Strong Family History Question

[Yukonjack]

I am new to the forum - First question as a new person please . My father died of PC at age 67 after a 4 year battle ( external beam at first) . this was 25 years ago. My Grandfather died of PC at age 77 . A urologist recommended a Radical , give my PSA3.8, Prostate 27 CC , Gleason 4+3 , velocity +1.3 0ver the year. I have been going to the same Urologist for 3 years now as my PSA was rising . The Radiation guys say that ( given this weeks MRI is fine- tomorrow I get it ) , both options are a consideration. Given this steep family history that I have , and the 4+3 cells , would a radical- Prostatectomy be a good option. I am 57 years old . Maybe I should post my Biopsy ....wasn't great ! . No nerve extensions and no external bits out of the prostate on Biopsy ....but how can they tell in absolute terms ? Thanks for your help !

[Tall_Allen]

You can read the results of surgery and various radiation options for "unfavorable intermediate risk" prostate cancer in this article:

prostatecancer.news/2018/10...

As you can see, surgery has relatively poor results. Brachy boost therapy has excellent control rates, but the urinary toxicity is high. HDR brachytherapy monotherapy and SBRT monotherapy also have very good control rates and have more favorable toxicity profiles.

[Yukonjack in reply to Tall_Allen]

Thanks for your help . DO you see any huge concerns with my Biopsy that I posted Sir ? -

[Tall_Allen in reply to Yukonjack]

You already said it was GS 4+3. What is it, beyond that, that you find concerning?

[Yukonjack in reply to Tall_Allen]

do you feel my 27cc prostate size or PSA at 3.8 a concern ? Anything that is a huge concern . GS4+3 is not the best , but treatable ?

[Tall_Allen in reply to Yukonjack]

Your prostate size, PSA, and family history do not add to your oncological risk.

[Yukonjack in reply to Tall_Allen]

My father passed away from it at 67 . im 57 . I took him back and forth from the hospital and several months in palliative care . I think I have PTSD from it Sir . Sorry for being overly cautious. Given my numbers I have a good chance at life with both methods ( RP and BT , et al ) ? ....

[Tall_Allen in reply to Yukonjack]

I didn't say chance of life, I said chance of cure. I said brachy BOOST therapy is your best bet, but may carry significant urinary side effects, HDR brachy monotherapy or SBRT may minimize those side effects. I said surgery is NOT a good option.

You seem to be in a daze, which is completely understandable, but it may get in the way of your understanding your options and making a good choice. When I was first diagnosed, I started on psychotherapy, which I highly recommend. You may need medication for anxiety, depression or sleep - do whatever you need to do.

[Yukonjack in reply to Tall_Allen]

Thanks for your helpfulness and kindness . Yes, having PTSD is not fun... having my father die in my arms after wasting away in palliative care for 4+months with PC , only to discover you have the same disease 20 yeas later is ...well, alarming to say the minimum.Thanks for understanding .

[Hidden]

I had 4+3 and a year ago opted for Tulsa-pro with a 38 cc prostate. which knocked it down from 9 to 2.1 PSA but it never got low enough for success. And it has since doubled. So apparently the ultrasound didn’t quite finish the job. So now I’m doing seeds and then radiation with 6 months ADT. Which is probably what I should have done to begin with but hopefully haven’t hurt myself. You’ll be fine

[Yukonjack in reply to Hidden]

Anomalous - Thanks for the encouragement. I hope your treatment is a blazing success ! The BT does a great job for most I hear. God speed, friend!

[maley2711 in reply to Hidden]

Did you have full gland TULSA, or targeted focal procedure? Though you seem to feel it failed as a cure(based on rising PSA?), were you happy that the TULSA performed well as far as minimal SEs? That seems to be the big sales pitch for TULSA?

[Hidden in reply to maley2711]

I did have whole gland ablation. I think I have a form of cancer that is just very resistant and any trace that was left (which there had to be some left or my PSA would have gone down to the .1 level) got a boost from some sublingual DHEA that I tried for a testosterone boost because immediately after that is when the PSA shot up. I liked Tulsa-Pro- a lot. I know it isn’t popular with some of the more knowledgeable on this site, but I continue to believe it has promise. And I know others that it has worked for. But I needed a sledgehammer it appears. It may be because I have some Intraductal cancer.

[maley2711 in reply to Hidden]

Sounds like you had none or almost no SEs??? Re TULSA, another possibility is that it wasn't as effective as Surgery or radiation...we can never know I guess. Is there any possibility that there are signiificant metastases that were already there and are the source of PSA now? In other words, TULSA was successful intreating gland, but........??

[Hidden in reply to maley2711]

Anything’s possible. My new RO doesn’t think I have any metastasis whereas my urologist thought I was oligometastatic. I guess there is a possibility I could do Tulsa again but I’m not going down that route again. There are many shades of gray in this field. I had zero urinary problems with Tulsa and erections came back within a few months, even though I am technically hypogonadal with a 300ish testosterone. As I said, I was happy with the convenience and side effects of the procedure and Its worked for some i know but who knows what the long term data willl be. Ar this point I am considering it a debulking pretreatment