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Totally New Guy - Biopsy or MRI

mstoriop
Posts: 37
Joined: Dec 2016

Hello to all and I appreciate any opinions.  I am 65-1/2 years old.  PSA checked every year.  Last test 4.5 then had % free PSA checked and it came back at 20.  My PSA velocity has been straight line for several years at about plus .55 per year hence now I am at the start of the grey area.  My doctor said I could "forget about it or get a biopsy" but he recommends biopsy.  Like everyone on here I have done a lot of reading and while I am not in the least bit scared of needles, pain or anything else I am wondering with my reasonably straight progression if a CT scan or MRI I have read about would be either enough for a doctor to make a judgement or if it would help with the biopsy decision.  My doctor does not seem to buy into this less invasive technique. Don't know if it is a familiarity deal, insurance deal or good science to do a biopsy right away.  I am not looking for reinforcement to skip out on anything I am wondering if anyone out there has a similar set of circumstances and how you proceeded.  Any thoughts appreciated and Merry Christmas to all.  Should have added first post my DRE felt normal per the doctor.      

Will Doran
Posts: 207
Joined: Sep 2015

mstoriop,

I would say, it's best to do both.  I had biopsy first.  My DRE was normal as well.  My PSA showed up at 69, with Gleason of 3+4-7.  Then a couple MRI's, and CT Scans.  Went on to robotic surgery.  I am now a three year survivor, and My PSA has been holding at undetectable levels.  I had follow up HT (Lupron) for two years, and also 8 weeks of radiation.  My testosterone is back in the normal range and I'm starting to feel human again.

So, I would say having all of those tests is normal and should be done.  You will need to make a decision whether you want to do surgey or radiation seeds, etc.  Make sure and study all thew side effects of all procedures.  The CT Scans, MRI's and Biopsy will help your doctors and you make the right decisions.  Make sure that you talk to Radiation Oncologists, Urologists, and Surgeons about all of your options.  My Urologist / Surgeon, insisted that I go talk to Radiaiton Oncology before I made my final decision as to what treatments I wanted. 

Others may have other ideas, but this is what I did and it worked for me, so far.

Good Luck

Know you are in my thoughts and Prayers

Love, Peace and God Bless

Will

VascodaGama's picture
VascodaGama
Posts: 3045
Joined: Nov 2010

Mstoriop,

I agree with Will's opinion above. Both are good starters and complement each other in the diagnosis of cancer. Taking the MRI firstly is better as it may locate abnormalities that can be aimed during the biopsy. A negative MRI result would not mean that cancer is not existent. Prostate cancer of tiny sizes may not be detected by this scan. A biopsy (investigation on prostate tissues under the microscopy) is always the way to diagnose a positive case.

The PSA can be increased due to several means but prostate cancer (PCa) typically relates to constant increases of PSA serum. BPH (benign hyperplasia) typically represents a graph of sharp increases followed by sharp declines (seesaw). Your info regarding the PSA velocity indicates a slow growing value which, if related to cancer, could signify an indolent type of PCa. The free PSA with a ratio of 0.20 has only 24% percent probability of finding prostate cancer. This is a good marker but alone it is not truthful. You need to find what is behind the PSA increase or just follow your doctor's advice in doing nothing and postponing the diagnoses, but never beyond the "gray zone" as you name it.

Here is a comprehensive link on PSA;

http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81944

Best wishes and a Merry Christmas to you too.

VGama

hopeful and opt...
Posts: 2226
Joined: Apr 2009

PCA3 test
This test is a  indicator, urine gene test that is available. The test is a molecular biologic assay. This test has a specificity of 75% and a sensitivity of 57%. (What that means is that among 100 bad tumors, for example, they only can identify 75 of them. And among 100 good tumors, they identify them as bad in 57). The test is done by a doctor who does a DRE and vigorously massages(the fun part...my doc is very experienced, has muscles on his finger, and can make a grown man cry) the prostate; the patient gives urine and the results are sent to Bostwick Laboratories(the only laboratory that does this) for analysis.

So the way the results work, 35 is the magic number, so the less one score is below 35 the better. Mine was 8.3 "Prostatic cells are present but do not over express the PCA3 gene", "value of 35 or greater suggests a high likelihood of prostate cancer"

It is also stated that only a prostate biopsy can diagnose prostate cancer. The test's preformance has been established by Bostwick Laboratories. It should not be used as the sole evidence for or against the diagnosis of prstate cancer. Clinicco-patholological correlation is indicated.

CowboyBob
Posts: 31
Joined: Oct 2013

Just so no one is confused, a sensitivity of 57% means that of 100 prostate cancers, only 57 were positive on the test. A specificity of 75% means that of 100 specimens from people who don't have cancer, only 75 would be read as negative on the test (That means 35 would be false positive!)Surprised..,,

To put it into perspective, let's say we test men who we think might have prostate cancer. For arguments sake, let's say we test 200 people and 1 in 4 has prostate cancer. Of those 50 people with prostate cancer, (1/4 of 200)  29 will be positive on the test (57% x 50). These are the true positives. Of the 150 people without prostate cancer ~ 113 will be negative on the test( 75% x 150). These are the true negatives. The 37 people who don't have prostate cancer, but the test is positive are the false positives. In this example the false positives (37) are more the the true positives (29).

This test is no better then flipping a coin.  

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3328
Joined: May 2012

Welcome to you, mstoriop. I'm sorry you are grappling with these questions in the Christmas Season.

It seems to me you are to some degree dancing around the issue of getting a biopsy, wanting to know what is "most reasonable" at this point.

What is most reasonable and clinically advisable is a biopsy.  Only a biopsy will determine PCa, and give a Gleason Score. No MRI, no PET, no form of blood work can or will substitute for a biopsy, as everyone above has noted.  Plus, the biopsy is cheaper, and has no radiation (MRIs of course have no radiation either, but PET scans and CTs do).  This is a no-brainer, like "Which is healthier ?  The grilled salmon, or the platter of fried chicken ?"   The biopsy is the test that is most important.

Your vector is not radical, but neither is it static.  A negative DRE, while better than a positive one, tells the doctor nothng about the front of the gland, since a DRE only feels the bottom portion of the gland.  It for certain is not an "insurance issue", since, as I noted, a biopsy is cheaper than many forms of scanning, not more expensive.  An insurance rep would advise you to get every scan known to medicine first if they were in charge.

There is no reason to not get a biopsy, but many reasons to get one. Then supplement the biopsy with these other, more expensive tests, if necessary.

max

Swingshiftworker
Posts: 1013
Joined: Mar 2010

There are reasons to NOT get a biopsy (mainly the possibility of infection, which is why you usually hae to take a dose of cirpo beforehand) BUT, even though false negatives are possible, without a biospy you  will not know with reasonable certainty whether you have PCa or not. 

An MRI before a biopsy "could" target the location of possible tumors but I doubt a medical insurer would approve an MRI before an biospy is done because of the costs and because it is contrary from long standing medical practice. 

The more likely procedure would be to follow a positive biopsy would be an MRI/MRSI (aka 3T MRI) scan w/a which could more precisely locate and determine the extent of the cancerf that would probably be approved following a positive biospy determination.

 

mstoriop
Posts: 37
Joined: Dec 2016

I want to thank everyone for taking time out of your busy days to comment on my post.  It is very much appreciated.  I am scheduling a biopsy next week and will go from there.  Hopefully all will be well or better identified and future tests and actions can be made.  I still have interest in the other tests but will take advisements from my doctor(s) if necessary.  As everyone has mentioned the other tests are good pieces of information but not the finite test.  A compression test on an engine is a good piece of information but not as good as popping off the heads.  Merry Christmas to all and God Bless.

Mike 

xNTP
Posts: 34
Joined: Oct 2016

I believe that mp-MRI first could become standard, a standard option or a more insurance accepted option in 2017.  

First, I did get approved for mp-MRI first, in December, with a resonably respected urologist's support.  Second a paper referenced in the latest 2016 NCCN guidelines shows that biopsy based cancer detection (AUC) was best from biopsies guided with software based fusion of the mp-MRI, better than the ca 12 core biopsy that is standard in many places today.   

I think that two steps need more AUA or medical oncology support:  better molecular profiling of prostate cancer, both as available tissue and blood work; and second, active surveillence combined with milder treatments of biologically based agents and regimens, before being forced by circumstance to the more drastic decisions. 

Not all locations have the automated fusion software available on a regular basis right now.   I am somewhat affected by installed availablity for 1st half 2017.

 

 

Clevelandguy
Posts: 471
Joined: Jun 2015

HI,

I feel the MRI should come first to point the direction for the biopsy samples.  If you do it the other way around then you are just shooting in the dark.

Dave 3+4

mstoriop
Posts: 37
Joined: Dec 2016

Hello to all.  Hope you all had a very Happy New Year.  For anyone that may find my update of interest I did undergo a 12 core biopsy December 21st.  For anyone contemplating biopsy or not as I was in my first post I can say that for me the whole ordeal and after effects were virtually pain free.  The shots in both butt cheeks were the only discomfort at all and not in any way what I would consider painful. 

on 12/29 I got a relatively non urgent call to check in with the Urologist.  As it turned out the Urologist that performed my biopsy has just retired and I will be switching over to another doctor in this group.  The PA I talked to said I had a bit of a problem and would need to consult with the new Urologist with appointment set for 3 weeks out.  She said she had no information that she could give but with a bit of prodding/respectfully asking have found out with no other technical info that 8 of 12 samples had no issues and 4 of 12 were 3+4=7.  Obviously I was hoping to be in the majority who come out clean with the measurables I had prior to biopsy. 

Luckily I am not an extreme worrier and will wait until my consultation but as with my original post above any comments/opinions/similar situations that anyone has experienced would be very highly appreciated.  From what I have read so far without knowing more I may not be a candidated for active surveillance which was the hope in my mind before biopsy should a condition be found.  Thanks to all         

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3328
Joined: May 2012

mstoriop,

I'm thankful the biopsy was not painful for you.

At least you got some info from the NP. A three week wait to get more information from the urologist is irrelevant, and won't affect anything.

The "3=4=7" number, as you seem to know, is your Gleason, and it means that those cores do have a bit of PCa in them.  Roughly 1/3 of the samples pulled.

A Gleason of 7 is regarded as mild to intermediate in aggressivity, and the volume (area with positive tumors detected) is not terrible.

Continue to read and study while you wait, and use whatever relaxation techniques or activities you know.    While you so far have only limited information, things certainly do not sound terrible at this early juncture.  Very likely, like most men, you will achieve a full and permanent cure by whatever treatment you choose.

I do not think you are in the common parameters for Active Survellance, but Hopeful and Optimistic and some others are the experts in that area, and probably will write.

max

hopeful and opt...
Posts: 2226
Joined: Apr 2009

Determining Gleason scores are subjective, and so it is best to send your pathology to a world class EXPERT. There is a difference between pathologists.

If your Gleason score has been given an interpretation that is lower or higher than that rendered by an expert, you may untertreat or overtreat your cancer based on erroneous information.

Do not be afraid to ask for additional assurance that your Gleason score is accurate, because this is a major factor in your decision making process.

Here are a few world class pathologists to choose from.

David Boswick , Virginia

Francisco Civantos , FL

Jon Epstein, Johns Hopkins

..................

Also ask for a copy of the results of your biopsy. See if there is other pertinent information in the report other than the Gleasons.

When you receive the copy of your report, for the cores that are positive, see what percent of each of the cores are 3+4=7, ...this will be an indication of extensiveness.

 

 

Clevelandguy
Posts: 471
Joined: Jun 2015

Hi,

With a 3+4 I personally would not go the active surveilance route with known cancer, but that's up to you.  The cancer will only grow, but who knows how fast?  I would consult with your urology & oncology doctors and see what they say. Cancer is nothing to fool around with but a 3+4  is not as agressive as say a  4+5.   Hopefully it's all inside the prostate, don't let it grow and get outside of the prostate, then that's a big problem.  Good luck

Dave 3+4 

VascodaGama's picture
VascodaGama
Posts: 3045
Joined: Nov 2010

I am sorry for the positive diagnosis. I believe you have been researching on matters of PCa so that you got an idea about the next steps. Your doctor will discuss about that too but it is better that you prepare a list of educated questions in advance for better comprehension on the conversation. The risks of treatments are high and you need to know details before any commitment. The options and decision need to be based on all the info gathered and the clinical stage. The higher the level of information/data the better option is chosen and the best outcomes are provided. These include the best guessing of cancer location, extent of the disease and expected side effects of treatment.

 I would suggest you to get second opinions, make a judgement on the recommendations and discuss them with your family.

Best wishes in your journey and a good 2017.

VGama

 

mstoriop
Posts: 37
Joined: Dec 2016

I finally got my biopsy from the doctors office with an official appointment with the urologist in a couple of days.  In summary 4 of 12 cores 3+4 =7 with Prognastic Grade Group 2.  8 of 12 benign.  Right Lateral Base, Right Lateral Mid and Right Lateral Apex all 40-50% of core length.  Right Mid says same as the other 3 with 50% but then says perineural invasion.  That's pretty much the whole biopsy description with the addition of the Gross Descriptions of labeling and how received and length.  No other technical language or descriptions.  I have started my list of questions from my research to date now that I know something.  I am definitely going to request another pathology reading and from suggestions above and my own looking it seems Jonathan Epstein at Johns Hopkins may be my choice regardless of how and whom pays for it.  With this information I am wondering if anyone has suggestions for questions and input I should try and gather from the urologist before I move along to other exoerts.  Don't know what he will suggest but wondering about more advanced tests now like the MRI tests etc.  Without knowing more I am not sure what kind of treatment path will  be suggested or what I may want to accept.  Anyone who has been in similar shoes that has input would be appreciated.      

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Jonathan Epstein at Johns Hopkins did my 2nd Opinion back in 2010. 

It only cost around $200 then.  The price listed now is $250 for slides or $350 for slide (plus blocks, whatever they are). 

Here's a link to JH's 2nd Opinion website:  http://pathology.jhu.edu/department/services/secondopinion.cfm

If you don't already know what treatment you'd like to receive and if you'd like to read a summary of the treatment choices available to you, you can read my post dated Sept 20, 2016 in following thread, in which I summarize the primary options: http://csn.cancer.org/node/305388.

Good luck!

 

VascodaGama's picture
VascodaGama
Posts: 3045
Joined: Nov 2010

At first glance from the above data you describe indicates that the cancer involves the whole right lobe with extensions at mid area to the left lobe. This is a voluminous case that one could think it producing higher PSA levels, probably higher than the 4.5 you indicate above. Your Gleason is also subjective and I think you doing it well in requesting a second look on the biopsy cores at JH. If G7 is 4+3 represents a worsen status that should be considered in the treatment. Negative DRE could mean it to be contained or that the cancer is sort of micro colonies not forming an aggregated mass tumours. In other words, my lay opinion is that it could be close to or at the outer shell.

The PSA is lower than the recommended to assure a true positive result in image studies but you should get one done (higher sophisticated types) at a reliable facilities. Multiparametric analysis MRI should be the minimum acceptable. Micrometastases are difficult of being detectable so that a choline contrast may provide better results. Bone scan makes also part of the protocol. With the collected data the doctor will then provide you a clinical stage (now at T1c, probably T2c) in which you can base your decision on a treatment choice.

Aggressive type of cancers should be aggressively tackled. You need to consider the risks and side effects involving each treatment option. Try researching on the matter now so that you can discuss with your doctor in your next consultation. Typically it takes about 2 to 2.5 months between diagnosis and treatment. There is no reason to speed up things but one should not sleep while waiting. Read, read, read. Second opinions on suggested treatments should be part of your last investigations before deciding.

Here are links that may help you;

 

http://www.lef.org/Protocols/Cancer/Prostate-Cancer-Prevention/Page-01

http://www.ccjm.org/index.php?id=105745&tx_ttnews%5Btt_news%5D=365457&cHash=b0ba623513502d3944c80bc1935e0958

http://csn.cancer.org/node/224280

http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

http://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/staging.html

A JH book "Choosing the right treatment for your prostate";

https://books.google.co.uk/books?id=16TbQ6as4uAC&pg=PA1&lpg=PA1&dq=choosing+the+right+treatment+for+your+prostate+cancer+johns+hopkins&source=bl&ots=RUO2tcFIuM&sig=KdfOBDSchbX6w12IDUn8JqvrZRE&hl=en&sa=X&ei=bZ4GVaOdMsWsUfq5hFA&ved=0CC4Q6AEwAA#v=onepage&q=choosing%20the%20right%20treatment%20for%20your%20prostate%20cancer%20johns%20hopkins&f=false

Best wishes and luck in your journey,

VGama

mstoriop
Posts: 37
Joined: Dec 2016

Thank you VascodaGama and Swingshiftworker for your most recent input and links.  They are very informative and helpful.  I met with my new Urologist yesterday and he was very nice.  Young guy only 35 and very honest about what he knew and did not know.  Did not try to really swing me to anything and made it very clear he was there to help me in any maximum way to decide on my cure.  Among things I learned is i have T1C stage.  No concern at the moment of anything outside of the prostate and the cancer not deemed particularly aggressive.  He confirmed from my first doctor's reports (doctor retired) that my DRE was felt to be normal.  Also said the doctor used I believe ultrasound on the biopsy and said my prostate volume was 30 GM.  Being an engineer that seemed weird to me as volume is not a gram unit of measure but I asked again and got the same answer so I took it to mean a weight.  Anyhow he was not concerned with that number.  Best news is nothing is off the table as far as treament options.  What I have done to date is my slides are going to Johns Hopkins for a second pathology opinion and I am being scheduled to meet with at a minimum a Radiation Oncologist at the Siteman Cancer Center in St Louis soon.  Siteman is very highly rated nationally in the treatment of cancer and will be a good place to gain second opinions.  I will most likely seek 3rd opinions as Siteman does not have Cyberknife technology but another very reputable hospital close to me does.  Traveling to the best place however cost is covered will be considered also.  While I have a ton of more research to do Swingshiftworker your comments in my post and other posts, along with my technical nature and pretty much hard desire to not do surgery is leading me down that path.  Actually before I even decided to get a biopsy and get pathology results I started researching treatments just to learn and this technology jumped at me. Knowing the technology has been around for a while and you had it 6 years ago with good results, and now the technology and long term statistics have gotten more robust with years I like my chances. 

Since now I know I have to deal with this I have jumped around quite a bit to other posts on this site, some dating back quite a ways and I see comments from many people taking time to help me now on my post that were doing this for others on many dated posts.  I appreciate it very much and I'm sure all of the other first timers feel the same.  Thanks very much.   

  

mstoriop
Posts: 37
Joined: Dec 2016

Here is an update on my progress should anyone in similar conditions to me find interesting.  I did get my second opinion biopsy results from Johns Hopkins as recommended by others above and would defintely recommend this for piece of mind and a new set of facts.  In my case, in addition to the fact they downgraded my right mid to 3+3 from 3+4, I liked a little bit more detail from JH in that they added observations that the remaining 3 cores all at 3+4 had less than 5% Gleason 4 involvement.  This helps me at least in my head that while I am intermediate risk it is on the low side of intermediate.  I have also since my last post met with one more urologist and a Radiation Oncologist.  While the hospital I went to for the radiation consultation does not have CK they perform a range of radiation procedures including proton beam and IMRT now set at 28 fractions rather than the traditional 40 plus.  It is a research hospital and a couple of trials were mentioned that are not underway yet but may be.  Not particularly interested so far.  I have my hopefully final consultation in 10 days with the hospital that does CK so my consultations so far are good practice for my interview of this facility as CK has been and so far is by far my first choice.  The hospital that I am visiting has had CK almost since the beginning of the technology so I am interested in finding out how many procedures they have done etc.  My second Urologist was going down the path of a bone scan and maybe a CT scan.  I did not schedule those but after my RO meeting am set for a 3T MRI March 18th.  This will I think really help set up the final path.  All doctors so far after looking at all available data feel I can safely wait on my procedure decision till later in the summer or early fall.  While health comes first I have family reasons to get through the next few months without dealing with side effects so hopefully the MRI further supports this thought.  Finally as so elequently stated by many people in these threads it is amazing how much research and time you need to spend doing due diligence to make a decision that fits for you.  Even one of my doctors stated that if you gave 10 doctors the same set of symptoms you could expect a minimum of 3 completely different treatment protocols.  As always suggestions and ideas are appreciated.  Thanks to everyone for the help to date. 

VascodaGama's picture
VascodaGama
Posts: 3045
Joined: Nov 2010

The result from JH lowers your risk for metastatic disease. At first look, CK may be enough in your case and you could schedule it definitively after receiving that final confirmation with the 3T MRI. I cannot see the point in extending the time to treat once you got the details in hand.

While waiting, you may investigate on the benefits you could gain from a combination of HT plus S8RT. In such a case you should start HT at least two months prior to RT.

Best,

VG 

mstoriop
Posts: 37
Joined: Dec 2016

Thanks for the input Vasco.  The first RO did suggest the possibility of a short course HT and inferred that decision would be looked at after the MRI.  I will pose the same questioning next week with the CK hospital's RO.  Since my post yesterday the Urologist office called and asked about scheduling an MRI and bone scan.  I told them that I was already on for the 3T MRI and was going to hold on the bone scan.  The RO did not think the bone scan was necessary at the moment.  Would it be your thought that since I am in the test/discover/decide mode that a bone scan would be beneficial?  For whatever it's worth I have absolutely no bone or body pains of any sort and no urinary probs.  I had to stretch to give myself a 3 on the AUA Symptom Score Sheet.  Thanks very much.  

hopeful and opt...
Posts: 2226
Joined: Apr 2009

The American Urological Association does not recommend a bone scan for those who have a Gleason less than 8. 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3328
Joined: May 2012

ms,

I'm glad things are moving along and that you are consolidating on your choice for Cyberknife.

My Gleason was a 6 (on the cores that were positive), and my volume was limited, and both my surgeon and radiation oncologist told me that a bone scan would be a waste of  time and money, given my particulars.  Because I chose surgery, I received no MRI either, and the patholigist's report proved that there had been no need for that either. 

"Pain," except in the UT, is virtually never encountered in PCa patients, unless they are highly involved with metastatic growth. My point is that the absence of pain, clinically, is not indicative of much in early-stage PCa.

You have studied this a lot. Combined with your reasonable and calm attitude, you should be PCa-free soon, for life.

max

hopeful and opt...
Posts: 2226
Joined: Apr 2009

Max,

By the way, I'm glad that that you are having zero PSAs, and everything went well with the surgery that you had, however, pllease note that a T3 MRI would have been appropriate for you before receiving sugery. The MRI is helpful in making the "best" decision.  

Thanks for all the wonderful posts that you give to this forum.

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3328
Joined: May 2012

Thanks H & O.

My doctors both viewed my case as quite minor and unproblematic. But it is a good corrective to know that an MRI is of value before even seemingly minor cases of PCa.

Thanks again,

max

VascodaGama's picture
VascodaGama
Posts: 3045
Joined: Nov 2010

MS,

I agree with your RO and the survivours above. Your data doesn't lead to think that you got PCa in bone. Most probably a bone scan this time would not identify lesions that could relate to cancer. However, any protuberance has higher probability of being identified when radiologists compare images with previous ones. A bone scan done now may signify little in your present diagnosis but it would be of great value in future occurrences, if any. Surely, the 3T MRI would be sufficient in such future image comparison of the pelvic area. Bone scans cover the whole body bones (including joints and diagnosis of arthritis). Substitutes are PET and CT scan (X-rays).

I would add, that many of us (young fellas above the 65) think being fit, symptom less, etc, and become surprised when found with cases of bone loss (osteopenia/osteoporosis), cardiovascular deficiencies, liver and kidney impairments, etc. I think that PCa patients should undertake a series of cautionary tests and exams to ascertain of ones real health status in all fronts. In my case along the years with PCa, I was found with osteopenia, high blood pressure and most recently renal deficiency (stage 3). All these may interfere with PCa care. Many prefer to enjoy life and treat when the problem arises. I make part of that "silly group" that prefer to know in advance what to expect.

Best,

VG

 

mstoriop
Posts: 37
Joined: Dec 2016

Ok Fellas I'm back at the well again.  I had a consultation with another RO today.  Hopefully my last due diligence ordeal.  The RO was unbelievable with time and discussion, as was the first RO for that matter, but he was great spending over an hour with me.  As mentioned above this is the hospital that has cyberknife and that is and has been what I am leaning towards.  The RO has been there since 2007.  The hospital has had cyberknfe since 2004.  They have done "countless" procedures per the RO without really investigating.  He approximates at least 100 per year more all the time.  One question I have from the group here is equipment.  The cyberknife is original equipment (2004) but has all modernizations, mechanical and software as put forth by Accuray.  Not sure if this is an uneasy point or not.  Another cyberknife facility in my area has equipment only one year newer apparently so maybe I'm overthinking?  This hospital is building a whole new oncology facility and they are installing new state of the art True Beam.  The RO was terrifically honest talking about how money talks and that the cyberknife was not going to the new building but was staying where it is and active.  Except his honest thoughts on how money talks and he could see the cyberknfe going away sooner or later (fall maybe).  He also was honest about his preference for cyberknife over True Beam only to the extent of the massive amount of personal, industry and hospital data they have versus what they are going to.  Apparently there is work on using the True Beam for larger fractions smaller number of visits like cyberknife but not as much info on it.  He also said the CK treatments may be more like 2-3 hours not the one hour I keep reading about so opinions appreciated here what has been your experiences.  Also his pretty much general protocol is a diagnosis stage of CT scan and bone scan.  Then if all well for using CK place the fiducials.  After fiducials then another CT scan and an MRI to plan the treatment.  Seems reasonable but opinions inserted here please.  He then does 5 treatments pretty much every other day, which I like, using 36.26 Gy.  Other than any thoughts what I really would like to know is what anyone thinks about the 3TMRI I have scheduled for next Saturday 3/18/17 at the first hospital.  I asked if he could use their results and he said he could but going back to his basic protocol he does use MRI but in a different spot.  I am leaning towards cancelling this MRI and getting my ducks in a row for CK at this facility.  Thank you all once again for your time and interest.         

Swingshiftworker
Posts: 1013
Joined: Mar 2010

FWIW, I think you are overthinking the process. 

What your RO described is pretty typical of the CK procedure.  Not sure what you're talking about in terms of 2-3 hours.  The 5 treatments I had (as I recall) only took about 30 mins each, which fits w/in your 2-3 hr parameter if that's what you mean.

Don't think it matters that the CK equipment was made in 2004, as long as the equipment has been properly maintaned and the software has been regularly updated, which I assume it has been done since the equipment it is being used regularly with apparent success.

Not sure what your concern about the 3T MRI that you have scheduled.  If you don't have to pay for it yourself, it certainly can't hurt.  it will identify the location of the cancer and determine if any of it has leaked out of the prostate, which will tell you whether CK would be suitable for treatment or not.

However, you will still need to do the MRI/CT scans before/after placement of the gold fiducials in your prostate because the program uses those to properly align and aim the equipment for delivery of the radiation.

 

 

Airbornelarry
Posts: 1
Joined: Mar 2017

Just found this cancer online support group and let me introduce myself. My first name is Larry, age 70, nad I was diagnosed with prostate cancer last August nad had robotic surgry on November 14, 2016. I was informed I had positive margins and would be scheduled for my PSA and the results were shared this week. Hoping for a "non-dectectable" but it was 0.12. My Surgeon/Urologist has scheduled a MRI and PET bone scan for next week. During the review of my PSA he did mention I may need hormone and radiation treatment. Not a fan of the proposed hormone treatment for the adverse side effects. May ask the doctor to conduct another PSA before rushing in for additional treatment but will wait for scan results. Anyone had elevated PSA similar after surgery and what option did you decide upon.

Larry

San Diego

101st Airborne Vietnam Veteran

VascodaGama's picture
VascodaGama
Posts: 3045
Joined: Nov 2010

I would suggest you to start your own thread as this post may get lost in the middle. In any case, after failed surgery patients look for salvage treatments that typically involve radiation administered alone or in a combination of radiation plus hormonal. It all depends on one's case and status. Please read this link;

https://csn.cancer.org/comment/1414101#comment-1414101

Best wishes and luck.

VG 

VascodaGama's picture
VascodaGama
Posts: 3045
Joined: Nov 2010

MS,

I agree with Swing above. CK is good and the 3t MRI is a plus in the diagnosis that will confirm your status. Choline based contrast for the exam would still upgrade the image study. I wonder what did the RO told you that made you change your mind. He may be so confident on CK that turn blind to peripherals. Follow your intuintion.

Best,

VG

mstoriop
Posts: 37
Joined: Dec 2016

Thank you Swing and VG.  The second RO didn't really say anything to change my thinking on the MRI.  I just thought that if an MRI was part of the protocol in the process and hospital I am choosing the first MRI at a different hospital may be redundant.  Thinking on it over the weekend and considering your thoughts also I think I'm going to go ahead and do it.  If nothing else it can serve as another chunk of good data.  I suppose I am reaching a little on the age of the equipment.  Not like a car or some other type of consumer commodity that wears out quickly.  As far as the 2-3 hours I did ask if this is per treatment as I was very surprised.  He did say that was per treatment and that in some cases they had to stop and change an iris and they could stop for bathrooom breaks whatever.  I'm not concerned about the time involved maybe he's talking from the time you walk in the door to leave.  I think when I heard equipment from 2004 and 2-3 hours it made me pause a little considering all that I have read. Has anyone found or heard anything about using the True Beam process with the higher fraction lower amount of visits i.e. CK?    

mstoriop
Posts: 37
Joined: Dec 2016

Partially answered my own question for anyone searching similar.  Should have known I'd find good info right here.

https://csn.cancer.org/node/299641

 

Old Salt
Posts: 720
Joined: Aug 2014

The thread that mstoriop mentioned does present a good discussion of two instruments that can be used to deliver SBRT. The point that I want to make is that what is most important is the experience of the team associated with the 'machine', not the 'machine' itself.

mstoriop
Posts: 37
Joined: Dec 2016

I hesitate to add many posts here as I have not had any treatments yet but I do hope this thread helps other new guys in their particular thought processes.  I did have the 3T MRI done and to the extent of it's precision have no evidence of lesion outside of the capsule and no evidence of lymph enlargement or involvement so reasonably good news.  As mentioned in so many posts here I heartily agree that second biopsy opinions and these types of tests should be done as part of your due diligence.  I have met with a total of 5 different doctors at four seperate hospitals, 2 Urologists and 3 RO's.  In my case all five were extremely unbiased and took great effort to explain all treatments and their effects.  One RO just about spent more time talking about surgery than his own specialty. It is time consuming but well worth it to get multiple answers to the same questions.  I am very fortunate to have two Cyberknife facilities of equal quality close to where I live.  Surgery for me was off the table from the get go unless absolutely warranted.  For me it came down to learning as much as I could about all of the radiation alternatives and comparing them to CK, which I had and still do have my bias to.  I have chosen CK and the facility.  Basic planning is underway but actual schedule of treatment not cut in stone yet and may be in mid June.  Thanks to everyone who has helped me to date.  If anyone who reads this feels I can help I most assuredly will.  Cheers.    

Swingshiftworker
Posts: 1013
Joined: Mar 2010

I obviously support your decision because it was the same as mine. 

Glad that you came to that choice in your own way.  I hope that the outcome for you is as good as it was for me and others on this forum.  Keep us informed about your progress. 

Good luck!

VascodaGama's picture
VascodaGama
Posts: 3045
Joined: Nov 2010

Many should follow your principles. Educate first then analyze options and decide.

Crossing fingers in your favor. Best wishes for a successful outcome.

VG

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