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tired682
Posts: 9
Joined: Dec 2012

I just received the results of my biopsy Monday. 

My history: 

2010 psa 1.70

2014.        3.79

July 2017 5.78

15 days of cipro, retest 4.40

I asked them to do a free psa at the time off the retest

It was 8%

The urologist /nurse practitioner wanted me to wait until November for another psa, that came in at 6.50

The urologist insisted on a biopsy

Two dre's both negative

Biopsy Results

Left mid. Adenocarcinoma 1 of 2 cores involved 2% gleason 6 (3+3) length mm 18 (5%) 19
Left apex 1 of 2 22 % gleason 7 (3+4) length mm 17 ,20 (40%)
Part c has 20% pattern 4
Gleason score grade group 2

He is a surgeon but is recommending hdr bracytherapy.

Three days of treatment over 4 weeks.

Any comments or suggestions would be very much appreciated. 

Thank you

 

 

 

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

Tired,

It seems that you are a survivor of AS so that you have some knowledge about this disease. I wonder about any image study you have done along the 7 years of your story. Brachy therapy is for low risk contained cases which outcome depends much on the experience of the doctor inserting the grains. However, the success of any treatment depends much on the location of the cancer, including the location of the tumours within the gland. I recommend you to get the best info in regards to the bandit's hideaways.

Surely you may already know that contained cases have high rates for good outcomes with surgery or any type of radiation. There are also other existing therapies being performed in contained cases such as cryo and thermo but these have fewer numbers of cases to be recommended over the present radicals. All these therapies are linked to risks and side effects so that, apart from the success of the therapy, one should decide according to preferences on the risks. In such regard, brachy presents a low risk if the pellets are placed in areas that would not affect the urinary sphincter. In fact all types of radiation are planned to be delivered avoiding that area totally or just applying low doses (which would restrict the dose planning of brachy to lesser numbers of seeds in the area). I think you should discuss with a radiologist specialized in PCa treatment, in regards to all methods involving the treatment of a contained case.

How old are you?

Best wishes,

VG

 

tired682
Posts: 9
Joined: Dec 2012

Thank you vg,

I'm 62. It really hasn't been 7 years, the first and second psa's were  just part of some general blood work being done. The suspicion of cancer started last summer. 

My surgeon (practicing 33 years) does the brachy therapy. He's been using it for 8 years, according to him with great success.  

He has me on Tamsulosin to relieve the urinary problems. We did not discuss  whether or not there would be further investigation of the tumor location. 

Thanks for the heads up, I'm going to find a radiation oncologist to look at my case.

Mark

Clevelandguy
Posts: 415
Joined: Jun 2015

Hi Mark,

1+ for what Vasco says

There are several types of radiation treatments, seeds,Cyberknife,Proton, ect.  I would ask your radiation oncologist to review the different types for your particular cancer and see which one has the least amount of side effects and the highest cure rate.  Time to get doing your homework.

Dave 3+4

tired682
Posts: 9
Joined: Dec 2012

Thanks Cleveland I'm on it.  I made an appointment today with the Huntsman Cancer Center for a second opinion. 

They're ordering a prostate mri before i see the doc.

 

ASAdvocate
Posts: 112
Joined: Apr 2017

I am recently reading of more men choosing HDR BT as a mono therapy. Recent studies show execellent results with low side effects. When I read discussions like this, it is apparent that people aren't quite sure what it is and make reference to "seeds", which are not used with HDR BT. 

It would be a great choice for a G(3+4) patient seeking treatment. Your next task would be to find a major center that offers it. Good luck to you.

SubDenis's picture
SubDenis
Posts: 130
Joined: Jul 2017

I am doing HDRBT, two treatments about 2 weeks apart.  Have to have colonoscopy first.  Our stats are not much different.  The treatment, I am told is a non-event. Doc said I could play golf the next day.  The side effects are minimal, as our anatomy is not altered.  You have a good Uro to recommend outside his specialty.  When I told my URO, he said that was a good choice. Here is a good site to learn more about it. WWW.CETMC.com.  I start my treatments mid-January.  I wish you well. Nice to see another HDRBT patient.

 

Also, HDRBT is not seed, Catheters are inserted in the perineum and then the source is put through the cath for a short period of time. So there are no restrictions like seed have. Denis

SubDenis's picture
SubDenis
Posts: 130
Joined: Jul 2017

I also believe the expertise of the RO is critical to ensure the Caths are inserted properly. My RO has done a 1,000 HDRBT and still practicing so I take it he is pretty good.  

Old Salt
Posts: 720
Joined: Aug 2014

Whereas most urologists can do brachytherapy with seeds, relatiavely few have learned how to do the high dose rate (HDR) procedure. As SubDenis already pointed out, it's very important to get treated by an HDR brachytherapy specialist with lots of experience. 

tired682
Posts: 9
Joined: Dec 2012

I don't know how many my uro has done but i will ask after i get the second opinion. He did say he's been doing it for 8 years with vey good results. He prefers it to surgery when possible. 

He told me that he gives 3 treatments spaced two weeks apart for each. 

I think my tumor is an aggressive one, maybe that's why the extra treatment?

Thanks you for your replies, they are very much appreciated.

 

SubDenis's picture
SubDenis
Posts: 130
Joined: Jul 2017

I do not think anyone can tell you it is aggressive.  You are intermediate risk favorable to me.  You have time to learn and make an informed decision.  We ask more questions of a car salesman when we are buying a car then we do of docs who we will choose to cure us!   Be bold and ask many, many questions. I am six months into this journey and just recently made the decision because I was unsure until then.  Denis

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

I am sorry for the mistake. I did not read the hdr (high dose rate) and, the comment that a urologist was the one doing the procedure made me think on the traditional brachy with seeds. In any case HDR brachy also depends on a good image study. The high dose is not advisable if the patient has/had ulcerative colitis so that a colonoscopy is advisable before the RT procedure.

Best wishes

VG

tired682
Posts: 9
Joined: Dec 2012

Went for a second opinion at the Huntsman Cancer Hospital. 

They gave me a 3t mri which showed a 2 centimeter tumor on the left side. No apparent spread to the pelvis area.  The doctor wants me to have a Prolaris genetic test but the lab that examined the original biopsy tissue doesn't seem to want to give out up. Too funny, anyway I'm going to call them tomorrow and see if i can motivate them a little!

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Anyone newly diagnosed with prostate cancer rated Gleason 6 (and usually Gleason 7) has all treatment options available to him and, since this cncer is considered "low risk", he has time to decide which choice is best for him.  So, the first thing a new prostate cancer patient should do is to do research on the available options before he actually has to make the decision regarding which treatment to choose.

The following is my response to other men who asked for similiar advice about the treatment choices avilable to them.  It's a summary of the available treatment options and my personal opinion on the matter.   You can, of course, ignore my opinion about which treatment choice I think is best.  The overview of the choices is still otherwise valid.

 . . .  People here know me as an outspoken advocate for CK and against surgery of any kind.  I was treated w/CK 7 years ago (Gleason 6 and PSA less than 10).  You can troll the forum for my many comments on this point.  Here are the highlights of the treatment options that you need to consider:

1)  CK (SBRT) currently is the most precise method of delivering radiation externally to treat prostate cancer.  Accuracy at the sub-mm level  in 360 degrees and can also account for organ/body movement on the fly during treatment.  Nothing is better.  Accuracy minimizes the risk of collateral tissue damage to almost nil, which means almost no risk of ED, incontinence and bleeding.  Treatment is given in 3-4 doses w/in a week time w/no need to take off time from work or other activities.

2) IMRT is the most common form of external radiation now used.  Available everythere.  Much better accuracy than before but no where near as good as CK.  So, it comes with a slightly higher risk of collateral tissue damage resulting in ED, incontienence and bleeding.  Unless things have changed, IMRT treatment generally requires 40 treatments -- 5 days a week for 8 weeks -- to be completed.  I think some treatment protocols have been reduce to only 20 but I'm not sure.  Still much longer and more disruptive to your life than CK but, if CK is not available, you may have no other choice.

3) BT (brachytherapy).  There are 2 types: high dose rate (HDR) and low dose rate (LDR).  HDR involves the temporary placement of rradioactive seeds in the prostate.  CK was modeled on HDR BT.  LDR involves the permanent placement of radioactive seens in the prostate.  1/2 life of the seeds in 1 year during which time you should not be in close contact w/pregnant women, infants and young children.  The seeds can set off metal/radiation detectors and you need to carry an ID card which explains why you've got all of the metal in your body and why you're radioactive.  Between HDR and LDR, HDR is the better choice because with LDR, the seeds can move or be expelled from the body.  Movement of the seeds can cause side effects due to excess radiation moving to where it shouldn't be causing collateral tissue damage -- ED, incontinence, bleeding, etc.   Both HDR and LDR require a precise plan for the placement of the seeds which is done manually.  If the seeds are placed improperly or move, it will reduce the effectiveness of the treatment and can cause collateral tissue damage and side effects.  An overnight stay in the hospital is required for both.  A catheter is inserted in your urethra so that you can pee.  You have to go back to have it removed and they won't let you go until you can pee on your own after it's removed.

4) Surgery -- robotic or open.   Surgery provides the same potential for cure as radiation (CK, IMRT or BT) but which MUCH GREATER risks of side effects than any method of radiation.  Temporary ED and incontinence are common for anywhere from 3-12 months BUT also sometimes permanently, which would require the implantation of an AUS (artificial urinary sphincter) to control urination and a penile implant to simulate an erection to permit penetration (but would not restore ejaculative function).  Removal of the prostate by surgery will also cause a retraction of the penile shaft about 1-2" into the body  due to the remove of the prostate which sits between the interior end of the penis and the bladder.  Doctors almost NEVER tell prospective PCa surgical patients about this.  A urologist actually had the to nerve to tell me it didn't even happen when I asked about it.   Don't trust any urologist/surgeon who tells you otherwise.  Between open and robotic, open is much better in terms of avoiding unintended tissue cutting/damage and detection of the spread of the cancer.  Robotic requires much more skill and training to perform well; the more procedures a doctor has done the better but unintended injuries can still occur and cancer can be missed because the doctor has to look thru a camera to perform the surgery which obstructs his/her field of vision.

5) You may also want to consder active surveillance (AS), which is considered a form of treatment without actually treating the cancer.  You just have to get regular PSA testing (usually quarterly) and biopsies (every 1-2 years, I believe) and keep an eye out for any acceleration in the growth of the cancer.  Hopeful and Optimistic (who has already posted above) has already mentioned this and is your best source of info on this forum about it. 

I personally could not live w/the need to constantly monitor the cancer in my body.  Like most other men, I just wanted it delt with.  Some men gravitate to surgery for this reason, thinking that the only way to be rid of it is to cut it out, but I did not like the risks presents by surgery and opted for CK, which is a choice I have NEVER regretted.  I am cancer free, there is no indication of remission, there were no side effects and my quality of life was never adversely affected.  Other men on this forum have reported similiar results.

So, for obvious reasons, I highly recommend that you consder CK as your choice of treatment.  The choice seems obvious when you consider the alternatives but you'll have to decide that for yourself.

Good luck!

Clevelandguy
Posts: 415
Joined: Jun 2015

Hi,

 

I would look into Proton therapy which shoots a fixed length beam at the cancer.  Tissue damage could occur on the way in but since the beam has a fixed length there should not be any damage past the Prostate.  Check it out & see if any local hospitals have the machine.  Your Onco guy should be familar with it.

 

Dave 3+4

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