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second opinion for treatment

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Posted 5/26/2017 9:05 PM (GMT 0)
need name of large hospitals that use multiple treatment modalities for a second opinion about treatment options.
One core out of 14 Gleason 3+4 involving 70% of one core approaching 50% Gleason pattern 4. This was from Epstein's lab. Original reading said 50% of one core. This was done after an MRI scan and MRI guided biopsy. I've seen Cleveland Clinic mentioned. I live in Florida but will go any where for this. My Dr. wants to watch and do yearly biopsy's in a research study. psa 4.02 75 years old great health Thanks
Posted 5/27/2017 4:57 AM (GMT 0)
I read somewhere that in USA, only 40% of patients over 75 years of age receive curative treatment when 90% below 75 years would be treated. High risk for undertreatment in your case, if you are otherwise healthy. Older men with PCa should be managed according to their individual health status not age.
Posted 5/27/2017 5:09 AM (GMT 0)
For what it's worth, I took my aunt's then 78 year old husband to see my doc at Johns Hopkins. His PSA was about 5.6 and his father and brother both had it. He was told to come back if it goes over 10. I suppose, that's meaning he would die with it, but not from it. He's 80 now, and his most recent PSA was 5.8.
Posted 5/27/2017 12:44 PM (GMT 0)
Where in Florida are you? Please don't limit yourself to the large hospitals as there are many excellent organizations that treat cancer and practice urologic oncology that are world renowned.

Moffitt Center, Datolli, Mayo, Florida Oncology and many others may be nearby. My brother-in-law lives in The Villages and found an excellent specialist nearby. He was similar in age and dx as you a few years ago. He used radiation treatment and is cancer free and has absolutely no negative side effects.

In your shoes with a G8 in the mix I would certainly explore my possibilities now. That may include AS, but you also have great non-invasive treatment options as well. Again in your shoes I would be consulting with Datolli in Sarasota. All they do is prostate cancer and have always been leading edge. Personally, I haven't consulted them because I had great centers here in Atlanta, but I did research them as a possible option.

As to multiple treatment modalities, surgery should be off the table at age 75. I wouldn't waste my time speaking with any surgeons. The best known surgeon at Johns Hopkins that developed the nerve sparing procedure, Dr. Patrick Walsh always has a strict cutoff at age 70. In his book he states that if a man over 70 wants surgery, he must bring both parents to the consult before the doctor would consider the procedure. HIFU has proven to be ineffective and cryo will nearly always guarantee incontinence and complete ED.

Your approach will be AS or the various effective radiation therapies. Of those Brachytherapy (permanent seeds or high dose rate temporary) and SBRT external beam offer the best results. Traditional IMRT is also very effective, but will take 35-45 procedures versus 5 for SBRT and one for brachytherapy.

The three main factors to pursue are effective cancer control, low expected side effects and treatment convenience.
Posted 5/27/2017 2:41 PM (GMT 0)
Not sure where in Florida you are, but JNF gave you some good options. The major NCCN cancer centers in Florida, if that's what you are most comfortable with, are Moffitt and Mayo. Two other comprehensive cancer centers, from what I've read, are University of Miami Sylvester Comprehensive Cancer Center in the South, and University of Florida Health System Shane's Cancer Center. I thought these last two were NCCN centers, but I was mistaken, nevertheless, it's my understanding that they are both well reputed.

With all that said, I think the most important thing is the Dr, you should seek out the best Dr you can find in each treatment modality,
Posted 5/27/2017 4:12 PM (GMT 0)
JNF has given you great advice. Surgery is not an option, and watching that lesion with almost a G4+4 is iffy.

Has a genomics test like OncotypeDX of Prolaris been done on that core slide? I would strongly recommend that as your next step. If that result is not favorable, then brachy or SBRT would be my choice.
Posted 5/28/2017 1:05 AM (GMT 0)
If you are in Florida, Dattoli Cancer Center in Sarasota.
Posted 5/28/2017 11:32 PM (GMT 0)
thanks ASAdvocate for the advice especially the genomics test. Also thanks to all who took the time and effort to post. I was on Hopkins site searching for a physician. I found a Dr Daniel Song who is a co-director of prostate cancer multidisciplinary clinic and is assoc. professor of radiation oncology. I will call him and maybe set up an appointment. He seems to use several types of radiation depending on the patient.
Posted 5/29/2017 1:12 AM (GMT 0)
Datolli should certainly be a consideration as well as your Mayo option. From what you have written, I gather that you don' t meet both parents going to the exam with you.Lol
Posted 5/29/2017 5:10 PM (GMT 0)
Hi JNF, I live in Boynton Beach. Cleveland Clinic has a second opinion option. You send them all your info including reports and slides. they then present these to a group of physicians, radiologist surgeons etc and send a report with their recommendations for treatments. Seems like a worth while choice. I,m trying to reach my urologist so I can get the oncotype DX . I think I should get this before seeking treatment choices. thanks again to all
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