robotic Radical Prostatectomy." The pros is that this procedure will get rid of ALL of the prostate cancer and that is a good thing, but the con is all the side effects that come with it! Ah, don't get me started!!

Doug

Not my opinion, but a recommendation from an expert panel of urologists from the American Urological Association

Clinicians should inform low-risk prostate cancer patients who are considering focal therapy or high intensity focused ultrasound (HIFU) that these interventions are not standard care options because comparative outcome evidence is lacking. (Expert Opinion)

The Nanoknife is never used for prostate cancer. But Stereotactic Body Radiation Therapy (SBRT) can be used to fight prostate cancer. We have several frequent posters on this forum, who have used SBRT (including me). The latter can be done with several instruments; the best known is CyberKnife. I do suggest that you and your Dad learn about this therapy.