Cancer is back after Cyber Knife

So I had two significant pieces of information in the last two days of my research. First of all, even though I could not talk with Dr. Jon Coleman at Sloan (NanoKnife), a nurse called me and said I was not eligible for IRE treatment, which I took to mean that IRE treatments are still only being done on a prostate as part of an approved study. But she also talked to Dr. James Eastham who's running a study on photodynamic therapy to see if I'd qualify for that. He must have looked at my records because he said that it was unusual to base a treatment on a biopsy that only sees 'radiation effect' adenocaranoma, especially when the PSA is still low. His recommendation was to wait.

Today I had a video meeting with Dr. Alvaro Martinez in Detroit. The very first thing he said was I was experiencing a PSA bounce, again based on the 'radiation effect' qualifier in the biopsy report. He said to wait and monitor as well. He added that my local docs acted too quickly.

I then asked if the time comes when I do have to act with a focused treatment, would he treat me with HDR. He said yes, with either HDR or LDR. I told him that an Atlanta doc declined HDR and he was surprised.

So I'm back on AS and I can breath again, at least for a few months. I do still have an appt with Emory Proton in Atlanta and I'm going to go just to see what options that holds.

I had to track down the report from the Epstein 2nd opinion and I should have that in my hands by Friday. I'll report on that. It will be interesting to see if he assigns or at least addresses the gleason issue, which the local pathology lab (SEPA) would not do.

Epstein report arrived. As with the local biopsy report, no gleason score was assigned. He did bump down the volume of the smaller tumor sample to 10% from 20% and left the following note:

NOTE: The tumor in this case shows treatment effect in that there are individual cells with abundant vacuolated cytoplasm where the nuclei show smudged chromatin and absent nucleoi. Cancers which show radiation therapy effect have in some cases been associated with a better prognosis than tumors which appear unaltered by radiation (CANCER 115:673-9, 2008).

So I don't think this changes anything either way except for confirmation that radiation effect is indeed going on here but without any assurances that cells without radiation effect are gone (for now).

Fingers crossed as always

So after being delayed for a funeral I finally had my appointment with Emory Proton Therapy (PT). It was somewhat of a disappointment. For some reason I thought that PT could do a focused beam, but the doc said no, that it's whole gland only and then she started talking about HDR at Emory. But the Atlanta HDR doc who declined to treat me recommended PT and I'm thinking, "why am I here?"

She wants to do a PSMA in the Nov time frame and said I would have to be treated at some point, where I said that my PSA could very well stay the same or drop further. (For new readers, I'm at the 18 mo point after Cyberknife and my recent rise and fall could be a radiation bounce). She said that if it drops she would be less inclined to treat. So I think that the referring HDR doc was thinking that I'd likely eventually have to treat the whole prostate even though my recent biopsy indicated that the adenocarcinoma is on the right side only. If that turns out to be the case then perhaps PT would be an option due to being able to program the beam to fall off after radiating the prostate tissue (I think it's called the Bragg effect). She said they also use fiducial markers for alignment as does CyberKnife. Either way, I think if my prostate starts showing real, growing cancer (as opposed to what we think is the case now with the biopsy note that it shows signs of 'radiation effect' - IE, cancer cells still in the process of dying) throughout the gland then I'd be concerned about excess radiation whether I'd select PT or SBRT, etc. A question for another day, but hopefully not...

She mentioned that they have a PET/MRI machine which I guess is the latest and greatest scan tech with better contrast and motion compensation. I'll have to research that to see if it's worth another trip to Atlanta if/when I have to have another scan.

I talked to my RO after this visit and his take is that in 6 mo or so if my PSA is still rising I should consider HDR (which if needed I would select Dr. Martinez in Detroit) and that if it starts rising fast do a scan.