Just dx with PC with 6 0f 12 bx Gleason 10 2@7 2@8 2 benign PSA 11.6
Scheduling MRI 3T monday with blood draw
Meet with Urologist end of January Trying to meet with Oncologist sooner
Advice? Direction?
Live NY,NJ,CT area
retired 76 yrs old. willing/able to relocate for best treatment
What is the point of the MRI now? You need a bone scan/CT. You can decide on what kind of doctor to see after the bone scan. If it is clean, your next stop should be a radiation oncologist specializing in brachy boost therapy (e.g., Michael Zelefsky at MSK, or Richard Stock at Mt Sinai). If you have metastases, your next stop should be a medical oncologist. Many good ones in the area - Are you in CT, NJ or NY?
I know nothing and am only going on advice given to me so far. Thank you for a direction to take
Some surgeons like an MRI pre-surgery to help them plan, others think it's a waste of time and money. That will depend on the surgeon you choose, if you choose surgery. But your first step is to determine if you are a good candidate for prostate surgery or radiation at all. That's why a bone scan/CT is required for cases like yours. It is a necessary prelude to deciding which direction to go in.
Guess I'm the only one confused with "Just dx with PC with 6 0f 12 bx Gleason 10 2@7 2@8 2 benign PSA 11.6" stating Gleason 10???
7 and 8 does not equate to 10 and the suggested 3TmpMRI would be used to locate an actual outline of the legions in the prostate. Absolutely agree with Bone and CT scans to check if outside.
BTW, a 12 core sound like a TRUS and I personally question the completeness of a TRUS since sampling of the entire prostate is extremely small.
OOPS, just reread and now understand that 6@10, sorry about that. Dummy me. The 3T will still show extent of each within better than just the TRUS
Good luck
Seems to me there are no dummies here bud. Only good people trying to help each other!
Expat do you have any other physical problems that we'd need to know about? That'll influence your treatment decisions. Diabetes, high blood pressure, anything else?
Nothing. Take no meds not even vitamins
Right bundle branch block but no effects
Just made first appointment with oncologist this Thursday
Will hopefully know more then
I am being aggressive on my own
Bloodwork from June showed elevated PSA but physician said nothing
Went for frequent and urgent urination in November and PA referenced elevated PSA referred to urologist, by, results n here
Urologist cannot see me until January 29 so took things into own hands with help n direction from family n friends
Here I am. Moving forward one step at a time and learning along the way
Thank you to all for advice n support. It means a lot
He’ll need a staging MRI for both Brachy and IMRT, so the MRI he’s doing Monday may be usable by the Brachy RO if he chooses that direction.
No- The planning CT for brachy boost is done with fiducials in. they use a CT, not an MRI. Bad idea to decide for the doctor what he needs - let him make that call after finding out if that direction is even appropriate for him with a bone scan/CT.
Bone scan/CT is required for staging a high risk patient - not an MRI.
No, after my biopsy/CDUS imaging and diagnosis of stage-t3b , the procedure was:
(1) PSMA scan to check for bone and LN mets -> N1 (UCLA)
(2) MRI to confirm stage of the tumor and planning for Brachy tx -> PIRADS: 5 (UCLA)
(3) Brachy tx and placement of fiducials for IMRT (UCLA)
(4) MRI to stage for IMRT (UCSD)
There were no fiducials prior to Brachy tx and an MRI was done for both Brachy and IMRT planning.
If Expat later has Brachy tx, the RO may or may not use the MRI done on Monday by the Uro. The Uro is probably doing the MRI to look for EPE or SV involvement as a planning stage for RP.
I assume your ROs ordered whatever imaging they required - why would you think it is better to avoid their expertise? UCLA now uses CT only for planning. CT has advanced to where they no longer fuse the images with an MRI. Even in the olden days when I was treated, the CT after fiducial placement was needed for planning. It is still preferred. UCLA is one of the few places that provides (for $2800) a PSMA scan for high risk patients - if one can get that, it may replace a bone scan/CT - otherwise a bone scan/CT is required.
Also, you left out the CT planning scan you had at UCLA after they placed your fiducials, before the brachytherapy (You were probably not awake for that). They needed that before placing the catheters.
"I assume your ROs ordered whatever imaging they required - why would you think it is better to avoid their expertise? UCLA now uses CT only for planning."
No, for high-risk patients, UCLA does not use CT for Brachy planning before the Brachy procedure. UCLA uses a PSMA scan and an MRI, otherwise, for example, for a stage 3b patient, a CT cannot pick up SV involvement, so how would a Brachy RO know how to plan the treatment field without knowing that?
"Also, you left out the CT planning scan you had at UCLA after they placed your fiducials, before the brachytherapy."
No, the CT is done after the placement of the catheters in the treatment stage during Brachy to verify their placement before radiation pellets were inserted. I was awake during this process. I was only asleep during the placement of the catheters and fiduciaries. I was awake during the CT.
You don't understand the term "planning" for radiation. They have to get a CT scan with fiducials in in order to plan where to deliver the radiation. They generate isodose charts and dose/volume histograms to maximize the dose to the planned target volume while minimizing nthe dose to organs at risk.
"Planning" is different from "staging."
It appears from your biopsy and PSA results that you have caught the problem early enough that definitive treatment may be possible. The key thing now, I think, is to get the best doctor. Here is a list of National Cancer Institute Designated Cancer Centers that, on average, have better treatment outcomes than most hospitals. New York City and nearby areas have an excellent collection of such centers.
cancer.gov/research/nci-rol...
You'll get better advice in those places than I could give you but, for whatever my thoughts are worth, if I were in your shoes I'd be attracted either to radiation treatment, or surgery plus radiation. The reason I like radiation treatment for cases like yours is twofold. First, radiation can treat both the prostate itself and the area surrounding the prostate. Gleason 10 cancers are aggressive and may already have penetrated outside the prostate capsule. Secondly, if you know you'll be getting radiation as a primary treatment (no surgery) you can get a shot of firmagon or other androgen deprivation treatment ("ADT") as soon as possible, maybe well before the end of January. In most cases, that will stop any spread of the cancer, weaken it for further attack by radiation 6 or 8 weeks later, and give you a breathing space to fully consider options and find the best radiation oncologist available to you. Generally, ADT has not been recommended before surgery, so if surgery is your choice, you have to find a good surgeon and wait for his availability. You can then get radiation after surgery (radiation makes it harder to follow with surgery) but you may have to wait for healing from the surgical wounds.
The choice of doctor is very important. You need one who is knowledgeable, experienced, keeps up with his or her field field, and is committed to his or her patients.
I know this is a very difficult time for you. The pressure and anxiety can be immense. Try to stay calm, learn as much as you can, and move forward.
Best of luck.
Alan
As one that has only recieved RT and got that first shot of firmagon prior I agree ..so far so good ..for me ..I’m proof that it can work. At first not being a candidate for an RP I thought I was toast .. I’m still here .Take care AlanMeyer
You could not do better than Memorial Sloan-Kettering.
This paper by Tilki and others supports that you can get just as good results with a modified radiation technique (called MaxRT) as you can with a modified technique of radical prostatectomy, (called MaxRP). MaxRT= hormone therapy+external beam radiation+ brachytherapy. MaxRP= radical prostatectomy+ external beam radiation.
This is consistent with TallAllen's recommendation that you see a radiation oncologist offering Brachytherapy boost.
D. Tilki et al, "Surgery vs Radiotherapy in the Management of Biopsy Gleason Score 9-10 Prostate Cancer and the Risk of Mortality," JAMA Oncol. 2019;5(2):213-220.
Hey ExPat, you might not be a candidate for surgery, given the blockages. But to me that's not a big deal. There is evidence that the MaxRT (hormones+ external beam radiation + brachytherapy) work just as well.
The bone scan is indeed the next step for you. It tells you the extent of the cancer in your body. Your condition can be: a) organ confined (i.e. in prostate only), b) locally metastatized (in prostate+ just outside of it) or c) distant metastasized (it's broken way out of the prostate into the rest of your body).
The bone scan looks for c), namely the distant metastasis.
I echo dadzone43's post.... Get an oncologist at Memorial Sloan Kettering Hospital, 68th Street and First Avenue, in Manhattan.... I meet many patients there from the tri-state area and from around the U.S. and the world.
Good Luck, Good Health and Good Humor.
j-o-h-n Monday 12/23/2019 2:52 PM EST
Update:
Not eligible for surgery due to age and Gleason
Only option given is hormone and radiation. Had first Lupron, 3 month dose to give me flexibility in travel
Second opinion at NYU January 27
Then to Eramus Medical Center, Rotterdam, Netherlands
Have Europe. Residency as well as European healthcare
Will see what they have to offer across the pond.
Anyone been there, done that, suggestions??
Hours of Fun
At last I've come to a decision.
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