I’m a newly diagnosed 64 year old, very good health, prostate volume of 32 cc, strong family history (grandfather, father, brother) with prostate cancer. Father with Gleason 9 and likely grandfather too but I don’t have those records. Brother was a Gleason 7 (3+4) treated with SBRT (Cyberknife). In 2019 had a PSA of 3.0 so had an MP-MRI which came back Pirads 2. In the following 18 months my PSA rose to 4.0 so my urologist ordered another MP-MRI which showed two lesions, one Pirads 3 in the base/mid right transition zone and a Pirads 4 lesion (0.9x0.8 cm) in the base/mid right peripheral zone with 5mm capsular contact. I had an ultrasound guided perineal biopsy which came back positive for prostate cancer. The positive cores read as follows:
A.Right Posterior Medial – Adenocarcinoma 3+3=6, Grade group 1, involving one of two cores measuring a total of 1.5mm and comprising 8% of all tissues.
B.Right Posterior Lateral – Adenocarcinoma 3+4=7, Grade group 2, involving two of three cores, measuring a total of 7mm and comprising 25% of all tissue.
C.Right Base – Adenocarcinoma 3+4=7, Grade group 2, involving four of seven cores, measuring a total 18mm and comprising 42% of all tissue.
All of the other cores were benign. So, it sounds like the cancer is concentrated on the right side of my prostate. I told my urologist that I would like to get a second opinion on the pathology report from Dr. Epstein but he said he would prefer to send the cores out to have genetic testing (Decipher) which would show the future aggressiveness of the cancer. He said with my small prostate and intermediate favorable Gleason 7 I was open to just about any treatment unless the genetic testing came back showing the cancer would get aggressive. If that is the case he would strongly suggest a radical prostatectomy. I find out the results of this testing in May.
Questions… Should I still send the cores to Dr. Epstein even though I’m having the genetic testing done?
I am leaning towards focal ablation such as HIFU, TULSA PRO, or FLA. I’m thinking starting out with minimal treatment would still allow a RP or RT in the future if the ablation fails. With my pathology is this a viable plan?
With the 5mm of capsular contact be an issue with focal ablation?
Travel is not problem. I live in Ohio so it would be best to have something close but where would be the best place to go for either of the treatments?
My second choice is Cyberknife, SBRT. My brother had this treatment with Dr. Merrick (who has since retired) and got along very well. Any recommendations?
Thanks in advance for any advice or comments!