Treatment - Unusual Recurrence of My Prostate Cancer Diagnosed as Gleason 3 + 3

First Posting

I have already posted several times about recurrence of my Gleason 6 prostate cancer after 5 years. This is the first posting of a series I intend to write about the treatment I am going to have. Let me start my giving a brief history, which I have gone over in several earlier postings.

In January 2011, because of my rising PSA referred me to an urologist. The urologist performed a DRE and told me he felt something and so he scheduled me for a biopsy. On February 27, 2011 he performed a 12 core needle biopsy without any anesthesia. But that was OK because I did not feel much pain, it was more like snaps of rubber band against my prostate. The biopsy turned up with two cancerous cores one 15% and another 5% with both Gleason 3 + 3. The cancer was found to be contained within the prostate. In spite of being an urologist, the doctor recommended brachytherapy. i did lot of research both on line and reading books. I was 70 at that time and did not want to risk surgery due to my age. On June 20, 2011 I had seed implant with 88 Iodine seeds. Everything went fine and I had virtually no side effects. By December 2011, my PSA went down from 3.4 before treatment to 1.1. By December 2012, it reached the nadir value of 0.1. Between December 2012 and December 2013, I had a small PSA bounce from 0.1 to 0.2 and in December 2013 the PSA returned to nadir value of 0.1.

Then things changed my PSA started rising reaching 0.4 by July 2015 and then a sharp rise to 1.5 by July this year. When I contacted my RO he dismissed it as simply PSA bounce and gave me a prescription for PSA test in January 2017 followed by an appointment with him. Luckily, I had an appointment with my urologist on August 10, who suspected that it could be recurrence. and talked about more frequent PSA tests. Then he performed a DRE and decided to have an biopsy as soon as possible. I had DRE many times. But this time it was different, I felt a sharp pain when he was performed the DRE. Now I understand why, there was an isolated nodule pressing against my rectum. A biopsy was performed on August 31, which found my prostate benign with treatment impacted tissue. However, during ultrasound for the biopsy the urologist show a mass emanating from the prostate capsule. He took two additional samples from the mass and that was found to be malignant. But because of radiation damage, no Gleason score was assigned.

My urologist had consultation my RO, who told him salvage external radiation is possible to treat the malignant prostatic mass. An MRI on September 16 discovered the prostatic mass to be quite large 24 mm x 22 mm x 25 mm (practically one third of my prostate of volume 33 cc) and pressing again the rectum wall. I quote from the MRI report:

"There are brachytherapy seed implants seen within the prostate parenchyma. Along the posterior rightward aspect of the mid gland and the base, there is a heterogeneous mass emanating from the peripheral zone measuring 24 mm anterior to posterior, 25 mm transverse, and approximately 22 mm superior to inferior. The superior aspect of the mass abuts the base of the right seminal vesicle and along the inferolateral aspect projects into the rectal prostate angle causing mass effect over the rectal wall. The lateral margin of the mass causes outward bulge of the levator and and the puborectals sling but does not extend through the muscle to the pelvic sidewall. Following gadolinium administration, there is early heterogeneous enhancement and the lesion is noted to restrict diffusion. Although the mass abuts the undersurface of the right seminal vesicle, no definite evidence of seminal vessel invasion is seen."

The RO told me it is a very unusual case, he had never come across such a case. He had performed close to 2000 seed implants. He suggested HT for a short period and cyberknife. Since it is quite likely that the cancer is confined to this prostatic mass, this might cure my cancer. If this fails or if the cancer has already metastasized outside the pelvic region, HT might well be the only option to keep the cancer under control.

I know it is a gamble, but it might offer me a chance of cure. So I decided to go through the cyber knife treatment. I already had fiducial markers placed in the prostatic mass and the first dose of two injections of Firmagon. Firmagon brings down testosterone very quickly. Today is the third day after the injection and I have several hot flushes, one episode very bad. The next step would be placement of a gel separator between the rectum and the prostatic mass, so that the rectal wall is not subject to high radiation. Then I will have CT-MRI planning scan and finally 5 days of cyberknife. I will keep everybody posted.