new member please advise

Birthday 03-28-47 68yrs old
PSA 8.64, vol 51 grams, bx 14 cores 2 positive bilateral disease with a gleason score of:

LA 3+4=7 , discontinuously involving 70% of one core (less than or equal to 5% gleason pattern 4)
with a Note; the presence of tumor in skeletal muscle , as seen in this case, does not necessarily indicate extraprostatic extension.

RLM 3+3=6 , small focus of prostatic adenocarcinoma, involving less than 5% of one core. Perineural invasion identified in this case.

clinical stage T1c.
PSA has been increasing for about the last 8 years. Three previous BX were negative. Urologist has advised me to treat with surgery or radiation. He seems to steering me towards surgery. Data from local path lab and confirmed by Johns Hopkins. Any advise would be greatly appreciated.

Welcome to HW, sorry you need to be here.

Urologists are surgeons, so naturally he likely has a bias towards surgery. Glad to hear you got JH to look at it.

At this point the thing that is going to drive you crazy is that most main line treatments will work just fine for you. There's good and bad in each option with little solid evidence that one is better than another.

What would be best now is to get a second opinion on treatment from a radiation oncologist and check out you radiation options. Age does play a little into it and you might find that you can tolerate RT better that surgery.

There is no rush to decide, but don't take forever either.

On the radiation side you have a number of options to look into: beam (IMRT or SBRT) and brachy seeds. or a combination.

Best thing you can do is to start learning all you can. Check out the sticky threads at the top of the forum for more information.

Hang in there and ask all the questions you want,
Andrew

Welcome to the forum. Don't be hasty about deciding. All options for treatment are open to you. Get second opinions. Hang around the forum and ask questions as you go through the decision process.

rlb-

What did your doctor say about the "tumor in skeletal muscle"? It sounds like it was in the muscle bed near the left apex - muscle tissue was associated with a tumor in the biopsy core? I don't understand how it could not indicate EPE - was it discontinuous in the biopsy core?

That seems to rule out surgery, doesn't it? How can surgery remove a tumor that has already invaded in the muscle bed? EPE rules out active surveillance as well, I think. It sounds like a job for radiation only.

Urologists usually don't know a whole lot about radiation - you have to talk to experts - radiation oncologists. And to make the job even harder for you, you have to talk to radiation oncologists who are specialists in each kind of radiation.

I'm guessing that SBRT, seeds, or HDR brachy would all work for you as monotherapies, but you have to talk to the specialists. Where are you? We might be able to recommend some.

I don't think that conventional IGRT?IMRT or protons are a good idea - they are expensive, take way too much time, have no better cancer control, and no better side effect profile than the others I mentioned.

- Allen

Here's the most recent and longest followup SBRT results:
Nine-year outcomes after treatment with SBRT
Also see links in my signature.

Suzhtz's husband Steve (a member here) just had SBRT by Kevin Stephans at the Cleveland Clinic after exploring similar alternatives. Hopefully, she will see this and comment. Henry Ford may be good for SBRT - I just don't know the SBRT doctors there.

In Detroit, you have Alvaro Martinez who is certainly the most experienced HDR brachy doctor practicing in the US.

For LDR brachy, you have some very top specialists not too far away - Jay Ciezky at Cleveland Clinic, Gregory Merrick at Schiffler in Wheeling WV, and Brian Moran in Chicago.

- Allen

rib:

Maybe others can chime in. I am not sure how much the experience would translate. I'd be real hesitant being the person's first.

Maybe others (Tall Allen?) might be able to recommend some more experienced folks.

Where are you located, and are you willing to travel?

Mel

Check with Martinez. He is a leader in High Dose brachytherapy. Similar to seeds but no radiation is left in the body. I had it five years ago and have done very well. Martinez practices with MHP Radiation Institute in the Detroit area, so about an hour's drive for you. Website is www.mhpradiation.21co.com. There you can get more information and contact numbers.