Newly diagnosed

Bosco,
If you like, click on 'my story' in my signature below to hear the story from the surgery perspective and my experience.

As far as how to choose? Well, you've summed it up nicely, and the decision is yours, based on your perception of the relative risk profiles, and your own life experience. For me, a lot of the decision was geographically based: I was a 2 hr/100 mile trip to wherever I was going to get treatment. The prospect of a single trip and done in a couple of days was significant. I also admittedly had a mental block about carrying the seeds around inside me for the rest of my life. There was a 'creepy' factor involved.

A key question regarding surgical side effects, as explained to me by my surgeon: Where are you NOW in relation to ED and what he called "Old man drips"? How it was put to me was, no matter where you are pre-surgery, you will likely move DOWN a step or two after surgery. Me, honestly, on the continence question, I was dripping before surgery from incomplete emptying, and now I'm dripping a bit at more random times. The volume is about the same, and the periodicity is about the same. So, it's an even trade. ED is not an issue...with a daily 2.5 mg cialis ;)

So....that's my take.

Halbert- I did read about your journey and appreciate the time and effort you put in to help newbies. Thank you.


It has been clearly stated to me by the urologic surgeons and RO at MSK that, in my case, the cure rate is the same for both surgery and radiation. At this time of my life I have no incontinence and no ED. Looking to keep it that way as long as possible. If it can be done without having to go through major surgery and all that entails then so much the better. I have also been told, by some of the brightest minds in the field, that there is a Plan B if Plan A should falter.

Currently leaning towards SBRT or LDR Brachy. Trying to compare the differences between these two.
My RO at MSK is Dr Michael Zelefsky who is a Brachy guru. Had one consult with him and he said either would work but because of his background he gave the "slight edge" to LDR.

I have read some of the studies that have been done ( Thanks Tall Allen ). It looks like the QOL study by Evans et al., that included some of the "leading lights" in radiation oncology, indicates that SBRT is the most favorable when it comes to QOL issues.

I plan on having another meeting with Dr Z to discuss further and try to come to a definitive decision so I can move on with my life.

________________________________________________________________________________________

Age 65
08/2016 Annual Physical PSA-7 (first and only PSA)
Negative DRE
4K-56
3T parametric MRI-10mm PI-RADS 3//4 lesion
Prostate 42cc
10/26/16 MRI guided fusion targeted biopsy
4 targeted cores benign
12 random cores - 6 of 12 positive
Left lateral apex - 3+3 5%
Right medial base - 3+4 70%
Right medial mid - 3+3 55%
Right lateral base - 3+3 70%
Right lateral mid 3+3 30%
Right lateral apex 3+4 80%

Post Edited (Bosco) : 11/26/2016 4:35:16 AM (GMT-7)

Bosco said...
My initial decision is to have surgery rather than radiation. I like the fact that the Ca is removed and can be followed accurately with future PSA tests, and radiation is an option down the line if needed.

Lots of great advice and discussion so far. I went the surgery route because I wanted to avoid hormones and wanted definitive answers (PSA) when it came to follow up care.

Well I got my definitive answer, my PSA is rising so I have started my "second bite of the apple". Not only do I have the surgical side effects, dry but still need daily Cialis, 1.5" shorter and the dry climax is nowhere feeling like what it used to, I now get to experience hormones and the RT SE's, the very things I wanted to avoid in the first place.

Please note - the SE's from either surgery or RT are very different for everyone. You could have zero issues, many complications or most likely someplace in between. Your status going into any option helps to predict your outcome but there is no real way to know where you will end up post treatment.

For me, having RT as a backup plan is a mixed blessing at best. You can never go back and I don't regret my surgical decision but obviously had I known I was not going to be part of the 80% "cured" I would have chosen differently.

Best of luck - You are at a tough spot in your journey, once the decision is made things seemed to get better.

Did tons more research during the week and met with my RO yesterday. I am totally convinced, all thing considered, that SBRT is the best route for me. I told Dr Zelefsky that I am ready to move forward and I'm waiting for a call back from his secretary to schedule the first step.

Paxton- you hit the nail on the head. After months of exhaustive research, multiple consultations and learning all that I could about the modalities I am a candidate for I now feel a tremendous sense of relief with the decision I made today. I am anxious to get started and to put this all behind me.
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Age 65
Physical 08/2016 PSA-7 ( first and only PSA )
Negative DRE
4K-56
3T parametric MRI-10mm PI-RADS 3 lesion
Prostate 42cc
MRI guided fusion targeted biopsy-10/26/2016
4 targeted cores benign - 12 random cores - 6 of 12 positive
Left lateral apex - 3+3 5%, Right medial base - 3+4 70%, Right medial mid - 3+3 55%, Right lateral base - 3+3 70%, Right lateral mid 3+3 30%, Right lateral apex 3+4 80%

Well Done, Bosco!

You have done your homework, gone to the appointments and meetings and have discerned what, for you, is the best treatment. Now you can begin setting forth your plans for the treatment itself. Once you have the Plan, all you have to do is "be there" for the next step, and soon it will be complete.

If your SBRT goes like mine, after the initial consultation you will need to schedule the procedure to implant the fiducials (metallic markers, usually gold, which are implanted into your prostate to guide the radiation beams.) After the markers are in place, usually about a week later, they will do a CT scan of your prostate and pelvis, and possibly an MRI. These scans use the markers as focal points, and are used to define the size and shape of your prostate and surrounding organs and structures. The Physicist on your radiology team uses these scans to plan the radiation patterns, beams and dosages that will be used to combat your cancer. After the scans are complete, they usually need about a week or 10 days to complete your personal treatment plan (although this time depends upon their workload and how your clinic works - my plan only took from Thursday of one week until Tuesday of the next).

I'll concentrate on the preparation stages for the moment. As you complete them, post back, and I can tell you all about how my treatments were done, what I experienced while "on the table" and what side effects I encountered.

For the moment, you should be prepared for some "uncomfortable" moments. Most uncomfortable, but not "I shouldn't have done this" painful, was the procedure to implant the fiducial markers. Some clinics do these through the rectum, like a biopsy. My clinic chooses to implant fiducials through the perineum - the area between the anus and scrotum. This allows them better access to the prostate for most accurate placement of the markers, and it allows them full freedom of placement of the ultrasound transducer independent of the marker placement instruments. They used a topical numbing cream, oral pain meds and some injected lidocaine. If I rate the pain of my biopsy (really well controlled) as a 2 or 3, the pain of the fiducial implants was more like a 6 or so. It hurt, but as soon as they finished, the pain was gone and I had no after effects. Considering that these were implanted to enable me to have a much less invasive treatment type, I felt it was a good trade off.

about a week after the implants, I had a CT scan. I couldn't have an MRI because my cardiac pacemaker is not MRI-compliant. They did two sets of images -- one without any contrast medium, one with. They did insert a Foley catheter into my penis for the procedure. The catheter itself just felt "strange" going in and coming out. I've had them before, so no surprises. The one caution, though, is if they tell you to be sure to drink lots of water after the procedure to flush out any remaining contrast material, believe them! The contrast material stings on the way out, and the more you dilute it, the less it hurts. I didn't drink enough at first, so when I first urinated, it felt like I had peed hot oil, mixed with broken glass and gravel. Once I was normally hydrated again, the pain level went way down, and within 24 hours there was no pain at all, and no after effects.

I'm not trying to scare you, by any means. I'm just explaining what I experienced, so that you can be aware and not surprised. I always find it easier to deal with "unpleasant" situations when they aren't surprises.

The prep work was much more of a pain than the treatments themselves. Once you've got your schedule, post it back and we can talk about that part of the journey.

Above all, don't get stressed out. You've made a choice, and it sounds like a good one to me. (Ok - I admit to being biased in favor of SBRT.) Now just build your plan, work the plan, and it will all work out as you've dreamed.

Bosco, you did a great job of researching this and made a terrific choice. Good luck to you and let us know how it goes.

Jim

Bosco, if I read your thread correctly, all your cancer is validated as a G6 condition. That in itself is wonderful. Once you have a "4" pattern the spread risk does go up.

I'm on the AS program, I do expect to have to make your decision at some later date. I will say this, it's my understanding that burning or cutting prostate cancer will never get you a 100% cure status. The D#@! stuff hides at the cellular level just about anywhere, at anytime. The decision is to buy more time with less risk on its reemergence. With a G6 condition, you will probably die of old age before the crap ever comes back.

Good luck on whatever treatment you choose.
________________________________________________________________________________

NOV 2016: PSA 3.7, Biopsy (12)cores Benign/Negative
JUL 2016: Bone Scan (NEGATIVE)
JUN 2016: PSA 2.7 (non std lab)
APR 2016: PSA 3.7

OCTOBER 2015
Age: 59
PSA: 3.0 elevated to 3.5 in (6) months
3T-MRI: (1) lesion identified
Fusion Biopsy Results: Lesion cores benign, (12) cores = (1)5%
Pathology Summary: Grade Group 1 (G6:3+3), 2nd pathology verification
Clinical Stage: T1c

Genetic DNA Profile: Above average risk for Aggressive PC (Genetics Test)
Existing Cancer DNA Profile: DNA risk unknown (Oncotype DX test cannot be performed, <1mm)
High Grade Biological Score: 27% aggressive risk (Mi-Prostate Score)
Other Health Conditions: Diabetes Type II (DX 2000), on meds & insulin

PCa Treatment: "Active Surveillance"
Risk: Undetected Cancer Progression
Risk Likelihood: LOW

My Story: https://www.healingwell.com/community/default.aspx?f=35&m=3528051

Post Edited (NewDay) : 12/5/2016 11:21:14 AM (GMT-7)

Sorry, my Bad. I thought the (2) cores were revised to G6

"I had the pathology slides read by senior uro-oncologists at both NYU and Memorial Sloan Kettering.
The second opinion actually downgraded 2 of the cores from 3+4 to 3+3."

New Day - It is technically possible to effect a "cure" for cancers beyond G6. It just depends upon where your particular G4 cells reside. If, for example, your G4's are all still contained within your prostate capsule, the odds are VERY high that you will either remove them in surgery or destroy them with radiation. Yes, the odds of these cells being already beyond the capsule go up compared to G3 cells, but their migration is not a universal truth. For example, in my case, with only an estimated 2% of my prostate being tumor-involved, and only 1 small core with any G4 cells noted, the odds are quite low that any cancer cells have escaped yet.

steveinErie - No spacer for me. My RO and I have read the same study that Tall Allen has linked, which basically found that the spacer did nothing to reduce rectal toxicities. That said, the only persistent side effect I have so far (12 days since final SBRT treatment) is some bowel irritation that manifests itself as more frequent bowel movements with some cramping during the movement activity. The severity of the cramping has noticeably decreased over the past week, and the frequency seems to be less of an issue as well. The two things that remain true are:
1) Never trust a fart. You never know what it really is.
2) You have to assume that if it feels like you need to "go" you really do. Not much advance notice, either. Know where the bathrooms are, always.

Good luck tomorrow. There are so many good SBRT stories here and I'm sure you'll be able to add to the list...

PHASE ONE COMPLETE-
Completed the fiducial and SpaceOAR placement yesterday without incidence. At MSKCC it is performed with IV sedation. When procedure was completed there was no pain, no side effects and Dr Z stated it went exactly as planned. Woke up this morning feeling good. Taking the post op antibiotics as prescribed and will start daily Metamucil leading up to the simulation session scheduled for next week.
Anxious to get phase two completed.

Truthfully not sure if it was the SpaceOAR that necessitated it or if they do all their placements that way. However, at consultation when discussing the procedure with Dr Z that is how it was proposed so I was happy to go along with it. I get the feeling that is how they do all their fiducials since Dr Z is hospital based and whether it was with or without the SpaceOAR it was to be done in the hospital as an outpatient anyway. Worked for me.