Intraductal with cribriform pattern patient discovered 9/24. 4+3=7, 2 cores grade 4 with 50%, non metastisized, perinural invasion (1 core), 2 cores 3+4=7 5 to 20% grade 4
Possible extracapsular extension.
MD Anderson surgeon ruled Not a candidate for surgery (margins, Extracapsular extension). they suggest Brachytherapy seeds HDR 15 GY, Proton beam 44GY (bead + lymph nodes). Premedicate with Firmagon and ERLEADA (3 months prior)
John's Hopkins surgeon and radiologist both say I am a candidate for surgery or radiation, radiologists suggest same plan as above except using ADT plus Xtiga. (stampeed trial).
Surgeon states I am a fine candidate for surgery, I have a very small prostate however suggests radiation.
My prior urologists said twice to me, your type of cancer does not respond well to radiation.
I have always thought radical.
I could use some help choosing.
Regards
Doug
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hi Doug. I’m also 69. I had cribiform, extracapsular extension, and perineural involvement. I also had metastasis to two local lymph nodes. My Gleason score was 9 (4+5). Barnes Jewish Hospital in St. Louis wanted to do nine weeks of IRT then HDR breaking therapy along with two years of first and second generation ADT. For a second opinion, I went to Northwestern medicine in Chicago. their team looked at my PETPSMA scan and MRI as well as my health history and recommended that I have prostatectomy followed by radiation to the pelvic basin and then 18 months of first and second generation ADT. Their team strongly believe that my best chances of a cure lied with removing the cancer mothership, i.e. the prostate, and then working to clean up smaller affected sites. After surgery, my PSA dropped to 0.41. I’m currently in remission and my PSA is on detectable.
Good luck to you on your journey. Don’t hesitate to ask any questions of me.
Today they use higher doses for radiation, therefore I think you can get radiation. On the other hand possible extracapsular extension means not a great extension. If the surgeon knows where this is located he can cut an extension there. If he did not remove all, you can get salvage radiation. Both treatments can be done.
With all these opinions it is almost impossible for a newly diagnosed patient to decide.
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.
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.
I was diagnosed with Intraductal seven years ago. The cancer was outside of the cap of the prostate and in two lymph nodes. I had surgery and the surgeon went wide removing as much as possible. 12 months later the cancer developed in a left iliac lymph node which was detected by a PSMA scan. I had stereotactic radiotherapy to the node which effectively killed the cancer in that area. I have just recently started Relugolix Hormone therapy due to the development of mets in my pubic bone & right iliac lymph nodes. My latest PSA test was undetectable. Like you at the start of my journey, I was told that intraductal Prostate Cancer did not respond as well to treatments however you can see that in my case by having surgery followed up by stereotactic radiotherapy (I could not have pelvic wide radiotherapy due to a pre-existing bowel problem) I am now seven years out with an undetectable PSA. I hope this helps.
So far I have had four Surgeon's state "do radiation"!!
Duke, MDA, JHopkins, Moffitt.
Complications listed in original post. positive margins, bulky tumor press'es against spincter and urethra. I'm two months into premedication. Recently I talked with Steve1960 from american cancer society blog and he had HDR Brachyboost and it came back in 5 yrs, he wished he'd have a radical. Its unusual for a premedicated patient to have surgery because of the pathology will change. I suspect there must have been some but I would expect some doctors prefer to remove and do radiation afterwards. The four surgeons state just do radiation, you will have a worse quality of life doing both. Are there advantages to do both?
I would think so but they say do radiation, that it works. Is there a conflict of interest here? Medically tumors with indraductal were always removed. Could the price of those machines have some issue here to pay them. Surgery is less expensive.
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