Biopsy Results:Pca found

Hi,
I had a Biopsy with 14 cores taken. Sorry to find 7 of the 14 cores were positive for Adenocarcinoma
with 10 - 70% and all given Gleason (3+3) = 6. Perineurial Invasion noted in 1 Core. No
Extra-Capsular Extension. The Biopsy went well - no pain - I did have injection for nerve blocking.

I have an appointment with my Urologist later this month.

In the meantime I am thinking and reading about treatment options.
I am not very positive about surgery when other good options are available, which in
this case Radiation seems a good option. If I had less cores/less involvement I would
choose AS but seems better to get some treatment.

I live in Houston,Tx and if anyone can advise about good Radiologist Oncology in this area
would really appreciate and any other advice / comments welcome.

Cheers!

BUSMAN-

I'm sorry to welcome you to our awful club. Do get confirmation of the biopsy results from Epstein's lab at Johns Hopkins.

Six years ago, I had a similar diagnosis (see my signature). Like you, I thought that there was too much cancer for active surveillance. Knowing what I know now, that even men with higher volume low risk cancer, do very well on active surveillance, I might have made a different decision. I don't know. I would have liked a few more years of ejaculate, but I have no lasting side effects.

At any rate, you have plenty of time to decide, and your frame of mind a few months from now may be different from what it is now. It's a good idea to slow it down.

Of the 3 kinds of radiation that are worth considering (SBRT, LDR brachytherapy, and HDR brachytherapy) I know of only an LDR brachy specialist in Houston - Steven Franks at MD Anderson. MD Anderson also has a proton center. Proton isn't bad, it's just a LOT of treatments (40-44), expensive, often not covered by insurance, and so far no better than X-rays at reducing toxicity. I'd be surprised if there weren't someone in Houston offering SBRT for prostate. If you want HDR brachy, you may have to travel.

Hi, Busman, and welcome to the club!

My pathology was a bit different than yours, but I was just a click or two to far to feel good about AS. I chose radiation, SBRT (CyberKnife) to be exact. I felt that this was a good balance of treatment efficacy versus potential side effects. I would recommend strongly that you look into SBRT. Even if nobody there locally offers it, the total duration of the treatment is about 2 weeks, and some men have simply taken a 2-week trip to have it done.

One other recommendation, one which may go against what some others may feel, is that IF you do choose to read Dr. Walsh's book, remember that he is a surgeon. I found his treatment of all the radiation therapies, ESPECIALLY SBRT, to be almost condescending. In his most recent edition, he still asserts that SBRT is experimental and should only be used under clinical trials. Where has he been these last 5 or 10 years? (It is OK guys, I have my flame suit on. . . ) His material on prostate cancer, the disease, is the best I've read, and he really has written the book on nerve-sparing prostatectomy. He just is not well-versed in radiologic oncology.

If you want to learn about the various radiation treatments, you really need to meet with a radiation oncologist who offers the specific treatment in which you are interested. A doc who specializes in brachytherapy probably is not the one who knows the most about the newest external beam radiation methods. The IMRT doc probably doesn't know all about brachytherapy. You get the picture? See the expert in each specific treatment - they will know all about it.

With your G3+3=6 pathology, though, at least you have time to learn about your options before you have to choose one.

Dear All,

Thanks for the comments and recommendations.
For learning more about Pca, researching the internet and reading on this site have been my
largest sources. I have not yet read Dr. Walsh's book but will look into it. I recently
purchased a book on Prostate Cancer by Dr. Aaron E. Katz which seems to have a lot of good information.
He is biased toward Cryotherapy and is up front about that - because he has used it a lot successfully
and perhaps he helped invent or refine some of the techniques.

I do plan to take my time on future direction. I have a pretty good diet and excercize routine but
am still looking and planning to be more strict on my diet. I am virtually 100% certain my Urologists
will want to inject me into surgery soon but I am going to resist that.

I will look into sending my Biopsy slides to Epstein at John's Hopkins.
I think around 3 months after my Biopsy, say during July, I will get a PSA/free PSA and see where those numbers are.
If those numbers are steady or no increased much I may give AS a year and see how that goes,
but formally I do not know exactly if I have to have a Urologists support or join a formal AS program.
In the meantime that gives me a lot of time to learn more and become convinced to get the best
treatment for my case.

Cheers!

Welcome, Busman!

Upon my diagnosis in April, 2014 by my urologist in Austin, I scheduled an appointment with the multi-disciplinary genito-urinary clinic at MD Anderson.

https://www.mdanderson.org/patients-family/diagnosis-treatment/care-centers-clinics/genitourinary-cancer-center.html

In one day, I met with three different specialists - a surgeon, a radiation oncologist, and the head of their active surveillance program. It was a lot of information, so it was helpful to bring someone with me to take notes. Ask to meet with Dr. John Davis, if possible. The only downside was that that box of blue gloves on the wall was running low by the end of the day, as each doctor wanted to conduct his/her own examination 😳

As noted by Tall Allen, MD Anderson has a proton therapy center - a $250M facility, one of only a handful in the country. If you are looking at radiation, they will probably steer you towards that instead of SBRT (Cyberknife). Keep an open mind and keep all options open.

Good luck with your journey.

If at all possible take someone with you to your appointments. Someone who can help take notes, be sure you are getting your questions answered, and to be sure you heard what you thought you heard...
All the best to you.