best treatment

[blizzardm17]

gleason 3-4=7 present in 2 of 2 cores 25% of the core volumes. perineural invasion seen right base prostate adenocarcinoma gleason 3-4 present in 2 of 2 cores involving 10% of core volumes. no perineural invasion. what should i do. radiation 40 treatments or surgery..68 years old

[Tjc1]

Hi, im no doctor just a guy who couldnt have surgery. If the pc is contained and the doctor has hundreds and hundreds of successful surgeries i would go with the sugery. Successful i mean having patients tha come out with few side effects. ie incontnence and sexual side effects. With the surgery you have radiation as a salvage therapy. Generally you cant have surgery after radiation. Very few docs do it or advise it. In my opinion i would try to stay away from ADT as long as possible.

Thats my 2 cents

Thomas

[blizzardm17 in reply to Tjc1]

thank you for answering

[softwaremom00]

Based on my Dad's experience with radiation and prostate cancer, I would pick surgery. Radiation caused him to be incontinent and eventually caused a sarcoma to occur(several years later) at the radiation site. The sarcoma killed him. I know his is a rare occurrence but it does happen. Radiation is exhausting.. for you and the person who takes you. I remember driving my dad to his 40 treatments.. and at the end of the 40 treatments I was so worn out. He was totally worth the effort.

At the time he picked the radiation because the doctor told him how low the risk was and how safe it was and that he would NOT be incontinent.

As stated earlier, It does give you the option of using radiation later.

Sending tons of hugs and prayers.

[blizzardm17]

thank you very much. i am now leaning toward surgery. heading for second opinion at sloan next friday

[Egerdes in reply to blizzardm17]

Dr Samadi Lenox Hill Hospital in NY is also a great surgeon. Was a Gleason 7 (4+3) did a great job on my surgery . Very little to no side effects. Highly recommend him. Did over 7000 robotic surgeries.

[blizzardm17 in reply to Egerdes]

thank you will look into lenox hill as well

[Tall_Allen]

Here's what you should do:

(1) Have your biopsy slides sent to Epstein's lab at Johns Hopkins for a second opinion ($250). it probably won't change the diagnosis, but it's good to be sure.

(2) Decide not to decide yet. you have plenty of time to make a decision. Even if you decide a year from now, there isn't likely to be any big change in your situation. PC is a slow disease in early stages.

(3) Set up appointments with specialists in each kind of therapy you are a good candidate for. Those therapies are surgery, SBRT, LDR brachytherapy and HDR brachytherapy. You probably don't even know what those are yet, and you need to know. Start doing some research.

(4) Stop asking random people on sites like this , or even doctors, what therapy you should choose. Only you can do the self-assessment necessary to answer that. Here are some questions to ask yourself:

pcnrv.blogspot.com/2017/12/...

PS - Unless you belong to an HMO that limits you to those options, you should not even consider 40 IMRT treatments. It's a thing of the past or should be. There is no need to put yourself for a long-term ordeal like that, unless that's the only radiation option available to you. Either hypofractionated IMRT or SBRT are significantly better and less expensive.

[blizzardm17 in reply to Tall_Allen]

ok thank you very much for the information. just got oked for 2nd opinion at sloan kettering , going to send them my slides and go from there

[Tall_Allen in reply to blizzardm17]

Michael Zelefsky at MSK is a world-renowned expert at LDR brachytherapy and SBRT. They don't offer HDR brachy monotherapy anymore, I think. My favorite surgeon in the NYC area is Ash Tewari at Mt Sinai, but the surgery team at MSK is excellent as well. Here are questions to ask (adapt to your situation):

pcnrv.blogspot.com/2017/12/...

pcnrv.blogspot.com/2017/12/...

pcnrv.blogspot.com/2017/12/...

[blizzardm17 in reply to Tall_Allen]

ok lots to take in and get educated on. going to ask about that nerve invasion thing that they said i had in one sample. thank you

[Tall_Allen in reply to blizzardm17]

Here's my recent article on PNI:

pcnrv.blogspot.com/2018/03/...

[blizzardm17 in reply to Tall_Allen]

thank you very much

[AlanMeyer in reply to Tall_Allen]

These are the most comprehensive lists of questions I've ever seen!

One caution for people using them. A lot of the questions ask doctors about their rates of this or that occurrence or side effect. In my very limited experience, a lot of doctors don't really know and the best they can say is something like "It happens sometimes but not too often." For some common side effects like ED (for both radiation and surgery) and incontinence (for surgery especially), if they tell you that this doesn't happen to _their_patients, then you may be dealing with a BS artist who can't be trusted to tell the truth, and maybe can't be trusted to do a careful and meticulous job in his treatment.

Alan

[Tall_Allen in reply to AlanMeyer]

You make a good point. A really empowered patient would have a general sense of what the population statistics look like. So if a surgeon says his patients never have ED or incontinence, it just won't pass the smell test. I've found that top doctors in top hospitals actually do keep very close track of their own statistics, and they are usually happy to quote them. It's also important to make adjustments for the individual. For example, if I'm a 70 yo man who already has some mild incontinence and always takes ED meds to get an erection, my expected continence and potency after surgery is likely to be much worse than a 50 yo man who is fully continent and potent.

[Break60 in reply to Tall_Allen]

TA

Are there any situations nowadays where low dose IMRT is the preferable treatment of the prostate gland? I had low dose SRT ( 1.8gy) to the gland in 2014 and lower dose (1.5gy) to pelvic lymph nodes in 2015.

Bob

[Tall_Allen in reply to Break60]

The direction is towards hypofractionation. Side effects and efficacy are no worse.

[Hidden]

Your decision, but why only 2 cores taken? A very small prostate? And how do you know that there is perineural invasion seen right base prostate? Suspected from the feel of the prostate?

My prostate was 80 gms and I had 15 sticks with 4 positive. PSA 6.8; Gleason 7 (4+3) back in 2003. After researching, the numbers indicated he same chance for success/failure (92-94%) for surgery or seeds plus a short course (25) of IRMT. I elected radiation.

It didn't matter as my PSA never really came down and within a year I had mets. Cancer had alreday escaped the capsule and was traveling through my lymphatic and vascular system. I opted for an immediate chemo-hormone therapy trial. I am glad I did.

Whether you elect surgery or radiation, you might consider enrolling in an adjunctive chemo trial immediately after your primary treatment to cover your bases. Of course, there are many who do not favor very aggressive treatment for PCa and prefer to wait the disease out. I wish you the best.

Gourd Dancer

[blizzardm17 in reply to Hidden]

i had 12 cores 8 were ok the other 4 had the cancer 2 cores had 10% the other 2 had 25% thats the one where the nerve invasion was noted on the report. did you start the chemo right after the radiation or after a year when you found out it had traveled? Thanks for letting me know your experience

[larry_dammit]

What does your urologist say. If it hasn’t spread I would say get it out. I’m no doctor but mine went rouge and stage 4. Mets. Before they found it. Know a friend that is 87 had his removed 25 years ago. Never looked back

[blizzardm17 in reply to larry_dammit]

thanks Larry, he recommended treatment so i am checking with msk on the best option for me

[j-o-h-n]

If you elect to have surgery and it's at Sloan Kettering I would recommend Dr. James Eastham,1275 York Ave, New York, NY 10065

Phone: [phone].

Good Luck and Good Health.

j-o-h-n Wednesday 04/18/2018 7:24 PM EDT

[blizzardm17]

thank you John, i may end up at phelps or someplace associated with sloans because of insurance issues. my insurance doesnt pay much . i will find out next friday

[Hidden]

There's another option that might apply, in addition to RP surgery or radiation: HIFU -- high intensity focused radiation. Google it. I chose that over the recommended 45 radiation treatments. No bad side effects but it was out-of-pocket and not covered by Medicare. I've heard that Cigna now covers it.

[blizzardm17 in reply to Hidden]

i will ask the dr about it thank you. what did it cost out of pocket if you dont mind me asking.

[Hidden in reply to blizzardm17]

Not cheap: $25K. But I did get a nice tax refund the following year, which represented a discount to that price. BTW, your doctor will likely be not familiar, or biased against this recently approved treatment. Most urologists are spring loaded to recommend conventional surgery or radiation. As Geico would say, "It's what they do". Check this out, my HIFU surgeon is included in their list of practitioners.

hifuprostateservices.com/