Frequent lurker - new member

I have been lurking here for a couple years off and on since my first diagnosis.
I have been on active surveillance since 3-16.
After my latest biopsy my Uro suggested it was time to do something and gave me an RO to see this past Friday. I had originally been against the thought of radiation treatment but now have a more open mind . I am to see my uro this coming Friday to discuss surgery. I have been reading everything I can get my hands on for the last couple weeks on both procedures but am not any closer to having a preference. My Uro is Dr Rajen P Butani at NJU and I have been seeing him for a number of years, originally for an unrelated problem.
Here are my test stats: (I also had a dna test on the second or third biopsy which came in at a low percentage, about 18% )

Forgot this Age 71

PSA
10-14-14 3.3
10-21-15 4
12-12-15 4.4 Free1.1 25%
4-29-17 4.6
5-24-17 4.8
1-27-18 3.6
7-27-18 4.1
2-9-19 5
5-10-19 5

Biopsy
1-29-16 RM-Atyp
3-18-16 RA-37% 3+3
>DNA test of sample Low risk
7-21-17 LLB-12% 3+3
LB-13% 3+3
5-10-19 LLM-5% 3+3
LM-60% 3+3
RLM-4% 3+3
RLA-35% 3+3

Post Edited (Grendel13) : 6/9/2019 6:27:58 PM (GMT-6)

Your age could be a significant factor on your treatment decision.

Hi Grendel,

If you have not looked into it or discussed, a high powered MRI followed by a MRI-Ultrasound guided biopsy, if needed, would be the logical next steps prior to picking a "solution". You have been in an active surveillance process (keeping an eye on it) which would require such things nowadays. You probably should discuss with your urologist and at least get the MRI done. Standard biopsies can easily miss lesions (what they are called before diagnosed) so you don't get a sample in a primary area of concern. After that, you should get a 2nd opinion on the pathology (J. Hopkins) just to confirm whatever it is.

The good news is you have the time to pursue these things now. The surgery option tends to stop at age 70 if you were wondering.

He is recommending IMRT, which is very likely to do the trick in the cure department. But since she also does brachytherapy (which should also do the trick), I'd be curious as to why he's recommending IMRT and 7 weeks of treatment vs the shorter brachy treatment. For the record, I had both IMRT and brachy, but as a G9, I needed the combo treatment. In your case, monotherapy would be Standard of Care.

Post Edited (Michael_T) : 6/10/2019 11:00:52 AM (GMT-6)

You have received great advice so far.

I have been on AS for ten years, and I agree that a large volume of Gleason 6 can signal a need for treatment. Many of my internet associates will not agree to treat any amount of G6, but everyone has their own opinions,

SBRT, PBT, and even the new TULSA-PRO protocol now finishing clinical trials would be what I would be considering as treatments.

I would also suggest that you buy a copy of Dr. Mark Scholz’ new book The Key to Prostate Cancer. He interviewed 30 prostate cancer experts and presents their descriptions of the treatments that they provide for men at different risk levels.

Grendel,
Be wary of Uro’s recommending surgery. Remember, that is all they do. I am familiar with NJU, formerly DVU. They recommended surgery with Dr. Butani, 5 minutes after they gave me my dx. Take some time and think about your other options as mentioned in the posts above. Whatever you wind up choosing, educate yourself first.
MSK is not that far from South Jersey. My thought process was to go for the best. They also have satellite offices in Middletown and Basking Ridge. I had my SBRT done in Middletown and brachy done in Manhattan.
Best of luck.

In two words: It doesn't.