After a high PSA test result (26.2), an abnormal DRE and an MRI that was PIRADS-5 (high risk of cancer but nothing seen outside of the prostate), I finally had a biopsy last week. The pathology results showed cancer in 10 of 12 cores, 4 were grade group 2, 5 were grade group 3, 1 was grade group 4. I guess that last one makes it technically "high grade". Bone scan coming up next. To complicate my treatment decisions (or possibly uncomplicate them), i had radiation therapy to the pelvic area for an unrelated sarcoma cancer in 2012. Fortunately, that cancer has no recurred, but the radiation i received in the neighborhood of the prostate may make me ineligible for radiation treatment and may impact the possibility of surgery for me.
My urologist immediately referred me to the oncologists at the closest rated cancer center (Knight Cancer Center in Portland, OR). So, we will see what initial opinions are from them. I am hoping for a good result from the bone scan first and foremost. It does seem curious to me that my pathology and PSA would suggest a somewhat advanced cancer, but the MRI shows no metastasis outside of the capsule. Hoping I get lucky and there is little or no spread outside of the capsule.
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mike__c
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I'm in much the same boat as you, except for the prior radiation for an unrelated cancer. I am Gleason 9 with no evidence of spread beyond the prostate on the basis of an MRI, numerous CT scans, and a bone scan. (My PSA was about the same as yours.) Due to the high-grade cancer, though, doctors at Hopkins recommended 40 radiation treatments and two years of ADT, a recommendation I accepted after getting a second opinion that concurred with theirs. The thinking is that it's possible, maybe even likely, that the cancer seeped microscopically and undetectably beyond the prostate -- thus, the aggressive treatment. My PSA is now undetectable and, in November, I'll be done with ADT. The side effects are no fun, but you can get through it. The future is uncertain, but we all have to get on with life and find things we enjoy. Please reach out with any questions or just to chat.
Two separate cancers and in the same area! That is more than anyone should have to put up with in one lifetime.
The bone scan will let you know if there are any distant metastases. The MRI doesn't tell you that - it is only a scan of your pelvis - not a full body.
If the bone scan is clear, then curative therapy may be possible. You are right that surgery on previously irradiated prostate tissue is tricky.
Radiation is not impossible. There is a kind of radiation, called SBRT, that uses fewer more intensive doses and has been successfully used for salvage after a failed first radiation therapy. The nice thing about it is the total dose of radiation is much lower and that is what matters to healthy tissues (for cancerous tissues the biologically effective dose is much higher so it kills them better). It can also treat an area outside of the prostate.
Here is an article about the promising results of SBRT for salvage after radiation:
The expert in using SBRT for salvage (which seems to apply in your case) is Don Fuller in San Diego. I suggest that after you get the bone scan results, you call him and get a phone consult to start with. The fact that you've had a sarcoma (which can be radiation-induced) may complicate things but this is beyond my knowledge.
I also recommend that you get a second opinion on your biopsy slides from Epstein at Johns Hopkins. Just tell your urologist to send the slides to Epstein. The cost is $250 and it is very commonly done. He is the world expert at reading biopsy slides.
Unfortunately you have the typical newbie reaction to your issues like many of us had. Quick, Quick and Quicker. You do have time to make decisions so don't drive yourself crazy by the word Quick. God Bless and make thoughtful serious decisions.
I was simply asking about the Epstein second opinion to know how to schedule other meetings down the road. If a second pathology opinion takes a month, then i probably won't want to begin treatment discussions with my oncologists in two weeks only to find out after that if there was a mistake with the pathology. Rushing may not be important but not wasting everyone's time probably is.
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