New to forum. Mr head

Mr head, welcome, sorry you need to join us, but it's a great group for both knowledge and support.

Seems as you said, an extensive amount of cancer, but intermediate risk with the G7. Have you had an MRI to determine the chance of escape from the prostate? And have you had a second opinion on the biopsy slides? (By Epstein at Johns Hopkins or David Bostwick at Bostwick lads- that's all they do - prostate slides)

Best advice I can give is explore all treatment options, don't take the opinion of one dr and run with it. Radiation may well be your best, or only option, but make sure you look at everything, just to be complete and re assure yourself that you've made the right and best decision

Mrhead,

It sounds like you're doing a lot of ruminative thinking that gets to be really annoying. I discovered a way out of that through psychotherapy and practicing Mindfulness. I can't tell you how much it helped me get through my anxiety - I very much recommend it.

You appear to have one of those weird prostate cancers that never puts out much PSA (2.62), doesn't create a lot of palpable masses (T2a), yet is predominantly Gleason pattern 4 and it's high volume. And you're relatively young for PC at age 55. This isn't a common combination - not unknown - but not that common either. For that reason, I think it's a good idea to have your biopsy slides re-read by Bostwick or Epstein.

I very much agree with Urologist's logic that if it's outside of the prostate already, and there is a high probability of that based on nomograms, then there is no point having surgery followed by radiation - just have the radiation. But based on what you've told us, there is a chance it's still contained. Some imaging studies - a bone scan and CT at minimum seem to be in order to confirm the staging. The Firmagon will hold any spread while you explore options.

For your "unfavorable intermediate risk" PC, the best results have been reported with a combination of brachytherapy and external beam radiation. Just a few weeks ago, and it's so new your doctor may be unaware of it, there was a major randomized clinical trial (called ASCENDE-RT) comparing the outcome of combination therapy vs. external beam alone. After 7 years of follow-up, the combination of LDR brachytherapy (LDRBT) and external beam (EBRT) had significantly better progression-free survival than external beam-only among intermediate-risk men like yourself (94 vs. 80 percent). The very high rate of progression-free survival with this combination ought to make you feel better about your prognosis. Here's my article about the study - I suggest you share it with your doctor:

EBRT + LDRBT boost provides superior cancer control compared to EBRT alone

If you mention where you're located, and whether you have insurance restrictions, perhaps I and others can recommend doctors who specialize in this sort of therapy.

Oh- you already got one from JH? You didn't mention that. Great!

I'm unfamiliar with MVP. You have to check with them before undertaking any therapy to see if they cover it.

I have been very impressed by Dr. James Mohler at the Roswell Park Cancer Institute in Buffalo. I think they may offer the kind of combo therapy I was talking about there. At any rate, he is among the top doctors in the world about prostate cancer and would be well worth the drive and the consultation.

If you don't mind travelling all the way to NYC, Michael Zelefsky and Marisa Kollmeier is running a clinical trial of a combination of LDR brachytherapy with SBRT at Memorial Sloan Kettering that may be perfect for you. The nice thing is that rather than 40 IMRT treatments, it only requires 5 treatments for the SBRT plus one for the seed placement. Call the number in the following link to get details about it:
Radiation Therapy in Combination With Brachytherapy for Clinically Localized, Intermediate Risk Prostate Cancer

- Allen

Hi Mrhead
Welcome to the HW forum,
Hang on there, you are indeed at the right place for info & advices.
Wishing you the best to your coming treatment.

I guess the only caveat,TA, would be their experience using it..I think they've only had it for 2 years. But with some experienced docs from elsewhere.
They also use UroNav, not applicable to this situation, but a pretty impressive 3T MRI, ultrasound fusion biopsy "gadget"

I'm not sure either, but it is mentioned in their prostate cancer brochure and the prostate speciic page on their website.