Update on my fathers Dx

[MBguy]

Hello making a follow up post about my dad. He's 65 years old, he did not experience any symptoms that are associated with prostate cancer such as painful urination, polyuria etc. He is a very active guy and works construction. PSA was 16.5 prior to biopsy. I got a second opinion from John Hopkins. The urologist suggests surgery to cut it out. We have an appointment Dec 10th 2020 with a radiation oncologist at Sunnybrook hospital (Dr. Andrew Loblaw). CT scans of abdomen did not show any obvious spread. Bone scan did not show any obvious bone mets. The urologist is saying it is most likely contained in the prostate. I've been doing as much research as possible to decide on the best procedure.

The following are the biopsy results

from St. Josephs.

John Hopkins biopsy results will be bolded

A) left paramedian apex (G 3+3=6) percentage of core involved with tumor 10%

3+3 = 6 (Grade group 1) involving 10% of one core

B) left lateral apex (G3+3=6) percentage of core involved with tumor 3%

3+3=6 (Grade group 1) involving 5% or less of one core

C) left paramedian middle (G3+3=6) percentage of core involved with tumor 30%

3+4=7 (Grade group 2) discontinuously involving 70% of one core, less or equal to 5% of Gleason pattern 4

D) left lateral middle (G3+3=6) percentage of core involved with tumor 35%

3+4=7 (Grade group 2) discontinuously involving 90% of one core, less or equal to 5% of Gleason pattern 4

E) left paramedian base (G3+3=6) percentage of core involved with tumor 30%

3+3=6 (Grade group 1) involving 30% or less of one core

F) left lateral base (G3+4=7) percentage of core involved with tumor 20%

3+4=7 (Grade group 2) discontinuously involving 60% of one core, less or equal to 5% of Gleason pattern 4

G) right paramedian apex (G3+3=6) percentage of core involved with tumor 30%

3+3=6 (Grade group 1) discontinuously involving 30% or less of one core

H) right lateral apex (G3+3=6) percentage of core involved with tumor 15%

3+3=6 (Grade group 1) discontinuously involving 40% or less of one core

I) right paramedian middle: High prostatic intraepithelial neoplasia (PIN)

Benign prostatic tissue

J) right lateral middle (G3+3=6) percentage of core involved with tumor 1%

3+3=6 (Grade group 1) involving 5% or less of one core

K) right paramedian base: High prostatic intraepithelial neoplasia (PIN)

Benign prostatic tissue

L) right lateral base (G3+4=7) percentage of core involved with tumor 35%

3+3=6 (Grade group 1) involving 30% or less of one core

Comments: The percentage of pattern 4 overall is very low (approximately 1%)

according to St. Josephs.

Perineural invasion present

according to St. Josephs hospital

We live in Toronto, ON. Any feedback, advice or experience would be greatly appreciated at this time! Stay well everybody

[Tall_Allen]

I was going to say that with the very tiny amount of pattern 4, AS is still possible, but the PNI probably precludes that:prostatecancer.news/2018/03...

You can consult with Dr. Klotz at the University of Toronto to see what he says.

Urologists almost always recommend surgery - no surprise there.

I think Loblaw at Sunnybrook is a very good RO. He will probably recommend SBRT or HDR-BT monotherapy.

Here are some questions you may want to ask:

prostatecancer.news/2017/12...

Here are some questions your father may want to ask himself:

prostatecancer.news/2017/12...

[MBguy in reply to Tall_Allen]

Hello Tall_Allen,

I'd like to thank you for posting all your suggestions on my previous post. My fathers English is not the best and I cannot trust any of his friends or relatives to properly advocate for him.

You suggested that I get into contact with Dr.Loblaw and that I get a second opinion at John Hopkins. I really appreciate the solid advice that you offer myself and others.

That being said, I feel as if my father is leaning towards getting some sort radiation therapy done. He sounds comfortable with brachytherapy, brachy-boost-therapy, SABR etc.

[Tall_Allen in reply to MBguy]

Brachy boost therapy is overkill for your father, carrying the risk of unnecessarily high levels of urinary side effects. The others should all cure him with about equal probability and equal risk of side effects. Let us know how your meeting with Loblaw goes - I'm glad you were able to see him.

[MBguy in reply to Tall_Allen]

I will keep you posted :)Thanks again Tall_Allen

[MBguy in reply to Tall_Allen]

I made an update!

[aceace12]

good luck , thanks for posting . all looks curable David

[MBguy]

Dr Loblaw was absolutely fantastic, could not recommend him enough. Very open, listening, and courteous. He is not rushing me or my dad at all.He suggests brachy boost therapy or SABR with 4 months of ADT. Its stated that SABR has very similar clinical benefits of brachy boost therapy with less adverse effects.

[Tall_Allen in reply to MBguy]

Why is he recommending adjuvant ADT? Because of the PNI?

[MBguy in reply to Tall_Allen]

He said PNI is a bigger issue when doing surgery. He mentioned that we could opt out of ADT and get HDR brachy or SBRT/SABR on its own but the treatment rate is higher with 4 months of ADT. I believe its because my father is an unfavourable intermediate risk

[MBguy in reply to Tall_Allen]

Tall_Allen correct me if i'm wrong but you underwent SBRT as your primary treatment ?

[Tall_Allen in reply to MBguy]

Yes, 10 years ago. No adjuvant ADT. No ED. No lasting side effects other than loss of ejaculate at orgasm.

[MBguy in reply to Tall_Allen]

I tried looking at your posts from the beginning and could not find your diagnosis when you were diagnosed. Were you low or intermediate risk?

[Tall_Allen in reply to MBguy]

It's in my profile - low risk, high volume. Unfortunately, at the time, there wasn't a lot of long-term data on active surveillance, and there were no mpMRIs. But with my high volume PC, I probably couldn't have stayed on AS for very long.

[MBguy in reply to Tall_Allen]

Thanks for the reply, I think I'm still having issues navigating this website efficiently. Fantastic, I'm glad to hear that you've been doing well 10 years post diagnosis. Thanks again for all your input, opinions, and knowledge. You've made this ride less bumpy for me and my father 😀

[MBguy in reply to Tall_Allen]

Still on the fence between SABR and brachy boost therapy however. My father has opted for SABR (SBRT) with 4 months adjuvant. The wait time is around 3-4 weeks

[MBguy]

My father underwent SBRT with 4 months of Lupron. Treatment ended Feb 18th 2021.

PSA was 0.055 in May 2021 with cast levels of test. PSA was 0.19 with a test level of 17.5 in Nov 2021. So far my father is very pleased with his decision to undergo SABR(Sbrt) treatment at Sunnybrook

[MBguy]

PSA result as of 2022-05-19 is 0.091 with a testosterone level of 22.8. So far my father is very pleased with the decision to undergo SBRT with 4 months of Lupron. For future readers, I would highly recommend Sunnybrook if you are in the Greater Toronto Area

[MBguy]

Latest PSA as of May 2023 is 0.085. Normal levels of test. No side effects noted