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Apex PCa - RP vs radiation

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Posted 6/4/2011 3:50 AM (GMT 0)
So, after review of my MRI results coupled w/my biopsy report findings, I've learned that my PCa is concentrated on my left apex.

Apparently this is a typical area for the cancer to concentrate, but my urologist (a non practicing surgeon) was concerned about the proximity to the apex and the ability for a surgeon to remove the prostate without having positive margins, thus requiring me to have a salvage radiation as a second course of treatment for a cure. Of course that would not be an optimal solution, as he felt radiation could effectively treat the apex more completely the first go around.

Basically he's saying that why get 2 treatments to solve a problem, when 1 will most likely do the trick - radiation.

Any thoughts around concentration of cancer in the apex and treatment options?

thank
Brian
Posted 6/4/2011 4:23 AM (GMT 0)
If your urologist feels your cancer has spread beyond the capsule and a positive margin is a high probability, then he is right, some form of radiation treatment might be a better choice..At your age, there are a lot of things to consider before making a treatment decision..I would talk to an expert prostate surgeon and a radiation oncologist and listen to their sales pitch..

Read the books by Patrick Walsh and Gerald Chodak to greatly expand your knowledge base..

Should you choose radiation, look into the combination of seeds and IGRT used in combination. This treatment delivers the highest possible dose safely and therefore delivers the highest 10 year "cure" rate. But at age 42, you need to be looking out further than 10 years so I would listen carefully to what the surgeon has to say...Don't get hung up on the apex issue, surgeons have been dealing with that for a very long time...The Best of luck to you...
Posted 6/4/2011 4:24 AM (GMT 0)
Your urologist is giving you some good advice. 51% of all positive margins occur in tha Apex. The probability of a positive margin is much greater with an Apex tumor than a tumor elsewhere.  Radiation does an effective job on Apex tumors. In the end it's your decision, but in your case radiation as a primary treatment would have a better probability of a cure and also result in fewer side effects.

JohnT

Posted 6/4/2011 6:37 AM (GMT 0)
Am I the only one that thinks that the naming of the parts of the prostate seems the wrong way round to me, so that the Apex is the bottom end nearest the penis and the Base it the top nearest the bladder. The Apex is simply the pointed end and the base the flat end.

Any "problem" with cancer in this area is that Apex is in the small area inside the pelvis that is hardest to access during surgery, and hence it is harder to manipulate the surgical instruments to be certain to get everything out. (This is one aspect where I would think the robot has the edge)
If your uro reckons there is a strong possibility of a positive margin though and thus a need for SRT, then I think your next step might be to get an opinion from an RT doc too.

Alf
Posted 6/5/2011 11:02 AM (GMT 0)
Mine was more in the apex and my uro said no surgery. He recommended HDR brachytherapy with IMRT. You can find out more about HDR at www.cetmc.com. Then you can compare with permanent seeds and surgery. My uro did not want to subject me to the risks and side effects of both surgery and radiation.

Granted, I am older than you and age must be considered. However, I have never understood how some people argue that RT is so terrible for a man in their 40's, but then support SRT for the same man a year after surgery failed.
Posted 6/5/2011 2:58 PM (GMT 0)
thanks for the information guys. I agree Alf, that the terminology seems a bit backwards. I had to ask my dr. to clarify a few times to confirm I actually understood it correctly.

will keep you posted on treatment options I choose. Right now I'm leaning heavily towards the proton radiation.

in good health,

Brian
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