Update and Questions

Hi All,
I really, really appreciate all of the information you folks have given me when I joined this forum in May and announced that I was diagnosed with PC. I biopsy slides were re-read at the Norris Cotton Cancer Center at Dartmouth and my Gleason Score was updated to a Gleason 9 (previously a Gleason 4 +4, tertiary 5.)

I am 51 and have done the whole MRI/Bone Scan thing and the MRI revealed that it appears the tumor is confined to my prostate (really good news) but that it is touching the capsule and the capsule is abutting the rectum with no discrete fat plane between them. (The MRI gave me a PI-RADS V rating.) I have elected to have surgery but there is concern from my doctor about the ability to leave a negative margin where the capsule/rectum contact occurs. The tumor has crossed the mid-line of the capsule's edge.

Secondly, my PSA has risen from 15.3 to 17 in a couple of months. In addition, the tumor (according to the MRI) is found along the margin of the urethra.

So, my questions: Should I be concerned with the PSA rise in the last two months? Given the proximity of the tumor (size: 22mm by 15mm oval on the surface) to my urethra and rectum should surgery be my best choice?

Hey, I realize none of us are doctors here but I would like to hear what you have to say.

Thanks,
Johnny99, and yes, a Bruce Springsteen reference

Bummer bro. My tumour was also cheerfully engaging my colon such that, during the RP the surgeon took a quarter - sized circle of colon tissue and sent it to the path lab to see if it was compromised. It wasn't, but if it had been I suspect I would have woke up with no colon. As it was, they just sewed up the hole and went on with what they were doing. *whew!*

I got that post - surgical radiation Halbert mentioned.

Surgery is just about the worst option for a clinical stage T3a tumor like yours. You would pretty much be assured that you will need adjuvant radiation afterwards which compounds the side effects of treatment.

The best results for high risk cases like yours have been reported for a combination of brachytherapy (preferably HDR brachy - see below) and external beam with hormone therapy starting 2 months before and continuing for up to 18 months. You should be talking to an experienced radiation oncologist about this.

Here are a couple of references:

Quality of Life After IMRT or IMRT+HDR Brachytherapy for Intermediate- or High-Risk Prostate Cancer: 8-Year Results of a Prospective Trial

High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer

If you are thinking that you can always get salvage radiation later if it fails, look at the evidence. The side effects are much worse than if you had had just done the combo therapy in the first place. Radiation can treat an area outside of the prostate capsule that surgery can't, and you already know that is where the cancer is.

I'm not saying that primary radiation will be a walk in the park either. The proximity of the cancer to the rectum and the urethra means that larger than usual areas of those organs will have to be treated. The reason I'd prefer HDR brachy combo therapy in your case is because seeds can't be pushed into the wall of the urethra and rectum whereas HDR brachy catheters can, thus increasing the chance that the therapy will be curative.