Pending Decision - Intermediate Risk

Heh Guys,
Wanted to update all with my progress on making a decision. I will recap so everyone can quickly benefit from beginning to current day.

Age: 60 - Caucasian

January 2021:
PSA 5.54 at family doctor annual checkup. My PSA had prior fluctuated in the 3-4 range for 4-5 years. Visit to Urologist followed.

February:
PSA double checked at MIchigan Institute of Urology. Dr. Oldford. PSA was 5.74. Examination did not detect any lumps. Ultrasound ordered.

March:
Ultrasound showed lesion / possible cancer. Ultrasound = volume of 19.67 grams. Left hypoechoic change of .7cm and right hypoechoic change. Biopsy Ordered:

April:
Biposy. Cancer found. Stage T1C NO MO Intermediate Risk. Biopsy revealed 4 of 12 positive. J location = 4+3 (40%), I location = 3+4 (30%), H location = 3+4 (60%), G location = 3+3 (5%), Perineal Invasion is identified, Cribform 4 pattern is present. No extra prostatic extension is identified.

May / June: Met with two surgeons, Dr. Johnston of Michigan Institute of Orology and Dr. Peabody at Henry Ford Cancer center. Both are highly experienced robotic surgeons. They felt surgery was the way to go, but I was still undecided and I took this forums advise to pursue more opinions.

June:
Met with Dr. McLaughlin of Ascension Cancer Canter in Novi, MI. He is a radiation guy who specializes in seeds with external beam. He advised to get an MRI before making a decision. This was based on the fact that the sphincter length plays a big role in whether I would be incontinent if surgery is chosen and we would also get a better look at the cancer. This guy is very, very experienced and one of the best in the world at this type of therapy as I understand if from other doctors.

July
MRI results / review with Dr. Mclaughlin. PSA was double checked prior to MRI. Now 5.88. Sphincter length is at least 1.5 cm with 1 cm being the minimum he felt for good continence outcomes. MRI showed prostate size to be 4.3 x 3.6 x 3cm with a volume of 27.ml. (which is larger than the ultrasound showed) Left peripheral zone = 1.4 x .9 cm T2 nodule in the posterior and lateral base portion of the midgland. It has a wide contact with the prostate capsule but no extension is identified. Impression is that the 1.4 CM lesion is PI RADS 4 (which translates to be clinically significant prostate cancer) He has a feeling that if surgery was chosen that follow-up radiation would be required at some point. I advised I wanted to share my MRI with other doctors and will then make a decision. He almost has me convinced this is the way to go.though.

August / Today 8/2/2021
I wanted to look into Proton therapy so I set up an appt. at Beaumont Hospital / Proton Radiation Center in MI. Met with Dr. Krauss. Great review and talk with him. He however does not recommend Proton therapy for me. He stated that the side effects are similar to external beam and seeds so it is not warrantied. He does offer HDR therapy. This therapy involves inserting 15-17 needles in between the testical and rectum and then a high dose radiation seed is inserted for a few minutes then retracted. It requires a pre-op scan to map out the locations then two one day treatments / two weeks apart. He stated the amount of overall amount of exposure to radiation was 80-90% less and no radiatoin passe thru the body. I really like what I am hearing so far on this treatment plan. All of my choices so far he said will provide an equally high level of cure rate. He thinks any one of them will have 90% and higher cure rates.

So this is my story to date. I am meeting with a medical oncologists tomorrow and then Dr. Peabody (surgeon) one more time next week. I did look into laser ablation and called several of the top facilities in the country but Dr. McLaughlin cautioned against this and given it is not covered under insurance... I think it is probably out for me, Thanks guys for all the advise., I almost went with surgery right out of the gate, I'm not so sure now.

Hi M1. You are doing everything right with your consults, investigation, and reflection. It can be a tough choice because (fortunately) we do have choices. Once you come to a decision, you'll feel much better psychologically. (I personally wouldn't choose laser ablation, especially with known pattern 4. No insurance coverage is also telling you something about it.)

All the best,

Djin

Thanks guys! More good thoughts / questions and info to look into. I’m definitely ready to get this thing moving in one direction or another. I have many - many hours of research into this to date. But I’m glad you guys pushed me in the directions you have. I’ll follow up another time or two before I make that decision.

I’ll take a pat on the back if it’s coming from you guys - so thanks! After tomorrow, I will have 3 pending therapy schedules created, just need to decide which one. I want to add for the others who have wives as well, that my wife had joined in on these consultations so it will be a team decision. But I get 51% of the vote.

LOL