Recently diagnosed

Had a prostate biopsy recently. This was after I had an MRI scan that showed a PRIAD 4 suspicious lesion. One lesion in the lower left prostate gland was identified. No extra-prostatic extension was identified. Although the MRI study showed distance of lesion to neurovascular bundle is 1mm. Which sounds pretty close to me.

Biopsy results showed three out of 10 cores with Gleason seven. 3+4= 7. Grade group 2. Percentage of 4 is between 25 and 35% in all three positive cores.

All Cores showing cancer are on the left side base and midline of prostate no right side prostate cancer was identified.

PSA at 3.75 up from 2.0 14 months ago. My PSA result led me to the MRI study.

My doctor ordered a PSMA pet scan to rule out cancer outside of the prostate but my insurance company denied it.

Any recommendations on what I should do from here? Do you think any other scan would be worthwhile to rule out cancer spread outside of prostate?

I have an appointment with a radiation oncologist and a prostate surgeon in the next couple of weeks. So I am leaning toward radiation (seed implements) but also investigating prostate surgery . I also have an appointment with you UCSF urology cancer department. To at least talk to a major center on their recommendations.

With a gleason 7 I read, I have some time to make a treatment decision. This is correct.?

Thank you

It's a good plan to go visit UCSF, and make sure you talk to both the surgeons and the RO's. You're probably a good candidate for SBRT.

G7 is a very common diagnosis, and absolutely treatable. I was diagnosed G6, but my post surgery pathology was G7. I'm coming up on 9 years (next week), and my PSA has been undetectable since 6 weeks after surgery.

Good luck. You have time to make a thoughtful, informed decision. Feel free to keep asking questions.

It's good that you are planning to see both a surgeon and an RO. Read up as much as you can bear on the benefits and side effects of different treatment options. That will make your visits with the docs more useful. If possible, take a spouse or friend with you to these appointments. A lot of information comes out and it's difficult to remember it all. Your spouse or friend can take notes. Good luck!

Hello jr...wanted to welcome you to the forum, although I'm sorry you have to be here. Glad you have access to a top notch facility. One thing that hasn't come up yet is getting a second opinion on your biopsy slides, just to make sure you're really a G7. That may or may not have any effect on the treatment path you choose, but at the same time it's something that's easily done and generally paid for by insurance. (And if not, it's not expensive.)

The second opinion pathology program at Johns Hopkins is where I had my second opinion done. In my case, I was upgraded, but I've seen guys here get downgraded as well. And most of the time, the first reading is confirmed.

Good luck to you and I hope we can help you with your journey.

JR… I believe every treatment decision includes some risk of unwanted side effects. I chose SBRT since the data I looked at suggested it would cure my cancer with the lowest risk of unwanted side effects. I first learned about SBRT on this forum and will always be grateful for the help I found here. No surprise that my urologist was ready to schedule surgery even though I was a low volume Gleason 6. That’s just how they’ve been trained and what they practice. My urinary and sexual function remain just as they were prior to treatment with the exception of reduced ejaculate. One advantage of beam radiation is that the areas around and near the prostate can also be treated. I found the actual treatments to be very interesting and painless. I had some minor discomfort when urinating that lasted about ten days and did not require medication. Although I’m a data point of one I believe my experience is the norm. I’d be glad to share any of my treatment details. Best wishes on the journey…Terry

Typically, a G7 would have either brachy or external beam radiation as a mono-therapy, but certainly something good to ask UCSF. (Of course, it would also be good to confirm you actually are a G7, as per my recommendation for the second opinion earlier in your thread.)

Re the PSMA scan, does your doctor have other G7s with similar diagnoses to yours that have had the scan approved by insurance? Hopefully, either your doc or someone on their team can help advise you there--the chances of spread are quite low, but I can certainly see what you'd want to know for sure. I had a bone scan, as I was diagnosed in the pre-PSMA days.

jr, here's something to think about. PC generally falls into several risk profiles. The higher your Gleason score, the higher the risk.

Low risk is G6 or below
Low intermediate risk is G3+4 =7
High intermediate risk is G4+3 = 7
Some class 4+4 = 8 as still high intermediate
High risk is reserved for G9 and G10.

You are low intermediate, so some of the things you're thinking about aren't particularly applicable. If you prove out to be 3+4, with no lymph node issues, no EPE, no other extensions, then you're at really low risk for future metastatic issues.

I was diagnosed at G6, but turned out to be G7 on surgical pathology. I have not had any of the newer scans, nor Prolaris, none of that. I'm also 9 years out from surgery (on Feb 17), and am undetectable PSA.

When Prolaris came out, it was touted as a predictor, in higher risk cases, for metastasis based on genetics. Now it seems to be turning into just another thing the medical establishment can charge for, that is designed to create more anxiety in patients (and lead to more unnecessary treatments for many)

You may want to discuss with your docs the value of (1) genomics testing of your biopsy tissue (looking at your tumor's RNA and its propensity to metastasize--e.g. the Decipher Biopsy test) as others have mentioned above and (2) germline testing (looking at your DNA for inherited mutations of the genes known, or thought, to be involved in hereditary cancers). The results might be of help in your treatment choice/plan.

Djin

JR, I have a friend who had LDR Brachy with Dr. Kurtzman and was very pleased. He is highly experienced and specializes in LDR Brachy with Palladium seeds. It appears you have chosen well.

Your stats are very similar to mine when I was diagnosed; LDR Brachy was my choice. Like most of us I struggled a bit with treatment choice with the eventual struggle being between LDR Brachy as a monotherapy or with a combo of external radiation as well. Ultimately I was swayed by the stats associated with LDR Brachy for cases such as mine (and yours) that showed high rates of success with minimal side effects.

Of course hindsight is wonderful but I've gotta say that this was one of the best decisions of my life. I'm now over 15 years post treatment with non-detectable PSA and a declaration of "cured". Also importantly the side effects were minimal. Some urgency and frequency of urination in the first few weeks but no lasting urinary issues. Zero impact on my sex life which continues active to this day (at almost age 78). The only lasting effect is diminished ejaculate which occurs with all treatments and is no big deal. Feel free to copy and paste my journey from my signature if you want some more details.

I can't say LDR Brachy as monotherapy is right or wrong for you but it appears you are doing your homework and making an educated decision. That's the key finding a good choice.

BTW, you might consider creating a signature of your own by going to your profile. It will help keep you from repeating yourself in posts and make it easier for others to understand your situation when they post back to you.

All the best and good luck.

Jim

I was diagnosed in 2017 with GS 8 but just in one core so I was probably High Intermediate. Thanks Halbert, as I've never seen that referenced before!

I choose Brachy Boost and six years later my last PSA was 0.089 without any HT.

My RO has since retired so he was probably as experienced as you can get.

I did experience chronic radiation proctitis needing two treatments of argon plasma coagulation which was two years ago. Things down there seem to have finally settled down so I'm quite happy.

JR…The best treatment decision is the one you select after thoroughly evaluating all the options. Unfortunately far too many men make that decision without understanding their options. Glad to see you make an informed choice. I hope you’ll continue to stay here sharing your experience as we all learn from each other. Terry