My journey begins (very long post warning. . .)

Wolfster, I've read about the focal treatments now coming into use, but it seems that all of them rely upon MRI for imaging. That imaging is an issue for me, as I have a cardiac pacemaker that is not MRI compatible. I've had this device (and its predecessor) for almost 6 years, most recently having it replaced last month, just before my biopsy. I would not think it makes any sense to try to change the device again only a couple of months later to enable me to have the MRI's, and I am sure insurance would deny paying for another replacement. I sure wouldn't be able to pay out of pocket for a new one, as the last one is nearing $100K in charges. Of course, insurance won't pay the full billed amount, but I wouldn't be in a position to pay even half. . .

Other than that, Wolfster, it sure does look like our pathology reports are really similar. My PSA is slightly higher and my prostate is slightly larger (38 cc), but as you noted, I am about 20 years older.

I'm still waiting for a callback to schedule a consultation with Dr. Hirsch (CyberKnife doc #2). I hope to meet with 2 RO's to see what treatments each of them feels would be appropriate for me, then choose one and get on with it.

A question for Tall Allen (if you read this far) - It seems that you feel that a period of AS would be reasonable in my case. Since I do have one core that was G3+4, is it possible that over time that area could become instead G4+3? All that would have to happen is for the G4 cells to multiply faster than the G3 cells, I guess. Probably wouldn't alter the recommended treatment path, but I guess it would increase PSA and probably trigger treatment activity. I'm not sure what the time would gain for me, though, as SBRT (if I'm able to choose it) seems to be less damaging than other treatments that would be appropriate for the diagnosis.

Instead of biopsies you can also have mpMRIs. I prefer to avoid biopsies if I can:

Klotz - Active surveillance for men with low-risk, clinically localized prostate cancer

George

Reminder:

Allen said...
The whole point of AS is that you are not letting it get worse -- if it gets markedly worse, you treat. Most PC is "indolent" -- it doesn't get worse. And for 55% of men on AS, it didn't get worth treating in 20 years.

Coming from a man who did not have the luxury of considering AS and instead had to use several years of aggressive treatment, I strongly urge you to not only consider it, but pursue it as long as is possible.

Many of us that had to treat yearn for AS while many who are candidates for AS yearn for surgery and radiation and drugs and all the risks and side effects. What a juxtaposition.

Nice writing Allen, thanks for reminding us to visit the site. Always good information.

Allen - I'm reading as fast as I can, but there is SO much to read. . .

At the moment, it is difficult to rationalize the thought of AS along with our "life plans" for the next few years. That will take some time to think through. Where would I go to have a consultation in which I could lay out my concerns with AS, and get some idea how to assess whether this would likely be a multi-year delay in treatment or merely months? It seems that this would be a conversation I would have with my uro, to discuss how he could help me to estimate my potential rate of disease progression. If that is a complete unknown, I would still have a tough time deciding how to value the benefit of delaying treatment for an unknown length of time. I've been told "It took years to get where its at" but I have no idea whether this disease follows a linear progression or something more exponential. I imagine there are some predictive tests for identifying how aggressive my cancer may be, but I haven't begun to look into those. I'm sure that is part of why all of you are advising me not to rush, and to allow myself plenty of time to learn, discern then act.

I'm also moving ahead with appointments with 2 radiation oncologists next month, so I will probably be inundated with information and statistics about various treatments, their plans/schedules, their side effects and timing thereof -- there will be a lot of information, I'm sure.