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Advanced Prostate Cancer
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Just had face to face with dr’s

Hello,

It’s taken months between tests, travel back and forth and biopsy done with MRI fusion etc... But they called Friday wanted my husband to fly up to talk face to face and they phone conferenced me in. He has had a recurrence and his prostrate is filled with a lot of cancer. 10 of the 12 biopsy’s showed 7,8,9 Gleason .

First time 10 years ago age 52, he had three months radiation , two years of lupron. This time the oncologist and urologist agree that the only chance for a cure is a selvedge prostatectomy (sp)? Even with high cost of side effects. Talking the end of July. It is at least showing it’s only in the prostrate in reference to all test but of course we know something could be hiding. The surgeon said since he had radical radiation it’s going to be damn hard getting through all the scar tissue. Any experience or knowledge would be helpful. He already had quite a lot of damage from the radiation.

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Salvage surgery is certainly his worst option - but there are many more. Here is an article discussing much better options with a summary table of them all at the end:

pcnrv.blogspot.com/2017/09/...

(also see the links at the bottom)

My guess is the doctors you spoke to are unfamiliar with those options. You really have to talk to a specialist who has experience in doing them. If you mention your nearest big city, i may know a specialist nearby. But it is worth traveling for to avoid salvage surgery.

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They had talked about cryogenics in the beginning. Not sure why that has been taken off the table. I will make sure my husband reads the articles and discuss with his dr’s. Thank you for your time.

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Because the recurrence is in multiple sites around the prostate, he will need WHOLE GLAND salvage therapy.

For WHOLE GLAND salvage, the best in clinical trials so far has been for SBRT (by Don Fuller in San Diego) with an 82% cure rate so far and relatively mild side effects. Here's a detailed explanation of his clinical trial:

pcnrv.blogspot.com/2016/08/...

Fortunately, NIH is running a FREE clinical trial of salvage SBRT. I suggest you call or email Theresa Cooley-Zgela, R.N.(240) 760-6207 theresa.cooleyzgela@nih.gov

clinicaltrials.gov/ct2/show...

Whole gland high dose rate brachytherapy has also reported good cure rates with low toxicity (by Joe Hsu at UCSF). He could also get this done at UCLA. If you are near Chicago, I suggest you ask Brian Moran if he would do salvage whole gland low dose rate brachytherapy . I'm not sure if he has experience doing it, but since he is nearby, it is worth a call to find out. As you can see in the chart, WHOLE GLAND cryotherapy has a poor side effect profile (although not as bad as surgery).

In general, salvage radiation (i.e., SBRT and brachyterapy) is more effective and has lower toxicity than salvage ablation (e.g., cryo, IRE, HIFU, etc.).

You should really go with the experts in these therapies. Every salvage therapy carries extra risks compared to primary therapies - he deserves to be treated by an expert.

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You are so kind to take your time and give us this information . I will help him dig into it all tomorrow. I think that might be what kind of radiation he has his first time was brackey radiation with a machine called the calypso. We live in Saint Louis but my husband started at CTCA his first diagnoses because he didn’t want surgery so they did the calypso, our daughter lives about 60 miles from San Diego.

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Calypso is just an image-tracking system using a radio transponder. it is used to accurately track the position of the prostate during external beam radiation (not brachy). If he had 8-9 weeks of radiation, it was most likely a kind they call IMRT. In St. Louis, Jeff Michalski at Siteman is a very good radiation oncologist. I'm not sure whether Siteman offers any of the salvage radiation therapies I mentioned - as I said, it's a very specialized field.

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Talking to my husband now. Did you use one of these treatments?

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Yes and No- I had SBRT as a PRIMARY treatment, not a salvage treatment. It has had virtually no lasting side effects for me, other than dry orgasms. But I am fully continent, fully potent, pee better than ever, and my PSA is very low (0.1). The treatments are a snap - I just laid down on a couch five times for 5-10 minutes. (CyberKnife machines take about 45 minutes per treatment - my RO used a faster machine.)

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If Calypso is used on a patient also receiving brachytherapy, is it possible that the Calypso beacons could block some radiation reach of the brachy seeds?

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No, the radio-transmitters (and the titanium shells of the seeds, of course) are transparent to the high power (6 MV) X-rays

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Salvage Surgery is Doable---worst Option--is someone talking the 'Standard Of Care',

My Surgeon has done over 100 of them, taking care of all the screw ups done, when an RP was a better option than External Beam Radiation---Maybe if in combination with Seeds the Radiation might have been more worthwhile.

And before any Talk back--my Surgeon Is on the Board of Directors of the Southeast Urological Society, and a Board Director of the Local Hospital I had my Surgery. And he Teaches Surgery at Duke---and yes it is a surgery that needs expertise---so if you go forward--find out how many were done by the Urologist.

Nalakrats

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Thank you for your time in answering. They had mentioned cryogenic treatment possibilities as maybe a option earlier not sure why that may have been taken off the table. His oncologist and urologist are at Cancer hospital of America in Zion I’ll.

His oncologist is Dr. Evan Pisick and Alsikafi MD Nejd is the urologist .

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I do not know enough about cryogenic other than it is available as an upfront treatment, along with Radiation, and RP surgery, Seeding, and other Beam techniques. Not heard of it being used as a salvage technique---but again I do not follow it.

Nalakrats

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Did you have a salvage surgery?

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No I had an RP, no radiation--and then on to a drug and supplemental program that I designed with my doc. and God.

Nalakrats

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Chemotherapy not an option as cure? Back in 2003-2004, I went from primary treatment of seeds and external radiation to chemo at 11 months when metastatic. Of course, almost all say that chemotherapy is not a cure. I seem to be the exception. I was able to stop Lupron in early 2010. Find the best with knowledge and experience; as some have written and I am sure that your doctors have explained, the procedure is doable yet tricky. Good luck.

Gourd Dancer

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Thank you for your response. I think they were speaking maybe too where he is with his cancer at this point. It has not metastasized at this point. I would think Chemo could “cure” and as you pointed out you have had a positive experience. Maybe this is a option they want to use if they end up not getting “it all” down the line.

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