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Posted 11/17/2018 4:25 AM (GMT 0)
Hello all-

Roller coaster ride. Found out my PSA was 5.5 on standard bloodwork in early 2018. Four subsequent PSAs ranged from 4.6 - 5.8 (latest). Bx in May 2018 showed G6 in 6/14 cores - all low volume. Second opinion from JHU reversed all 6 and stated atypical glands and HGPIN. I’m 55 y/o and in excellent health. No cancer in my family and no past health issues.

Had the mpMRI on 10/24/18 and it showed one PIRAD-4 lesion in TZ zone/mid-gland. Prostate is 25cc with no ECE/LN involvement. MRI fusion bx on 11/8/18. Results were all G6 in 8/18 cores, with 4 of the cores in the detected lesion area. Classified as G6 with 5 cores on the left and 3 cores on the right.

Spoke with Dr. King at UCLA today after he reviewed by MRI and biopsy. He’s saying AS would be an option even with 8/18 G6 cores. The cores had 3 > 70% with the others at 4%|6%|15%|40%|50%. King stated since most of the cores were centered on the detected lesion versus random, he felt AS would be an appropriate option. Dunno, but he was confident in AS and wasn’t pushing SBRT. Great person, BTW.

My urologist is pushing hard for surgery since it’s 8/18 cores and 3 > 70%. He says I have a few months to decide, but no AS or radiation....and only surgery. I’m in the Bay Area, but have no issue going to UCLA for SBRT. I’m also considering HDR Brachytherapy at UCSF. My current urologist says SBRT is experimental and not proven. You really have to be your own advocate with all the conflicting information thrown at you during the most important health decision in your life.

I’ve ordered the Prolaris genomic test, but still leaning towards SBRT with King with HDR as an option. I’ve read this board for months and respect all of you who post. The information gathered on HW makes me feel more comfortable with my decision making progress than my current urologist who seems to be pushing hard for surgery - with a G6 disease. All input is welcome, especially after receiving two conflicting options today. Thank you.
Posted 11/17/2018 4:38 AM (GMT 0)
my only suggestion would be to send those new cores to JH again.

You don't wanna be treated if you don't have cancer.

Take care
Posted 11/17/2018 4:52 AM (GMT 0)
You are doing a good job with your research. Yep, you're going to get conflicting advice. Most UR will indeed push RP. King is great -- I went to see him for a consult as well. Recognize the while SBRT is five treatments, it's likely three weeks of going to LA. There's a planning visit the week before, and then SBRT spread over two weeks. Since the drive to LA just for the consult sent my blood pressure soaring, I opted for 5 weeks of IMRT here in San Diego at UCSD.

But by all means, get those slides looked at by JHU again, and think about if you are an individual who can deal with the uncertainty of AS. But if I was a G6 and not a G9, I would have strongly considered AS -- especially having the mpMRI (which I went with as well). The mpMRI gives you a higher confidence that your biopsy wasn't just random but rather targeted the areas with the highest PIRAD scores (probability of cancer).

But in the end, we can all share our experiences and offer our opinions, but only you can decide what's best for you.
Posted 11/17/2018 5:06 AM (GMT 0)
Yes, will send JHU slides - again. King recommended the genomic test and felt a second opinion on slides wouldn’t change much, but it certainly did for me the first time.

Any input on SBRT as it relates to the RO? For example, Gottschalk at UCSF seems solid. I’ve read a lot about King on HW. Is there a big difference in outcome with SBRT based on the RO or machine used?

HDR seems like a good option. Same question on HDR. Is the outcome RO-based or is all HDR pretty much the same? If I choose radiation, staying in SF would certainly cut the travel/logistic planning. I’m not sure I have the mentality to do AS, but it depends on the Prolaris reading and JHU result. Thanks for the feedback.
Posted 11/17/2018 5:06 AM (GMT 0)
You need to fire your urologist for saying that SBRT is unproven. Its has nine and ten-year results, which are superior to surgery.

These uro's are the same ones who were promoting Robotic surgery when it had less than five years of results. Ignore them.
Posted 11/17/2018 5:39 AM (GMT 0)
SBRT has been around for a long time. Only a very uninformed doc would call it experimental.

I vote for SBRT at UCLA - good place, good docs, and great results come out of there.

Andrew
Posted 11/17/2018 5:48 AM (GMT 0)
Thanks Andrew. I’m leaning that direction.
Posted 11/17/2018 10:01 AM (GMT 0)
Anytime a surgeon says only surgery and better do it soon to a G6 it is clearly time to eliminate that doctor from the playlist.

AS to start looks very reasonable. If you do half to treat then HDRBT or SBRT will serve you very well. No need to suffer the damage of surgery when it will not provide better cancer control.
Posted 11/17/2018 11:28 AM (GMT 0)
You have a bit more G6 than I but I had a touch of 3+4 on the second opinion. I choose HDR BT and the procedure and post recovery where a breeze. Two treatments two days apart. I played golf the next day after each treatment. I am now 9 months post and PSA has gone from 5.7 to 1.2. I wish you well keep asking questions. If I can help with questions on HDR please PM me. Denis
Posted 11/17/2018 11:48 AM (GMT 0)
Hello DTT and welcome. I concur with the others who feel your urologist is biased and/or uninformed. I had a couple of those before I found one who was interested in me instead of his boat payments...

Of course getting the JHU second read on your slides is the next step and, if confirmed as G6 or less, AS is still an option. If you still decide on treatment then the options you are considering seem very reasonable to me. I don't think you can go wrong with either. One other option you should probably consider is LDR Brachy which should also cure you. Assuming your prostate is normal sized and you don't have urinary issues, that can be a great choice as well.

Good luck and let us know how you progress.

JIm
Posted 11/17/2018 1:44 PM (GMT 0)
DTT,

Outstanding job of doing your research and for getting medical opinions. Not much for me to add to the advice already given. I agree that your Uro could be cut from the mix.

I think you’re well equipped to make the decision that is right for you.

Good luck and keep us updated.
Posted 11/17/2018 2:03 PM (GMT 0)
Congratulations on your 3+3 results. In the big picture (since you are over 50, you have >50% likelihood of PC), it is the best result amongst the likely possibilities.

Active surveillance doesn’t mean that you don’t have treatment. Rather, it means that you continue to examine, evaluate and monitor it with increasingly sophisticated tools and techniques, as Dr King has suggested, living your life normally with a newly discovered chronic condition. If and when your monitoring indicates treatment might be beneficial, then you treat. If you treat now, you are reacting/treating your emotions only and there is no medical benefit. I suggest that at every step you treat the disease, not the emotion. It’s like golf: “play it as it lays.”
Posted 11/17/2018 3:01 PM (GMT 0)
Dr. King is one of the best in the field of treating prostate cancer. Your urologist is not. I would pay attention to only Dr. King.

Paul
Posted 11/17/2018 3:56 PM (GMT 0)
DTT - Welcome to our little world - the club none of us wanted to join. You are now experiencing the typical new patient dilemma - who should I believe? You are also meeting at least one of the stereotypical docs - your urologist. He fails to note that not only is Dr. King one of the early adopters of SBRT, and one of the best known and highest regarded, but Dr. King also is a leader in publication of his long-term results. His 10-year results were published last September (just Google "King + SBRT results" or the like and you will see. A number of current and past members here have been to Dr. King for SBRT and all speak highly of him and his staff.

I did not go to Dr. King, but I did have SBRT for my G3+4 prostate cancer. I am pleased with my results, and with the entire process. I love my RO, and got through it all with no disruption to my daily life - and that included working 50+ hours a week and hitting the gym daily. Oh, yeah, I was 68 at time of treatment. My pre-treatment PSA was about 5.7, and now, 2 years post-treatment, it is down to 1.9 and still trending downward. I'm a happy camper.
Posted 11/17/2018 5:36 PM (GMT 0)
Great info from all - thanks. The Prolaris results will be key in my decision making process. King provides hope as he wasn’t pushing his specialty on me, but instead provided an option to monitor and then act if needed. There’s so much conflicting info from studies, doctors and publications that you really have to be your own advocate.

Happy Thanksgiving to everyone on HW.
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