HealingWell
Search Close Search
☰

postive test

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 5/19/2017 5:03 PM (GMT 0)
year and a half ago did health screen at work psa came back 6.9 went to see doctor so they did biopsy,
12 panel came back negative, had sample tested for risk, came back low monitor for a year psa went up to 8.9
did mri , found small spot , they did 16 panel biopsy came back positive only in the spot 2 cores one was gleason score 3+3=6 involving 20% of biopsy, negative for perineural and extraprostateic invasion second one gleason score 3+4=7 involving 5% of biopsy negative for perineural and estraprostatic.
doctor suggested seed or external radiation.
any help or suggestions
Posted 5/19/2017 5:15 PM (GMT 0)
Yup, RT would be a good choice. SBRT is a great choice these days. Get a referral to some good ROs.

Note that an RO tends to specialize in one type of delivery - the SBRT ROs do don't seeds and the seed guys don't often do beam, so you'll want to talk to a couple of doctors.

You've got the time to do your research and make an informed choice - don't rush, but also don't wait for months.

Andrew
Posted 5/19/2017 5:19 PM (GMT 0)
On this site: Comparing Prostate Cancer Treatments they compared the various options. As you can see, they found seeds to be a better choice than EBRT.

George
Posted 5/19/2017 5:36 PM (GMT 0)
If you have not read Dr. Pat Walsh's book, "Surviving Prostate Cancer" now would be a good time to read it..
Posted 5/19/2017 6:19 PM (GMT 0)
Raquetball-

Your being in Wyoming will limit your choices unless you can travel for treatment. There are probably no surgeons with enough experience there - I guess the closest place where I'd trust the doctors to have adequate experience would be Huntsman in SLC. There's a good HDR brachy doc there too (Dr. Hayes at GammaWest). For seeds, you'd probably want to travel to Seattle or Chicago. For SBRT to Denver or Seattle.

Send your biopsy slides to Epstein in Johns Hopkins for a second opinion.

George-
The site you linked is run by a medical practice that has an interest in promoting brachytherapy. It's now run by Peter Grimm's widow. I question its accuracy and reliability. One must be careful about the sites one relies on on the Internet.
Posted 5/19/2017 6:38 PM (GMT 0)
Allen,

I was not aware of that. I saw Dr. Dattoli refering to these results in a presentation. Agreed, he promotes brachytherapy as well.

George
Posted 5/19/2017 6:51 PM (GMT 0)
I have good Insurance and can travel, has anyone have any info on Prostate Laser center , and thanks for the responces
Posted 5/19/2017 6:55 PM (GMT 0)
I was thinking on second opinion from the Mayo in Phoenix
Posted 5/19/2017 7:10 PM (GMT 0)
anyone know anything on the Prostate Laser Center in Houston Texas Dr. Ara Karamanian
Posted 5/19/2017 8:15 PM (GMT 0)
You would be a good candidate for focal ablation (laser, HIFU, cryo, etc.). But you should understand that we do not have enough history with it to make a call on its long-term efficacy. Please read:

/pcnrv.blogspot.com/2016/12/focal-ablation-unresolved-issues.html
/pcnrv.blogspot.com/2017/01/what-should-focal-therapy-be-compared.html

At the end of the first article is a response from Dr. Karamanian and my response back to him.

Since traveling for treatment is not a problem, here are some suggestions:

Seeds: Dr. Moran in Chicago or Dr. Zelefsky at MSKCC in NYC
SBRT: Dr. King at UCLA (my RO)
HDR brachytherapy: Dr. Demanes at UCLA
Surgery: Ash Tewari in NYC

I can't recommend other external beam therapies like protons or IMRT, as their outcomes are no better than SBRT yet have extended treatment times and higher costs.
Posted 5/19/2017 8:25 PM (GMT 0)
Racquetball - You're in about the same category that I was. They call us "favorable intermediate risk" cases. We're lucky, yet unlucky. (Or is it the other way around?)

Yes, we do have cancer. But we have found it early and ours is a relatively low-risk variety. We are also "unlucky" in that virtually any of the mainstream treatments for Pca will give us good odds at a cure.

I would remind you firstly that you have the luxury of time. Our variety of cancer is a somewhat slow-growing cancer, so taking a couple of months to learn about your treatment options and choose what to do will not change your ultimate outcome. Yes, we are (or, in my case, were) shocked and worried and may feel that we have to rush into action. . . but we don't have to rush.

Next, I would recommend that you read the sticky postings at the top of the forum that are addressed "To the Newly Diagnosed." These are a wealth of information about all to do.

You have been given some good information about ensuring that you see practitioners of any therapy you are considering. We've all learned the risk of trying to discuss the benefits of treatment 'A' with a doc who only offers treatment 'B.'

I also "caution" you if you choose to read Dr. Walsh's book - for much the same reason as my doctor comment above. Dr. Walsh is a surgeon - and a world-class surgeon at that. But he is not (as of his most recent edition) up-to-date in his coverage of non-surgical treatments for prostate cancer. His most recent edition continues to label some of the current radiation therapies as something like "only suitable in the setting of clinical trials." He may now have more to say, but the publication is not up to date - especially for therapies like SBRT (known as CyberKnife, etc.).

The other MAJOR point I will raise is the question of whether you need to seek active treatment at all at the present time. With your pathology report, I believe that you would qualify for one or more of the Active Surveillance programs (unless I am missing something in their acceptance criteria). I'm sure somebody who knows more about these programs will join in.

Sorry for the wordy response. I'm just trying to help you to realize that you have a lot to learn and that you don't have to rush into treatment immediately.
Posted 5/19/2017 9:01 PM (GMT 0)
Paxton -

AS is absolutely an option for "favorable intermediate risk" guys. But it has to be monitored very closely, preferably with a confirmatory template mapping biopsy and frequent mpMRIs read by expert radiologists. There is a man in my support group who is doing that- but he has easy access to the excellent AS program at UCLA with one of the top radiologists. I doubt that a man in Wyoming would have that kind of easy access. And because he already has some GS 3+4, he isn't really buying a lot of time with AS. Still, it is not out of the question, and that fact alone should provide support for your wise counsel to take his time making this decision.
Posted 5/19/2017 10:52 PM (GMT 0)
The University of Colorado Cancer Center at the Anschutz Research campus (Denver) can do just about anything you can think of...Also, TUCC, The Urology Center of Colorado is a top drawer treatment center. Their radiation department has all new equipment installed last year....
✚ New Topic ✚ Reply