Just a quick update on my continuing journey.
OLD STUFF RECAP
58 yo. Psa 8.4M
Fusion plus random 30 cores. Gleason 3+3 and 3+4
Local uro gave standard answer of surgery good, radiation really bad, downplayed risk of side effects.
Had bone scan. Results from that look good.
Had Polaris genetic screen. That says I am not great candidate for active surveillance.
NCCN Risk = Favorable Intermediate
Prolaris Molecular Score = 4.2
Risk when pursuing active surveillance= 6.4% DSM (disease specific mortality)
10 year Risk when pursuing active treatment (single modal) = 4.5% METs
Met with urologist / oncologist at Fox Chase (center of excellence). Unlike local uro, he was pretty honest. He feels I am a good candidate for either surgery or radiation with high likelihood of good outcomes either way. He was very honest about risks and his numbers seem consistent with real data versus wishful thinking. TAs checklist of questions was a great help. IF I were to do surgery, I think I would use him but, that is still a big IF. . My spouse did ask the, "what would you do question". Not surprisingly he said surgery but I respect his reason why. He did not say radiation is bad, that you have no options if radiation fails, etc. He said that for him it would be because of the greater certainty which comes from biopsy of the whole gland and being able to use PSA as a measure afterward. Fair enough.
Next week I meet with radiation oncologist at Fox Chase. Hopefully, I can come to a treatment decision after that.
Unless I learn I would not be a good candidate, for me SBRT or Brachy still seems like the lesser of evils. As I told my spouse, for me it is about balancing quality of life with length of life.
My one concern with radiation is that I currently do have BPH. I take daily afuzosin which works well for the retention, no nocturia issues.. I understand that you can have retention issues after radiation and there may not be many options to treat it should that happen?? I'll certainly ask radiologist about that.
In a side note, when this all started I was certain I would go for Tulsa even though I would likely go into debt to do so. Unfortunately, science reared its ugly head and the efficacy data simply is not there. Spending $50k only to then need surgery or other in 2-3 years did not make sense to me.