New Member

Current PSA 4.3, dowm from 4.6 a few months back.
Initial MRI 9/21
TECHNIQUE: Low pelvis T1 weighted imaging. High-resolution small field-of-view multi
parametric MRI the prostate gland performed with axial, coronal and sagittal
T2-weighted imaging, axial T1-weighted, diffusion imaging, ADC mapping and dynamic
contrast-enhanced imaging. 13 mL Gadavist IV contrast

FINDINGS:
The prostate is small measuring 3.5 transverse by 2.0 cm AP by 3.5 cm craniocaudal
(12.74 mL). In the left base anterolateral peripheral zone, a linear area of 80 mL
hypo intensity of restricted diffusion is noted measuring 1.4 x 0.5 cm (PI-RADS 3). No
additional areas of abnormal signal are seen in the peripheral zone. The transitional
zone is extremely small with no definable abnormal signal. Seminal vesicles are normal
in appearance. Urinary bladder is normal morphology no pathologic-appearing lymph
nodes. No abnormal bone marrow signal.

IMPRESSION:
1. Prostate is within normal limits in size.
2. PI-RADS 3 lesion in the left base anterolateral peripheral zone measuring up to 1.4
cm.
3. Extremely small transitional zone with no definable abnormal signal.

MRI Fusion Biopsy 1/22
# of cores taken 17 # of positive cores 7
Greatest grade group Gleason 3+4
Right Lateral Mid: Adenocarcinoma, 0.5 of 18 mm (3%), Gleason 3+3=6, Grade Group 1
Left Mid: Adenocarcinoma, 0.5 of 19 mm (3%), Gleason 3+3=6, Grade Group 1
Left Lateral Base: Adenocarcinoma, 0.5 of 17 mm (3%), Gleason 3+4=7, Grade Group 2, (10% Pattern 4)
Left Lateral Mid: Adenocarcinoma, 0.7 of 19 mm (4%), Gleason 3+4=7, Grade Group 2, (10% Pattern 4)
Left Lesion #1 Adenocarcinoma, 6.0 of 18 mm (33%), Gleason 3+4=7, Grade Group 2, (5% Pattern 4), one core
Adenocarcinoma, 4.8 of 14 mm (34%), Gleason 3+4=7, Grade Group 2, (5% Pattern 4), one core
Adenocarcinoma, 4.6 of 10 mm (46%), Gleason 3+4=7, Grade Group 2, (5% Pattern 4), one core

Synoptic Report
Number of Positive Cores 7 Greatest Grade 2, Gleason 3+4=7
Total Cores: 17 Invasion: Pattern 4: 5%
Length of 245 mm
MRI: 1.4 cm lesion left base anterior-lateral peripheral zone

CT scan with iodine came back clean.
Bone image entire body with contrast came back with no body metastatic changes

Decipherbio genomic results independent of the NCCN risk category
0.28 In the middle of the low-risk scale 0-1

DBozz…Glad you found us and sorry as well. This is a great place to ask questions, learn and become informed so you can make informed decisions. You can see from my signature I’m a low risk guy who decided to have aggressive treatment. I found RT (SBRT) to be safe, effective, and more convenient than the more common EBRT. Terry

Bozz - I have some of your issues (valve replacement, afib), and after open-heart surgery some years ago, I didn't want to do another major surgery. I chose SBRT, which is a form of external beam radiation that is delivered in only 5 sessions, over a two-week period. It has better disease control statistics than traditional 40-treatment radiation, out to 10 years experience. Mine was done under the "CyberKnife" brand, but there are others.

I suggest that you look for a radiation oncologist who specifically offers SBRT (Stereotactic Body Radiation Therapy) for prostate cancer, and meet with that RO. Radiation is one form of treatment where you must meet with the specialist who delivers that particular type of treatment to get the whole story. If you are interested in brachytherapy ("seeds"), you must meet with a doc who specializes in that. If you are interested in SBRT, you must meet with a specialist in that treatment. There is no radiation generalist who does all at your choice. If one claimed to be that, I would go elsewhere.

I've been pleased with the results of my SBRT, in spite of some minor after effects. The important thing is that it is keeping my PSA down. You may favor another treatment, as it appears that you have many options at your pathology level. The bad thing is that there are so many treatments to learn about to choose what is right for you. The good thing is that there are quite a few that will do well for you.

DBozz, welcome to our club. Unfortunately, with your G7 results, Active Surveillance is probably not a good choice--you're going to have to treat it.

I would second the suggestion of SBRT--honestly, if it had been widely available and well established 7 years ago, I might well have gone that route. With your cardiac issues, that adds concern for RALP surgery--but your docs can answer those issues better than we can.

good luck man. see the quote in my signature to see my recommendation

Hello, DBozz and welcome. As others have noted, AS is probably not a great option for you with the G7 diagnosis. However the RT options mentioned are all likely to cure you (as will RP). I think a full course of 38 radiation treatments and RP are both overkill for what you have. My opinion is that the three best options with your diagnosis are, in no particular order, SBRT, HDR Brachy and LDR Brachy. These are usually practiced by different specialists so just seeing a "radiation oncologist" is not enough. Seek out specialists in each of these procedures, ask your questions, and you will undoubtedly come to a sound conclusion.

Good luck. Stick with us and ask any and all questions; that's what we are here for.

Jim

Thank You for of the replies.

I am about 25 miles east of Omaha. My URO mentioned the RT in the last visit as an option, but only recall the 38 dose RT. Not sure he mentioned SBRT. I will reach out to him to request recomendations

So if anyone has any specific Radiation Oncologists for SBRT or other, please share

And I do not have any issues traveling a reasonable distance from Omaha NE region for a top notch RO

YIA

DBozz, Urologists are surgeons and that’s what they practice and most are very good at it. They also are so busy keeping up with that specialty that most know little about the latest forms of guided radiation treatments for PCa.

The guided RT’s for PCa are significantly improved over what was available 10-15 years ago. SBRT because of the higher dose rate and fewer fractions must be guided. CT or MRI scans are done real time to precisely guide the radiation. I found it helpful to use this site as well as other sites to assist me in narrowing my radiation choices down. I did have to travel a few hours away before I found SBRT being offered by Cleveland Clinic. In the end the drive was no big deal and my results have been fantastic. Proton and HDBRT would have been my second and third choices although I also believe that IGRT is also safe and effective. I just didn’t like it taking 45 sessions. Don’t fear asking questions there are a lot of very informed and helpful people here to assist. For me I see it as payback for those who helped me.

Thanks to all thus far. Please keep adding options/opinions. Have a great weekend

Update. I have decided to consult with a RO about SBRT, HDR Brachy and LDR Brachy.
I asked my URO for a referral and am set up for initial consultation on the 28th.
Dr. Alireza Mirmiran is a radiation oncologist at Methodist Estabrook Cancer Center
I researched this Dr and really didn't find much data on him. Specialties, etc
The consultation will determine my path. If....<>....I will reach out to UNMC. When I was 1st was diagnosed I found some really good research and scholarly articles from a Dr in I believe Iowa City, I know they have some excellent medical care in that area. Will have to find him again.
In any event moving forward.
Take Care

I opted for the Triple Play with HDR Brachytherapy, 04-21-2020 thru 05-29-2020. Before treatment, I was disgnosed aa G9 (4+5), Stage 3, PSA 36. After HDR I dropped to 1.84 and now 21 months later I am 0.05 PSA. I took my final ADT shot on 9-7-2021. The reason I opted for The Triple Play is because the end results seem to be as good long term as those who elected prostate removal, but with a lot less side effects. I can say personally I've had very little side effects from ADT. I never spent a night in a hospital. I have no regrets doing the T-Play under UT Southwestern Radiation Oncology clinic.

Post Edited (WayneTX) : 2/8/2022 9:55:16 AM (GMT-7)

It's good to hear you're exploring your options.