new G 7 (3+4) T2c with heart disease

Hi all,
Diagnosed yesterday. Thanks to info here, I have requested 2nd opinion from Johns Hopkins about pathology. As I understand, I am intermediate risk so surgery, and radiation (and hormone therapy?) is possibly curative. I am very concerned about negative side-effects from hormone therapy because of heart disease. I have yet to consult with radiologist. Any feedback on any issue most appreciated. Thank you all for an informative forum.

Urologist is Mehrdad Alemozaffar at Emory University in Atlanta
heart disease, stent in widow-maker artery; another is still 50% blockage

psa 5.6
Dx 5/2/2018
Clinical stage T2c
G7(3+4) 40% GC2
G7(3+4) 70% GC2
G7(3+4) 70% GC2
G7(3+4) 25% GC2
G6(3+3) <5% GC1
G6(3+3) <5% GC1
G6(3+3) 20% GC1
G6(3+3) 30% GC1

Post Edited (Steve Smith) : 5/3/2018 9:00:20 PM (GMT-6)

Sorry that you're the latest member of our club, but glad you're finding this site helpful. Sure was for me when I was diagnosed.

Assuming that Epstein confirms your G7 (3+4) diagnosis you wouldn't typically need hormone therapy as part of radiation. (I'm also unaware of its impact on heart disease, but I can certainly understand your concern.) And you're correct...all treatments have a very good chance of being curative for you. If you go the surgery route, you want to find the most experienced guy possible. For radiation, I agree with Andrew about checking out brachytherapy and SBRT. That might take a bit of doing, but not all ROs practice all kinds of radiation.

Good luck to you and I hope we can help you navigate the months ahead!

Whether or not ADT increases CV risk is a subject of a lot of controversy. It seems to be a risk primarily in men like you who have pre-existing atherosclerosis. If you're a nerd like me, you may find the following video interesting:

/www.urotoday.com/categories-media/1748-advanced-prostate-cancer-intersection/648-embedded-media2016-09-02-00-42-09.html

If you get to the end without falling asleep, he puts forward the hypothesis that treatment with GnRH antagonists (i.e., Firmagon) may not have the same hazard as GnRH agonists (like Lupron). This has been backed up by a subsequent randomized clinical trial:

/meetinglibrary.asco.org/record/105873/abstract

So if you needed ADT, Firmagon would be the way to go.

However, with your biopsy results, you may not really need adjuvant ADT with the radiation treatment. While you don't fall into the "favorable intermediate risk" category because of the high volume of cancer, you had no higher grade cancer than GS 3+4. I think you should forgo conventional IMRT and LDR brachytherapy, which might benefit from some ADT, and stick to either SBRT or HDR brachytherapy, neither of which have shown improved results with ADT. I assume that surgery is off the table because of your heart disease.

Appreciate replies; I will reply to others soon, too; but to begin, Tall you said, "I assume that surgery is off the table because of your heart disease." Would you please expand a little? (I haven't watched the vid yet, but will soon.) And other comments appreciated too. Neither my cardiologist nor urologist expressed any concerns about surgery. FYI, I had a drug-eluding stent placed in 2015; just had another cath last week, and all is well. I take a low dose of baby aspirin; Plavix ended about a year ago; also low dose metoprolol, lisinopril, and a statin. Thanks guys and gals.

The "widow maker" is the nickname for the artery with the stent. One of the two major descending arteries. It was 99% blocked. I had angina for a year in the gums and arms. I had every stomach test for GERD; all clear, which led to cardiac stress test, then angioplasty and stent. I'm good on that front. Thanks for the info; I will consume it all with great interest.

Tall, results from nomogram:
PROBABILITY OF CANCER-SPECIFIC SURVIVAL AFTER RADICAL PROSTATECTOMY -- 99% survivability for 10 and 15 years.

PROGRESSION-FREE PROBABILITY AFTER RADICAL PROSTATECTOMY -- 5 year 77%, 10 year 64%

(sorry caps, just copied and pasted)

Post Edited (Steve Smith) : 5/3/2018 7:01:11 PM (GMT-6)

Saipan, After stent placement, one must take a wicked blood thinner for anywhere from 30 days to forever (depending on the "science"). This "could" be the disqualifier for surgery, but it is often stopped briefly for things like tooth extraction. RP sounds like a lot more blood flowing. (again there is science saying plavix-like thinners only needed for 1 month; don't tell your cardiologist!) Mine was Plavix and I kept on it for 18 months. Even the slightest nick would grow a stalagmite-like "scab" that could take days to harden over. Once I fell on a golf ball in my pocket. I then had a baseball-size purple bump on my hip for weeks, actually months if I recall correctly. And simple head injuries that normally just show stars for a few seconds can be killers, literally.

Post Edited (Steve Smith) : 5/3/2018 7:26:43 PM (GMT-6)

Tall, et al., I think I over-looked the section labeled, "Extent of Disease Probability". I will ponder this for awhile.

Can't make it up: during my ct scan last Friday at Emory University Clinic, the technician banged on the machine like we used to do on the TV back in the day. Not a good look.

Steve, I would be very averse to surgery with your heart situation. Several radiation based therapies will be better than surgery without the side effects or risks. I am Atlanta and can give you some grood referrals and explain my experience.

Tall Allen said...
But did that fix it?

Tall, yes! I was so shocked I just submitted to his expertise. Tall, can you recommend SBRT clinic for prostate in or nearest to Atlanta. I'm not having much luck, but I haven't yet dug hard for the info. You seem very knowledgeable on technology and surgery resources, so perhaps you know?

There was someone on HW who got SBRT in Atlanta, but I can't remember the name. Try calling Debra Freeman in Tampa. She is very plugged into that community; if anyone would know, she would. JNF was treated with HDR-BT in Atlanta, so you can get the name of his RO for that at least, if he does monotherapy as well as brachy boost.

Steve,

As TA said, I am in Atlanta and can provide specifics on my docs. In fact another man on Healing Well met with them yesterday and will start HDR brachytherapy and IMRT in July. My clinic does both the combined therapy and HDRBT mono-therapy based on the initial risk assessment.

I know there are SBRT practitioners in Atlanta, but don't know them personally. The clinic I used does perform SBRT, but I don't know whether they use it for PCa. They do more HDRBT than any other clinic around and are excellent. I see my urologist tomorrow and will ask him. He generally uses HDRBT for the radiation based treatment, but he is in the Atlanta mainstream of PCa work and may be able to provide info on SBRT practitioners.

I think you are well served pursuing brachytherapy. It certainly worked for mew. Which method are you interested in....permanent seeds or high dose rate?

Jack

Well my slides are now officially lost by Emory University; not just never sent to JHU, but NOT EVEN A RECORD OF ME IN THE SYSTEM OR THE BIOPSY PATHOLOGY BEING DONE IN THEIR LABORATORY, even though I posted result here weeks ago. Steer clear guys! I'm hoping I can go to Johns Hopkins for my next biopsy, with no out of network issues. We have Blue Cross, Federal Blue, PPO