Best PCa treatment centers in western US?

With the potential that my HDR brachy has not worked, I've decided that I need to find more, and more experienced, help. My choice of doctors here in western Idaho seems somewhat limited, and there are certainly no highly respected and well known PCa treatment centers here. So it looks like I'll need to travel. Easiest for me to get to would be Salt Lake City, San Francisco area, and Seattle.

My next activities will be to try to find out where the cancer is. Since the radiation apparently failed, there are 3 likely possibilities:
1. The cancer is gone, and the PSA rise is being caused by a persistent infection - find out if this is true and get rid of the infection.
2. The cancer is still localized to the prostate and simply didn't die - either not enough radiation or my cancer is radio-resistant. Do a biopsy or something else to find out if this is true. The person doing the biopsy would need to be familiar with biopsies through radiation-scarred tissues.
3. The cancer has moved outside the prostate and it needs to be found. This would likely involve detailed imaging. I just had a CT scan done yesterday, but the results aren't back yet. I don't believe a CT scan is likely to find my cancer at this stage - my PSA level is still quite low. Imaging would need to be much better, perhaps a PET scan.

So given those immediate needs, where would you recommend as a place to take my treatment?

I've had a couple of inputs already from an earlier post regarding my rising PSA, but I'd like more input.

Thanks, all.

Greg.

People from my area, southern Montana, generally head to SLC. The Huntsman Cancer Institute is located at the University of Utah and has a pretty good rep. Can't talk specifics about doctors (and I hope I have to learn more about them).

They don't seem to skimp. My daughter has a friend who works there and is a specialist in speech therapy recovery for throat cancer patients. The friend told me a couple of years ago that, at the time, she was one of only three such specialists in the US.

My first stop would be to Dr Mark Scholz in Marina Del Rey. He's probably the best medical detective for PC on the west coast and that's what you need at your current stage.

Thanks to all of you. Good input and I'll consider everything.

I like the idea of a "PC detective" and this does indeed sound like what I need. I wonder if anyone at the Hunstman Center or elsewhere in Utah would do this. I'll definitely travel to LA or elsewhere to get the best treatment, though.

I'll do research on each of the places you brought up.

Greg.

Hi there,

If you can do some traveling, I would suggest some of the iconic places for PC treatment, such as Johns Hopkins. My own personal "prejudice" happens to be Mayo Clinic in Rochester, MN. They have what is believed to be the largest prostate cancer database in the world.

Mayo is a marvelous place for finding out elusive answers in a short period of time.

Wishing you the best of luck!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

Seattle Washington
Fred Hutchinson Cancer research center
WWW.fhcrc.org

Seattle Cancer Care Alliance
WWW.seattlecca.org

Good Luck.