Newly diagnosed prostate cancer

You need better advice!

The data that you presented indicate that several therapies are possible. You will need to educate yourself and consult with different specialists. THe advice from your urologist seems off (to say it nicely). 

Without knowing the details, I will state that you might qualify for brachy. There are two kinds of brachytherapy and either one can be combined with another form of radiation for a 'double punch'. Perhaps hormone therapy needs to be added (triple therapy). 

I strongly suggest you find a competent radiation oncologist for guidance. Preferably one at an NCI Designated Cancer Center. 

NCI-Designated Cancer Centers - National Cancer Institute

 

My statistics were a bit worse than yours (PSA=11.9; cancer confined to the prostate, but many Gleason 9 foci). I enrolled in a clinical study that combined hormone therapy (Androgen Deprivation Therapy) + SBRT (Stereotactic Body Radiation Therapy) + EBRT (External Beam Radiation Therapy). Treatment was eight years ago and so far, so good (knock on wood!).

Surgery

Do not automatically exclude surgery because of your age.  While I am slightly biased in favor of some form of radiation, every case is different.  I myself was sixty five and obese when I had a very difficult prostate removal (prostate was 240 grams and surgery took ten hours), and I had a very decent recovery.  Talk to both an excellent surgeon and radiation oncologist, do your research, and pick what best fits you.

Eric

Assessment

Dave, I disagree with nothing any of the guys above have written.   With high gleasons from a variety of cores, and an overall score of 8, I think most Best Practices doctors in the US would steer toward RT (radiation therapies) as a curative hope.   In the US, age per se is not usually an argument against PCa surgery for men under 70 years, IF they have normal heart and lung health.  But diabetes would likely skew this, I just have not read a lot about diabetics and RP specifically.

Gleason 8 usually suggest capsular escape, but this is NOT always the case; doctors often proceed cautiously, treating as if spread has occured.   IMRT/IGRT is the radiation therapy used in such cases, but SBRT is also used by some radiation oncologists in such circumstances.   You definitely need to consult with a radiation oncologist before deciding on a path.

CMO2021 said:

Urinary Contamination

I'll throw my two cents in.  Urinary contamination may mean you dribbled a little bit with urine drops on the scrotum which then show up on the scan.  I had a note in my bone scan that said " surface contamination due to excreted urine". So that maybe what they were referring to.

 

Best regards,

CMO

CMO,
CMO,
I think you hit the nail on the head. The technician performing my last bone scan mentioned having urine (radioactive tracer in it) on oneself could influence the interpretation of the scan results.
I tried my best.
Bill

Look for second opinions before deciding

Dave,

According to the info you describe above, the term used by the radiologist as “urinary contamination” is to justify the inefficiency (false negative) of the CT in identifying tumors, in spite of your voluminous cancer case of 8 positive cores. I strongly believe in the possibility of you having micrometastases and tumors of small sizes (less than 7mm) that are out of reach of the common CT capabilities. In your shoes I would request a MRI,  preferably a 3Tesla MRI, that is more reliable in smaller tumors cases. The MRI will help in justifying a better clinical stage from where to chose a therapy. 

Gleason score 8 cases with voluminous biopsies are usually directed to RT therapies. Most of these cases are found to have extraprostatic extensions (EPE) therefore not contained. The negative BS (bone scan) can lead to think that you have a localized case. To such extent, your preference with Brachytherapy would require a combination of brachy plus EBRT. Probably the hypofractionated SBRT + EBRT described by Old Salt above could be a better choice because of the micrometastases possibilities.

The bady in your case is the Gs8 diagnosis. The goody is the negative BS. Surely you need to recheck the involvement of lymph nodes and seminal vesicles to have a clue of the field of attack for the radiation.

I think that you should look for a second opinion on the issue together with your doctor’s recommendations of Friday. Try visiting a specialist at a top institution. Your family should be involved in the decision process. 

You doing well in investigating further.

Best wishes and luck in your journey. 

VGama

 

davedavalan said:

My uroligist called yesterday

My uroligist called yesterday and told me the bone scan and CT scan were negative and that it was good news. She also said surgery is back on the table and we would discuss at my appointment tomorrow....but as my luck would have it, my son tested positive for covid today and he lives with me. My daughter and her husband and 4 young boys possibly have it as well because they all went down to Florida a couple weeks ago. I know I have to disclose to my uroligist about this since they ask upon arrival if you been around anyone with covid. Although I have been vaccinated, I'm sure they will want to reschedule. That means, more waiting! This is torture!

Tom Petty

dave,   Tom Petty, also from Florida, noted in a hit that 'the waiting is the hardest part.'  I agree.    Interesting that a decision was made for surgery.  The good thing regarding surgery is that, upon removal, and analysis in a patholigy lab, the doctors will know precisely what has been going on with the disease, and will have strong evidence regarding whether metastasis has occured.   If it has, RT will be started after surgical recovery.

davedavalan said:

Robotic Prostatetomy

Went to see uroligist today. She is now saying gleason score of 7 and 8. I am scheduled to see surgeon up in St. Louis on 9/16 which is about 30 miles east of where I live.

He works for Mercy hospital in St. louis, and I work for Mercy hospital in my hometown. I have read some very good positive reviews about thi doctor, so I am pretty convinced I don't need a 2nd opinion. Another interesting fact is Mercy is in the process of opening there own proton facilty next summer.

.

Vasco gave you good advice. 

A CT scan does not provide the definition that an MRI with a Tesla 3.0 will. Additionally there are now PET PSMA's that provide better definition than bone scans, whether it is a T99 or even the better F18 bone scan. With the large amount of aggressive cancer indicated in your pathology, you want tests that provide best definition so you can best make a treatment  choice. 
Please be aware that surgery is a localized treatment. If there is extra capsular extension, an additional treatment such as radiation will be needed. The side effects of each treatment is cumulative. 

Best wishes in determining where you stand 

H