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Posted 10/13/2019 12:16 AM (GMT 0)
I don't know how supportive this is...but the thread does bring up something really interesting and new, at least to my ears: This whole idea of making a diagnostic decision based on something other than a biopsy appears to be a new thing.

To the OP: the subject has now had his biopsy--or in the next day or two--and that will add a good piece of information. Doctors do make treatment decisions all the time from experience--maybe that's what is happening here. It will be interesting to see what the biopsy says--and what the docs say about it.
Posted 10/13/2019 12:37 AM (GMT 0)
Halbert,
I agree that making a diagnosis without a biopsy is interesting; however, these two doctors have gone one better and also made a prognosis without the biopsy. Now that one leaves me wondering.
Posted 10/15/2019 10:53 PM (GMT 0)

jasperx10 said...

ASAdvocate said...
That snatcher's opinion was simply wrong.

He was. But you calling all surgeons 'snatchers' is equally biased.

Amen and mega ditto!

Please Harry, do some self analysis. Your inflexible, and at times insulting, attitude toward surgery is both wrong and unhelpful to new brothers.

Cool it, my friend!
Posted 10/18/2019 5:57 PM (GMT 0)
Update – MRI guided biopsy results…

G7(4+3), Took only six cores (?), three positive, 3+4, 3+4, 4+3. All cores taken from one side(?).
EPE close to nerve bundle, PNI positive.
20% - 90% involvement each core average involvement 45% He has sarcoid in his lung which will probably make surgery not the best option, although it probably isn’t the best option as it is. He has made appointment with surgeon at Mount Sinai, Tewari, and will see radiation oncologist at MSKCC

I told him he should send the slides to Johns Hopkins for a second opinion. Although not sure what an upgrade or downgrade would do as far as informing treatment option but you never know.
Posted 10/18/2019 6:26 PM (GMT 0)
Prato, sorry for your friend's diagnosis but it was not unexpected. I see your ?'s re the number of cores but at this point it probably does not matter since he clearly has multi-focal PCa. He may get a little lowering from Epstein but the treatment options are not likely to change greatly. I'm sure you will remind him that there are specialists in each of the radiation protocols so he needs to be prepared to see more than one "RO". With the 4 + 3 it is likely that an LDR Brachy guy will recommend IMRT as well as LDR so I would think that SBRT and HDR Brachy as mono-therapies might be the sweet spot. You know how I feel about surgery, even with a top guy, so I won't even go there...

Good luck to him.

Jim
Posted 10/18/2019 9:37 PM (GMT 0)
JIM regarding surgery, in this case I agree with you wholeheartedly.
Yes I told him that he needs to talk to RO about SBRT for sure, And plan to discuss with him further regarding Brachy IGRT etc.
Once I get past SBRT, regarding primary treatment I’m not as well-versed, so I’m going to encourage him to come here or at least give him the right questions to ask
Posted 11/28/2019 4:18 PM (GMT 0)
Update on my buddy’s situation...

He has met with 2 surgeons, and 3 radiation oncologists, one in Florida by phone. So he’s certainly done his due diligence, I’m glad to say. He’s handling this very well emotionally which I’m glad about because he’s a really good guy.
So bottom line, he is going to be treated by Dr Zelefsky at MSKCC. Started Casodex yesterday, will get his first Lupron shot I think next week, and will start SBRT in about two months. HDR Brachy/triple play was not discussed.
I think he’s making a good decision.
Posted 11/28/2019 4:57 PM (GMT 0)
I think that is an excellent choice.
Posted 11/28/2019 5:05 PM (GMT 0)
I think it's a great choice also. Good job Prato, guiding a guy such that he can make his own best decision.
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