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Posted 1/20/2017 10:09 PM (GMT 0)

JackH said...
Before Step 3, you should insert "Evaluate whether immediate treatment is necessary/appropriate or not."

It's not clear, yet.



I'm so glad to hear that you followed-through on the biopsy 2nd opinion, and have now more clearly found that immediate treatment is not necessary or appropriate! Not following-through with a data-driven approach is where so many others fail in their so-called due diligence.

Congratulations!

Post Edited (JackH) : 1/21/2017 6:46:27 AM (GMT-7)

Posted 1/21/2017 1:53 AM (GMT 0)
If HDRBT is appropriate, why not SBRT? Their BED stats are similar, and many SBRT dosimetry plans are patterned after those of HDRBT.

Not that I'm saying one is better or worse than the other, just that there are multiple viable options to consider. If robotguy's pathology is accurate, with 1 core of G3+4, he has time to learn, discern and choose what he feels is best for him now and into the future.

I do agree that surgery might be like swatting mosquitoes with a bazooka, though.
Posted 1/21/2017 3:19 AM (GMT 0)
JackH, why do you conclude very low risk if the mpMRI indicates PI-RADS 4, and one path report indicates G(3+4)? What makes you discount those?
Posted 1/21/2017 3:30 AM (GMT 0)
JNF, I thought any RT made salvage surgery much more difficult. Not that I think it will be necessary, just thinking 2 steps ahead for planning options. Also, I think the RT secondary cancer risk is very low, but it is higher for RT than for surgery. Thanks for the feedback!
Posted 1/21/2017 10:39 AM (GMT 0)
Surgery as salvage is rarely appropriate and usually not needed. if the original radiation is not successful it most always means the cancer was already elsewhere outside of the radiation area. Then you use systemic treatments. If the cancer is still in the prostate area you can usually use reduction again especially if you started with HDRBT and do not also add IMRT.

Radiation is as successful killing the cancer as surgery is removing it. Often it is more successful as the area that is radiated is larger than the area the surgeon can cut out. Thus if the surgeon has a positive margin the radiation would have covered that and been better.

The argument that you can radiate after a failed surgery but can not use surgery after a failed radiation is a disengenuous red herring falsehood used by surgeons to support their method. If radiation is so good when surgery fails then why not use radiation in the first place and avoid the risks and side effects of surgery? And if in the rare event the radiation fails and the cancer is still local there are numerous ways to re-treat but not surgery.
Posted 1/21/2017 1:45 PM (GMT 0)
Robotguy, aw darnit, I missed the PI-RADS 4 update in your post...so sorry. I'm going back and modifying what I wrote yesterday so as to not be confusing in the future. MRI targetted biopsy in the areas found in the mp-MRI is probs your next step.
Posted 1/23/2017 10:19 PM (GMT 0)
Had my consult with the urologist today. He is comfortable delaying treatment for a while and going on AS. 6 mo. PSAs, 12 mo. Bx. I updated my signature. Much thinking to do and discussions with dear wife. Go on AS to delay side effects for a while, and risk it escaping the prostate? Go for treatment now to minimize risk of spread, and get the healing process going while still young, with risk of having to live with possible SE's for many many decades? Tough choice. Thanks again to everyone who posts here and offers support.
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