Biopsy Results Question and Opinion Help Please

DKan,

First, welcome, and good for you for learning how to advocate for your father. Also, good plan to send the slides for second opinion.

Not a bad biopsy. Some positive cores, but for his age and PSA, particularly with the meds he's on, not a big issue. He is G7, assuming it's confirmed. He should be absolutely cureable. Also a good plan to get the cytoscopy, given his urinary issues. I don't see in the MRI report an estimate of prostate size, so that might be a concern.

If you've been reading here, or elsewhere, you'll know that radiation therapies come on various flavors. Basically there are 'internal' treatments, where radioactive pellets are put in the prostate to radiate it from the inside. LDB (Low density brachytherapy--permanent seeds) and HDB (High density brachytherapy, where the seeds are put in, and few days later, taken out). Both are good treatments--but many ROs don't do them on very large prostates, because it's more challenging to hit the right spots, and because they can cause swelling of the prostate and other problems.

Then there are the external treatments, classically IMRT, which is daily zaps for between 30-40 treatments, and SBRT where they put in gold markers inside the prostate and use them to focus the beams, usually 5 treatments over 2 weeks.

Again, if he has issues with BPH and a large prostate, radiation can be an issue.

If he goes for surgery, make sure he has a highly experienced surgeon, and ask specifically about his personal record regarding side effects for cases similar to your father.

Good luck!

Good morning DKan.

To clarify some of the information regarding High Dose Rate Brachytherapy (HDR-BT). First 15-18 thin catheters, think of a long juice box straw, are strategically pushed into the prostate and seminal vesicles. These are closed at the end. These are positioned using ultrasound and then the positions are fine tuned using CT scan so the catheters are placed exactly according to the radiation plan and patient’s anatomy.

Then a single highly radioactive pellet that is attached to a wire is fed into each catheter in a planned sequence and for specific periods of time. This is so the amount of radiation dose can be varied. More where there is cancer, less where there isn’t. This entire process takes about 15 minutes.

Then the wire and pellet are removed from the last catheter and placed back in protective storage. The template and catheters are removed from the patient. And after a brief time the patient is sent home. No radiation is left in the patient. There is no follow-up removal as the pellet is not left in the patient. That is an advantage of HDR-BT compared to permanent seeds brachytherapy which leaves the radioactive seeds in the body forever, hence the term permanent seeds brachytherapy. These permanent seeds have a very low radioactive dose that wears off over 6-9 months depending on the seed chosen. So the HDR-BT delivers in 15 minutes what it takes permanent seeds to deliver in 9 months.

For excellent, in my opinion, information about HDR-BT, see www.cetmc.com. This is the website of Dr Jeffrey Demanes, the father of HDR-BT. For permanent seeds see www.prostrcision.com. This is the website of a large seeds provider, Dr. Frank Critz, the pioneer of combining permanent seeds brachytherapy with external beam radiotherapy. Both Demanes and Critz have retired in the past few years, but their clinics are in continuous practice, Demanes at the UCLA Medical Center and Critz in Atlanta affiliated with Northside Hospital.

For my treatment, I assessed both versions and decided on HDR-BT. I have several friends and a brother-in-law that, in their mid to late seventies, have successfully used various forms of radiotherapy to treat their cancer.

As Mumbo points out, any treatment method must be assessed by a board certified doctor specific to that treatment to determine the best way forward. Get surgical assessment from a board certified surgeon. Get radiotherapy assessment from a board certified radiation oncologist. Don’t let one speak for another.

Thank you all for the replies. Truly grateful for this community. I will follow the advice and read up before the RO appointments.

@Halbert his prostate volume was 40cc.