Just got my biopsy results .. now what?

grahambda said:

So the opposing view from a Robotic Surgeon

I met with the Dr that performed my biopsy earlier today to gain his insight on my prognosis and recommendation. Not surprisingly as the leading  radical robotic specialist (11,000 surgeries and counting !)  he was suggesting  that surgery was the way to go given my age and biopsy results. In summary his thoughts...

 

 

• Although he concurred my current state is on the lower end of intermediate risk,  but  due to the fact that 7 of the 21 core samples were confirmed cancerous  Gleason 6 (3+3 for three  of them) and Gleason  7 (3+4 four of  them) and were widespread in the right lobe and near the exterior of the gland,  in his opinion  Active Surveillance (AS) is not recommended as I already have a 15% probability that the the cancer may  have escaped the gland.
• When I requested a Genomics DX test he was fine  to make that referral  and would expect the result to return a low to intermediate  risk of aggression  given my Gleason and PSA score , "but the cancer is not going away and will only get more aggressive over time,  so a low DX score today may convince me to go the  AS route but this would delay the inevitable and longer I wait the probability of the cancer growth and spread is guaranteed - its not  IF but WHEN"
• When we discussed radiation as a treatment option in his opinion: "the side effects will eventually equal or exceed that of surgery, difference being with surgery the impact is immediate (ED and incontinence) but with a 90% chance of reversal within 3-6 months (of course no guarantees)  vs Radiation where the side effects will inevitable occur  but at a later date (6-12 months). He also noted that due to my biopsy revealing a widespread cancer within the prostate the radiation would need to attack the majority of the gland which could be an issue and needs to be considered. 
• He also cautioned that radiation "may" cause the secondary  spread of  cancer , so although it may treat the prostate there is a published high probability that cancer may appear in the rectum, bladder, colon  etc at a later stage  which would result in far more radical surgery being needed to address those areas  vs the  immediate  removal of the prostate which would greatly reduce  any such risk..
• He did make an "of the cuff" remark that if I chose the radiation route "that is  fine- but eventually you will come back to surgery for removal with  more serious  consequences and a higher probability of permanent   ED and continence issues".

 

So as you can imagine I am now totally confused, concerned  and unsure of which direction to take :-(       I know that the final decision has to be mine but to reach that conclusion  I need to be as informed as possible and have no regrets post- treatment regardless of outcome.

 

Thnask once again in advance for any input.

I have not written to you before graham, but have followed this discussion since Day 1.

A few common "truths"  (factoids that are mostly undisputed by mainstream sources).

1. Surgery is mostly for non-metastatic disease. If pathology after surgery indicates metastasis, curative IMRT will be started afterward.  So the core question for you becomes: How likely is there escape from the gland ?

2. Although I am a guy who chose surgery with excellent results, I do not advocate for any form of treatment.  There was a discussion above about RT causing secondary cancers. I would say that this is profoundly UNcommon today. Very unlikely for most men.  What is slighlty more common is colon burn or bladder damage, but these, too, are very uncommon today.

3. "There is no surgical option following RT."  True and false.  My urological surgeon has a subspecialization in operating on failed RT patients, but this is a very rare skill set.  Some surgeons will address urine pproblems after RT, but even this is tricky.  So while issues after RT can in theory be surgically address, it is uncommon and problematic. 

When I asked a radiation oncologist, Director of the Department, straight up what options there are if first-line radiation failes to cure PCa, he replied "Hormonal Therapy."  Never thought twice about it, and said that surgery post RT is a non-starter, at least toward curing PCa.

In your case, I might lean toward IGRT, which is a somewhat improved technology over IMRT. Ask specifically about IGRT.

max

grahambda - 

Hello, and welcome.

SBRT patient here, coming up on 4 years since my treatment. I don't post much these days, but I do check in and felt compelled to reply. My story here: http://csn.cancer.org/node/264905, as well as this related to my treatment: http://csn.cancer.org/node/292915.

You are moving toward a treatment decision, one that is so personal in nature that no matter what others' experience may be, you must make your choice based on what YOU are most comfortable with. 

Ultimately, my choice of RT (SBRT, CyberKnife) was made after allowing myself the time to process, first the Dx, then self educate and explore treatment options.

You are on a good path of understanding the "beast" and how to attack it. You are at a good place here with the folks at CSN. 

Best wishes my friend. Take care...CC52