Prostate Surgeons in Southern California

Got Biopsy Gleason Score of 4+5 = 9. Grade Group 5. 10% Gleason 5 Pattern - Involving 50% of one core and 26% of a second core. Tumor Lengths: 4MM and 6MM. MRI Scan showed nothing. PIRADS 2/5
Report states: Carcinoma is seen only in the biopsies from the left apex. This reveals a GG5 lesion mostly pattern 4 but with some pattern 5 invasive carcinoma. The target lesion is benign. Otherwise the cores show florid prostatic hyperplasia of ducts and acini.

Not sure what all that means.... though i am now reading like crazy everything I can. This seems to be an incredible forum with a lot of knowledge. I do know that Gleason Score is not good. Indicates aggressive cancer etc.

I am, as of now, dealing with Dr. Timothy Wilson. He used to be at City of Hope, now at St. John's in Santa Monica. Are there any suggestions for So. Cal surgeons? I hear Wilson is highly rated... any comments? Also... suggestions for a second opinion on the biopsy (should I bother)... I read that Dr. Epstein and John Hopkins is the place for a second opinion. AND.... any suggestions for top notch So. Cal oncologists I could consult with.

Scared but trying to focus and move forward. Help is truly appreciated.

I will be brief. You really need to get input from a (renowned) radiation oncologist. Surgery MAY not be optimal for a high-risk case such as yours. And keep on reading!

Here is a link to a long discussion:/www.healingwell.com/community/default.aspx?f=35&m=3897208

Good luck with the decision process.

Please note (from my signature) that my diagnosis was similar to yours.

Billy...I didn't see this, but just posted on your other thread. I see some here are trying to make the same point as I did there. Not to say surgery isn't right for you...it certainly could be. But do try and explore all your options.

My only long-term SE from my treatment is that I have a somewhat decreased urine flow--maybe 70% or so. But I take a Rapaflo and it's back at 100% and one pill works for 4-5 days. I just posted on a separate thread that my latest PSA is quite low and it remains stable. One important thing: radiation for high-risk guys includes ADT and that is NOT a walk in the park, although it's doable.

I had a bone and CT scan...I'm not sure if PSMA was available at the time. Even now, I generally here it being used more as a diagnostic tool after treatment, but I'm not one of those guys on the cutting edge of the latest tools.

Tim Wilson performed my RP back in 2011 at COH. He is a great physician and robotic surgery is his forte.

I agree that second opinions for treatment would be in order. Consider Howard Sandler at Cedars Sinai in Los Angeles. He is a world renowned RO and has dedicated his entire career to PCA research and studies.

Best of luck.

Rick

I had combo BT/RT 10 years ago. No long term SEs at all. Short term, frequent and burning urination, loose stools. Lasted during treatment and about 4 weeks after treatment. Very tolerable and did not effect daily activity, such as work or golf.

Absoutely concur about Chris King at UCLA

Mel

My husband is also a Gleason 9 (4+5).

I also recommend talking with Dr. Chris King at the Santa Monica UCLA medical campus. He's a wonderful radiation oncologist. Whether you choose the surgery or the radiation route, I believe you'll be able to make a much better informed decision specific to your own case if you speak with him.

My G9 husband decided against surgery because with the higher gleason scores, it seemed most likely that surgery wouldn't end up being his only treatment. We determined that for us, surgery would only be preferable if he could have surgery and be cured...with the G9 that theoretically could happen but it was unlikely...and he didn't want to have to deal with recovery and SE's from both surgery and radiation, so we went with the triple play of HDR brachytherapy, 25 sessions of IMRT and hormone therapy. It's a longer haul, but we felt it was his best chance of a cure while also managing side effects and quality of life long term.

Best of luck. Dr. King is wonderful and I really believe you'll feel better after speaking with him, no matter what treatment route you choose.

Thanks to those who posted... I'm in the process of getting the slides sent to Epstein at J.H. Then I'm going to set an appointment with Prostate Oncology Specialists and Chris King at UCLA. My surgeon wants me to get this PSMA PET scan - to get a better indication as to whether the cancer has spread, etc. Surgeon suggested I get the procedure done within 6 months. That kind of worries me, i.e. I don't want things to get worse, etc. I will not make a decision until I have spoken to a variety of doctors in this field. We'll see how it goes with Epstein's evaluation of the samples... and what the PSMA shows. I'll keep you all posted as I appreciate all the guidance and suggestions I get. A very big help!

Bill

Billyboy:

Something I found from PCA Advisor dated 8-02-16:

"Survival Outcomes in Gleason 9-10 PCA Similar With Radiation, Surgery"

"Radiation therapy and radical prostatectomy (RP) offer men with Gleason score 9–10 prostate cancer (PCa) equivalent cancer-specific and overall survival, according to a new study.

Findings also suggest that extremely dose-escalated radiation therapy plus androgen deprivation therapy (ADT) might be the optimal upfront treatment for these patients, researchers concluded in a paper published online ahead of print in European Urology.

The investigators noted that their study is the largest comparative study of outcomes exclusively for patients with Gleason score 9–10 PCa.

The study, led by Amar U. Kishan, MD, of the University of California Los Angeles, included 487 patients with biopsy Gleason 9–10 disease. Of these, 230 underwent external beam radiation therapy (EBRT), 87 were treated with EBRT and brachytherapy (BT), and 170 underwent RP. Most radiation therapy patients received androgen deprivation therapy and dose-escalated radiation therapy.

The median follow-up was 4.6 years. Local salvage and systemic salvage were performed more frequently among RP patients (49% vs. 30.1%) when compared with EBRT patients (0.9% and 19.7%) or EBRT plus BT patients (1.2% and 16.1%), Dr. Kishan's group reported.

The 5- and 10-year rates of cancer-specific and overall survival were similar across the 3 cohorts after adjusting for age, clinical stage, biopsy Gleason score, initial PSA level, year of treatment, and use of salvage therapies, according to the investigators. For example, the 10-year rates of cancer-specific mortality were 8.4%, 4.4%, and 8.3% in the EBRT, EBRT + BT, and RP groups, respectively. The 10-year rates of overall survival were 79.9%, 84.7%, and 90.3%, respectively.

The 5-year and 10-year distant metastasis-free survival rates were significantly higher with EBRT plus BT (94.6% and 89.8%) than with EBRT (78.7% and 66.7%) or RP (79.1% and 61.5%).

“Our finding that EBRT + BT provides improved systemic control over both EBRT and RP in this setting is novel, and suggests that optimal local control (offered by extreme dose-escalation) and an upfront method of systemic control (offered by a frequent use of ADT in this cohort) may represent the best upfront treatment strategy for these patients who are at high risk of harboring micrometastatic disease at presentation,” the investigators wrote.

The equivalence of cancer-specific and overall survival following EBRT-based treatments and RP in the current study differs from most prior comparative studies, the investigators pointed out. “Importantly, the majority of EBRT patients in prior studies received neither long-course ADT nor high-dose RT,” they wrote. “In contrast, the majority of RT patients treated in our series were treated in accordance with contemporary standards.”

They noted that nearly 94% of EBRT patients had upfront ADT with a median duration of 24 months and 97% of EBRT patients received doses isoeffective to, or higher than, 75.6 Gy in 1.8-Gy fractions."

Hope this helps.

Rick