I need to find a surgeon to remove my prostate that is competent.
Trying to get a second opinion here at
MD Anderson/Houston.
There pushing radiation. Which does not behave well with my disease.
pubmed.ncbi.nlm.nih.gov/310...
Who here has this type of cancer?
Doug
They are right to rule out surgery. You are possibly misunderstanding that link. It only suggests that radiation is less effective in men with cribriform and IDC-P vs men without those risk factors. So, radiation intensification and hormone therapy are probably a good idea.
Cribriform pattern with intraductal carcinoma was associated with adverse outcomes in men with Gleason 7 prostate cancer treated with external beam radiotherapy while cribriform pattern without intraductal carcinoma was not so associated. Future studies may benefit from dichotomizing these 2 histological entities.
Read conclusion please and remark.
The conclusion of that study simply compares cribriform pattern with IDC against cribriform without IDC when treated with EBRT. The same result is true of prostatectomies - i.e. cribriform pattern with IDC comes out worse than cribriform without IDC when treated with RP. There appears to be a lot of unknowns in the treatment of cribriform pattern PC, for instance: pmc.ncbi.nlm.nih.gov/articl...
As there does not appear to be a definitive study on the treatment of cribriform, I would go with whatever treatment reduces risk of BCR and that is EBRT using the most modern machine you can find, plus ADT. Basically throwing the kitchen sink at it.
I went to UF Pronton center Jacksonville, they would give 40 treatments, maximum dose , start 2 months on adt , then treatments, remain on ADT for 2 years. (MD Anderson say 6 months). Also the doctor states 40% chance of failure, in his notes, and 30% chance with Radical. Which was my choice.
My MRI report states mild capsular bulge.
Proton people said I was a candidate for radical, my urologist oncologist that did my biopsy said I was a candidate for Radical and said twice to me ‘’with your type of cancer radiation does not behave well” !!!
Get an opinion from Dr. Matt Biagioli. I think he has offices in Orlando and Sarasota. There's no advantage to protons.
I read the whole article. You misunderstand it. It just says that cribriform+IDC-P has worse outcomes than without those risk factors. It does NOT say that radiation does not work. It argues for intensified radiation, not no radiation.
I would think that capsular extension and surgery is not a good combination.....but I'm not a surgeon. I'm sure you asked "why"....and their responses?
I'd agree with the mob....good chance post-surgery will leave you with RT treatment anyway due to ECE. I was diagnosed with IDC upon my pathology. No crib however. I did a lot of research on IDC and found out that nobody knows anything definitive about it other than it's more aggressive. But to what end? That's where the studies mix. I'm now 37 months at <.02.
I would NOT dwell/worry about IDC/Crib at this point. Seriously, your drx's will know the proper dose/field of RT. I would listen to MD Anderson...they're good folks.
You have a terrific RO at MD Anderson, Dr Chad Tang. He’ll take care of you
I am assigned Dr Osaka Mohamad
When I was in that position my second opinion Dr. said go to Dr. Patel at Celebration hospital in Florida. At the time in 2015 he had done 8000 Davinci's 9 years later his staff still calls every year to see how I am doing. Great job started me on Viagra right away . Look him up people come from around the world to have him do it. My opinion.
I went to Dr. Patel for a second on surgery. He has no fear and will operate on anyone. One thing to be aware of with him is that he doesn’t do all of his own surgeries anymore. He has a team of surgeons that do most of the procedures. So be careful that you know that he’s going to do the entire procedure and not just part of it, or none of it.
That's the problem with RP. It can be an excellent long-term treatment or it can be a disaster. Unfortunately, most of that depends on skilled human hands. Also, proper qualification of patients....low comorbidities/existing issues, cancer 100% contained via imagining systems, age, condition, etc. Although I like my uro I would not allow him to do my RP. I found the best in my area and I think that speaks for my results....<.02 for 37 months now. Excellent erections and no urinary issues like I had before RP. I'm still in shock of what a difference sleeping through the night has made on me. I just got used to sleeping for intervals of 90 minutes, voiding, back for another 90 minutes...thought that was normal for older guys!
Surgical removal is the most invasive option with potentially the worst quality of life side effects. Slow down and consider your options. There are many.
Sorry found that humerus. Interesting suggestion to “slow down” from a guy named fast_eddie.
oh my. We are right in the middle of where you could potentially be. My husband (64) is 4+3, Extraprotastatic extension, IDC w cribform, seminal vesicle and perineurial invasion, and lymphovascular invasion. The only thing we knew prior to the prostatectomy was the 4+3. We opted for surgery so we could fall back on radiation if it recurred. That was Dec 2022 - one nerve spared, clean margins, no firm erections and some urinary incontinence. PT3b PN0 - WASHINGTON Medstar DC
Fast forward to August this year and find out he has bio recurrence. .2 He has been put on orgovyx for 4-6 months and 38 sessions of radiation. We are two weeks into the orgovyx and he is depressed, angry, can’t sleep more than 2 hrs per night. Sex is a thing of the past and for him this is the most dreadful part of it. I have no clue how we are going to get through 4-6 months. I am very afraid he will stop the adt before he finishes.
On top of it all he has heart failure and vtach and is being worked up for a potential heart transplant when he finishes treatment.
This is the first time I’ve ever posted anywhere but I read everything. Forgive me if this is for patients only but I consider us a team and what he goes through, I go through
Do not underestimate how important your love and support for your husband is. Keeping his moral up is half the battle.
Doug, Please see my bio. I have cribiform and Intraductal histology and G9. In addition I am BRCA2 positive. Had ADT, HDR Brachytherapy and EBRT. Currently 18 months out from stopping ADT. PSA is .06 with testosterone in the 120’s. As they say your mileage may vary but food for thought.
These graphs will show you what the others are saying…
Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
prostatecancerfree.org/comp...
It is best viewed on computer or just print it on paper. Not so viewable on phone.
To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.
Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.
And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Some of them are more dangerous than the cancer.
My husband is newly diagnosed. 55 yrs old. Gleason 9 Grade 5. Had RP on 3/16/20 t3b n1 with 9/43 positive nodes. PSA 1.4 at 6 weeks.
Is a call from your oncologist on Sunday morning ever good news??
Drug Prices
dbrooks_h we are all brothers here
CAREFUL WHAT WE SAY, PRONOUNCE AS TRUTH HERE. NEWBIES MAY THINK ITS GOSPEL.
