New Guy in the Club--Considering Options

[daBoomer]

Evening All,

I'm 60 years old. I had a physical in July, 2018, which revealed 5.7 PSA. (Only previous PSA was 1.7 in 2013). Referred to urologist who noticed "hardness" on digital rectal exam and schedule me for TRUS biopsy on September 18, 2018. 12 samples at 6 sites. Got results on September 24, 2018.

"Prostatic adenocarcinoma, Gleason grade 3+3 (score =6; prognostic grade group I), involving .06 mm (~5%) of 1 of 2 cores." Focal High Grade PIN on two other samples.

Did some reading, wasn't too alarmed despite inherent creepiness of having cancer floating about.

Got referred for consult for focal therapy. Doctor wanted to do a 3D mapping biopsy. As I understood, mapping biopsy takes 100 or more samples from prostate. I'm not onboard with this idea. I want this small cancer to remain confined to prostate. It then follows that poking 100 or more holes in the prostate might not be the best idea to promote containment. Just logic, not medicine.

I think the next step is a 3T-MP-MRI. I'm going to wait until December, 2018 to let the prostate heal from the September TRUS biopsy.

Next week I'm flying to Los Angeles for the day and meeting with the Prostate Oncology Specialists in Marina del Rey. I like Dr. Scholz' book and these folks seem like a good source to ramp up my knowledge level.

My guard is up as my little experience in this chapter of life suggests many medical providers peddle their own specific treatment for their own reasons. I want to become informed and calculated in my decisions about my life.

Sorry to be in the Club, but glad I found the Clubhouse. I'm interested in everyone's perspective and thoughts.

Thanks in advance for your time.

Regards,

Doug

[Tall_Allen]

Why aren't you considering Active Surveillance?

Here are some factors to consider about focal therapy that the doctor who you are talking to probably didn't tell you:

pcnrv.blogspot.com/2016/12/...

Spreading the cancer with a biopsy is very rare. It is highly doubtful that GS6 can live outside of the prostate:

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

If you truly have only GS 6, you have little to worry about with a template mapping biopsy:

pcnrv.blogspot.com/2017/11/...

I'm not a fan of seeing a medical oncologist while active surveillance/ curative therapy is still on the table. They are not experts in these therapies - talk to the real experts.

[daBoomer in reply to Tall_Allen]

Wow, great information. Thank you.

I am considering Active Surveillance and thought that would be discussed with a the medical oncologist. How do I locate an expert in active surveillance/curative therapy?

[Tall_Allen in reply to daBoomer]

Where are you located? Most major cancer centers of excellence have their own AS program. I'm in LA, and I'm partial to the one run by my urologist Leonard Marks. I'm also very impressed by the work MSKCC is doing with their AS program. Johns Hopkins probably has the strictest criteria. There is no consensus on protocols, so you have to find the program that suits you. I think it's important to get on someone's program, and not try to manage it for yourself.

Curative therapies comprise surgery (which is done by urologists) and radiation monotherapies (which is done by radiation oncologists who specialize in each type - SBRT or brachytherapy (both kinds)..

[judg69]

No question here. At this stage, active surveillance is the normal plan. Best Regards, judg69

[Vitruviusman]

Keep us informed

[Jeff85705]

Your Gleason sounds like a non-aggresive ca. I would consider active surveillance, rather than going full-on with surgery or other treatment. 5.7 PSA is slightly above normal. The only other factor is that apparently you had a positive DRE ("hardness"), which complicates things a little potentially (though I am not sure of this).

Unlike Tall_Allen (who is an excellent resource here) I think seeing a medical oncologist is actually a good idea. That's what I did. They are less likely to be biased in favor of one treatment (RP vs RT) over another. I had excellent results seeing a specialist in prostate ca who gave me great advice relative to my situation (Gleason 7, PSA 10 negative DRE).

Sounds as if you have been doing your due diligence in getting research done and being active in your health. Sorry you have to be a part of this "club"! Best wishes and good luck!

[cpcohen]

>>>

I think the next step is a 3T-MP-MRI. I'm going to wait until December, 2018 to let the prostate heal from the September TRUS biopsy.

>>>

That's a sound idea. Stick with it.

You might want to compute your PSA doubling time, since you have two readings. THere's a calculator here:

mskcc.org/nomograms/prostat...

. Charles

[Hidden]

You might consider HIFU as a treatment option if the disease shows progression but is still contained within the prostate.

[407ca]

I would consider active surveillance. You seem to fit the bill.

Doctors tend to sell their own specialty because it is what they know. I think the more focal treatments are harder to find simply because they are newer. If I could do a focal treatment that is what I would do is active surveillance were not an option.

Best of luck.