Good Friend PSA 4.2 Pathology _ feedback Please

Greg - you're a great friend to have.

The perineul involvement isn't the best thing to have, but still all the mainline treatments should work. It does make it a slightly higher risk case. Even with that, I'd say he has time to look into all his options first.

You gave him all the good points. I would add that he should really talk to at least one RO before selecting treatment. The RT might deal with the margins better than surgery.

Hate to see people rush into treatments without getting all the options available. Hopefully you can talk him into a second opinion or two.

And tell him we're mostly friendly.
Andrew

Greg - I have a friend who helped me at the start, just as you are doing for your friend. My friend is younger than I, and he chose surgery. I'm the old fogey (now 69) and I chose radiation. With mostly 3+3 and a bit of 3+4, they should tell your friend that any of the mainstream monotherapies will work about the same. That is both good and bad news.

You didn't share your friend's age, which might be a factor in our advice. If he is younger, then most docs would agree that surgery should be considered. If he is older (60-ish?), many would strongly recommend that he at least consider radiation. If he is willing to consider radiation, I strongly sugget that meeting with "at least one RO" won't do him justice. He should read here and on the web about all of the various radiation monotherapies and decide which ones might interest him particularly. Then he needs to seek out the best doc he can reach who specializes in each of the target therapies. This is because although there are numerous radiation therapy options, the person who is a top specialist in one of them is most likely NOT a specialist in any of the others. For example, here near Chicago we have Dr. Moran, who is the "go-to" guy for low-dose brachytherapy (implanted seeds). If I wanted seeds, he would be the guy. But I opted for SBRT (CyberKnife), so talking with him would have wasted his time and mine.

With your friend's pathology, I would probably consider SBRT as well as either high or low-dose brachytherapy - if he is inclined to consider radiation at all. SBRT and HDR-brachy in particular, show good disease control with relatively minimal side effects in their results studies.

I am now 4 months out from the end of my SBRT treatment and aside from some aggravation of my pre-existing IBS symptoms, I'm doing really well. (I'll know about PSA/disease control in a week or two.)

I think your advice is spot on...take your time--particularly with his diagnosis--and make decisions from a position of strength and knowledge, not when frightened and reacting.

Please encourage your friend to get a CT and bone scan. It will help identify if the cancer migrated. Also, if he goes ahead with his surgery he should have a discussion with his surgeon on what to do if they find a cancerous lymph node. (Most surgeons test a few pelvic lymph nodes to see if they are cancerous. If they find one a lot of surgeons will stop the surgery right then no there.). In my case there was a strong chance that the cancer had migrated. I argued with the surgeon before the operation that if the cancer only spread to a couple of lump nodes that I wanted him to continue. Turned out to be the correct decision as there was one lymph node that was 100% cancer. The cancer is a rare form (Ductal) that does not repond well to radiation, Chemo or hormonal therapies. Surgery even in advanced cases, is the recommended primary treatment.

As an aside, my catheter went though my stomach.