Hello All,my daughters father in law,age 60,just Dxd ,12 core biopsy,5 cores were G6s.I dont know yet what % of cancer was in each core,or if that would make a difference as to treatment if needed.His father died of prostate cancer. So my son in law age 36 should at some point get a baseline PSA ?

I told him to go onto HW as he did and read the newby stickies.He will be joining us soon.I told him to ask his Uro to send his slides to John Hopkins for 2nd opinion which he did.

So my question is, are 5 cores of G6s usually have to be treated with surgery or radiation or does it depend on the volumn of cancer in each core.Or would AS be acceptable ? He knows I was treated with SBRT and is doing his research.He is from lamar,Mo about 4 hours from St.Louis where my daughter and hubby live.

All imput is appreciated.Happy holidays to all.SemperFi,John

G6 is in the AS range. He could find a good AS program and see. Certainly it would be the first thing I'd ask for.

With a family history 36 would be good to get a baseline, but waiting till 40 would be okay.

Andrew

He should go to the sticky thread and determine what his "risk" status is. Risk is made up of Gleason score AND other factors.

Then, and only then, should he start thinking about possible paths to take because they are based on which risk category he is in...

First things first...encourage him to follow a fact-finding mission, not an emotional knee-jerk.


(Great job, BTW, encouraging him to get a 2nd/expert reading on his biopsy slides!!!)

Rad, On these types of forums, "sticky threads" are those groups of postings that an administrator has "stuck" to always be at the top of the forum topics. Their position is not affected by when they were last updated.

AS = Active Surveillance, which should be, IMHO, the default consideration for men with very low risk and low risk prostate cancer classifications.

Here is the direct link to the Newly Diagnosed thread:

https://www.healingwell.com/community/default.aspx?f=35&m=2652250

Glad you told him about HW. I hope we can be of help to him and will get him to examine whether AS is appropriate for him or not...

dm, welcome to our little corner of the world, sorry you have to be here. But with all G6 you are going to be fine.
Be aware, after you get the results from JOHNS HOPKINS, you can call and ask to speak to DR EPSTEIN, he is very ccessible, and will give you his opinion on next steps, Inc;using your suitability for AS.

Good luck and keep us posted

dm1254,welcome here to HW,you have entered into the Twilight Zone. What was your first ever PSA score ? You are in good hands here.Keep us informed and ask questions .We are here to help. SemperFi,John

dm1254 - A belated welcome to the club that none of us asked to join. Also, welcome to The Waiting Room - the virtual room where many members spend a bit of time while they are learning, discerning and planning their journey.

You are among friends here. We talk about all aspects of PCa -- even the ones that would embarrass most people to discuss. We're all in this together.

You are also among the luckier members. With your biopsy report, you have time to learn about various treatment and surveillance options and to choose the path that makes the best sense for you.

I'm a "raddie" and my pathology isn't much worse than yours. I chose radiation because I have already, in my own opinion, had enough major surgery to last a lifetime. Make no mistake, prostatectomy is major surgery. Even the robotic approach really just limits the size of the incisions made. There is still a lot of cutting to be done and the risks of complications, blood loss and after effects are not trivial. I'm NOT trying to steer you away from surgery, if you are so inclined. I'm just trying to explain why I chose radiation.

Within radiation, there are a mind-boggling array of choices. Each has its own acronym, so you will have to get used to alphabet soup. 0311 can probably fill you in off-line (he helped me a lot, too), but I'll just give you the tip of the iceberg.

There is Low-Dose-Rate Brachytherapy. This is where they either implant permanent radioactive seeds into your prostate in an outpatient surgical procedure. LDR Brachy is one of the oldest modes of prostate radiotherapy and it has been refined immensely over the years. Many low-risk patients choose this with excellent results. If you, like a few of us, are in the Chicago area, Dr. Moran at the Chicago Prostate Cancer Center has done thousands of cases. A rep from Chicago Prostate Cancer Center did a presentation at our support group and they are most impressive.

There is also High-Dose-Rate Brachytherapy. I'm less educated on this one, but in this case they move high-dose radioactive seeds into and out of your prostate while you are in the hospital. This is, IIRC, typically about a 2-day stay. HDBT has excellent cure rates,

Add to these that there are 2 or 3 or 4 versions of external beam radiation, where you are placed on a treatment table and photon beams are aimed at your prostate (and some calculated areas of surrounding tissue) from outside your body. These treatments can range from a week or two all the way up to 10 weeks. Different radiation machines have different capabilities, which helps the radiology oncologists to plan and deliver the proper dosage to your tumor(s). 0311 and I both had CyberKnife treatment, which typically is delivered in 5 treatments over a 2-week period. CyberKnife (and other forms of stereotactic body radiation therapy, or SBRT) have dose/delivery patterns very much like HDBT, and are among what is now felt to be the most effective radiation therapies.

If you read a lot, you will also run across the Chicago Proton Center, or other centers that treat PCa with protons, instead of the usual photons. This (proton therapy) is yet another new form of radiation, which claims to deliver effective dosage to the target area but claims to do less damage to surrounding tissue. The jury is still out on this one, but so far the clinical research hasn't shown proton therapy to be much, if any, better than the standard photon radiation. It is still an 8 to 10 week commitment, very costly, sometimes not covered by insurance, and may be no better than the older systems.

There are other focal therapies, but I don't know much about them. For those of us with multiple areas of cancer within our prostates, I don't think focal (single point) treatments are likely to be recommended. Remember that PCa is a multi-focal disease, so most patients have several tumor foci, and the available imaging may not be able to adequately visualize them all to target them.

I'm sorry that I ramble so, but there is such a wide array of available treatments, and most of them will do a fine job for low-risk patients. In my case, I finally based my decision on the potential side effects of each form of treatment, and how I felt that these side effects would affect my life.

Hopefully I have given you enough information that you are beginning to understand that there is time, and there are choices, and that in the end, whatever treatment or management plan you choose is the one that is best for you.

Thanks to everyone who have replied. My first ever PSA "this year" 9-9-16 was 5.8.

Thanks. I live in southwest MO. about 40 minutes north of Joplin, MO. My Uro is located in Joplin and he has referred me to a surgeon in Springfield, MO and a doctor to discuss radiation treatment options in Pittsburg, KS. I have a son who lives in St Louis.

There you go,dm1254,you in a club that no one wants to be in,but in a club that every man should be in when prostate cancer is a reality.You will be fine.Now go and enjoy the holidays and give our Lovely Grand-daughter,Lucy,a big hug.I would like to wish all our members,really an extended family a big joyous Merry Christmas,SemperFi,John

I checked and Barnes-Jewish/Wash U/Siteman in STL is not an in-network treatment center for my insurance. Do any of you know of another place you recommend?