Just getting started

[Sttickman]

I’m 62 and retired. I have watched my PSA rise over the years. 2 years ago it was checking around 6. I had an MRI that showed nothing. Had a biopsy that showed nothing either so I decided to not worry about it for a while.

This spring when PSA checked again it was up to 10, MRI again showed nothing. I decided to get a 4K score and it showed a score of 26. Previously it was 4. So we decided to do another biopsy and cancer was found. 6 of 12 samples checked positive with Gleason Scores of 4,6,6,7,7,& 8.

I’ve just started looking into my options. I checked on Cyberknife and am not a candidate. Will be see some radiation oncologist soon.

Looks to be an enormous amount of info here!

[Tall_Allen]

Dr King (UCLA) has a clinical trial for high risk (GS≥8) patients using SBRT. He tells me he has not had a local failure yet. But the tried-and-true best therapy is external beam radiation with a brachytherapy boost to the prostate with about 2 years of hormone therapy:

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

If you can somehow get either a PSMA scan (preferred) or an Axumin PET scan, it's a good idea to check for micro-metastases in the pelvic lymph nodes that can be irreadiated at the same time.

Also a good idea to get a second opinion from Epstein's lab at Johns Hopkins ($275) on your biopsy slides.

[Sttickman in reply to Tall_Allen]

Tall_Allen, is it normal procedure for labs to keep the biopsy slides?

[Sttickman in reply to Sttickman]

Never mind, found out, yes. Setting up second opinion, thanks

[westof in reply to Sttickman]

Hmm... When I decided to get a second opinion at Sloan Kettering, My RO explained that I could hasten things If I could get slides, MRI dvd and bone scan results from the local hospital I went to; after my dx 15 months ago (G9,S3,high PSA 28 and no mets. Also I turn 71 in 10 days).

The next day I called the various departments and asked (politely) if they could have everything ready for my pickup @ 1pm. They agreed and they did (except for the slide keeper). She explained that she would overnight them in special packaging, (due to their fragile nature) and she did!

I brought everything to MSK (except the slides) that afternoon!

You have to be proactive.

Best

[Dogdays1]

Hi Sttickman,

I was diagnosed in 2016, age 63 as a GS9. I’ve had the same treatment plan that Tall Allen mentioned. Actually, after his advice on another forum. High risk patients need to throw everything we can at this. After my brachy (LDR) and SBRT and 18 months of ADT (last lupron shot in July 2018) my numbers are keeping me happy. T level is a little slow but moving up and the PSA has been <.05 since my brachy and SBRT were completed in August of 2017.

Follow his advice on the second opinion. Possibly a downgrade may be in your future. It’s worth the money.

Best of luck,

Dogdays

[Sttickman in reply to Dogdays1]

Thanks for the input gentlemen. I’ll be looking into these suggestions.

[Jeff85705]

You should consider Da Vinci robot-assisted radical prostatectomy as well as radiation. They both have equivalent risks and side effects, including some incontinence and ED. I had RARP and have not regretted it, though it did result in worsening ED (improved with Viagra) and temporary incontinence (about 2 months). I would recommend you're seeing an RO, a urologist and a clinical oncologist, if you are in the US. Do your research and make your decision based on what's best for you. But with your numbers, I would say that some form of invasive therapy is indicated. Best of luck.

[j-o-h-n]

Greatings "double T"

Give us more info please: Location, Treatment center(s), doctor's name(s)? All info is voluntary but helps us help you and helps us too. Thank you. If you do respond add that data to you home page for your use and for our member's use. Also post that info on another day and not directed to me.

Good You retired at 62... Now don't panic and keep posting here for good information, advice and camaraderie.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/17/2019 5:22 PM EST

[Sttickman]

Will do, I left all my info at the in-laws place. Will get up soon. Thanks!

[Gemlin_]

Downgrading Gleason 8 biopsy at prostatectomy is not uncommon (and you would then be intermediate risk and not high risk). In that case 2 years of hormone therapy would be over-treatment. But you will only know if you have prostatectomy.