I need some input

[Katamiran]

I wrote in a few months ago with a more favorable seeming diagnosis, but little factual information, and left feeling like i had plenty of time to decide on a course of action. After meeting last week with Dr. Johnson at Huntsman Salt Lake (who I really liked, btw), I now need to get on the stick it appears. Here's my vitals:

"66M with unfavorable intermediate prostate cancer (G3+4 [12/15 cores], PSA 14.76 (12/20/21) 16 (3/10/22), cT2a, Grade Group: 2) with MRI prostate showing a 3 cm lesion on the left extending from base to apex and including the peripheral, transitional central and anterior gland, likely EPE and early proximal bilateral SV involvement pending final radiology read, prolaris 5.2, Bone scan with nonspecific uptake in the anterior right 3rd and 4th rib suspicious for neoplasm but could potentially be prior fracture as well as focal nonspecific uptake in the posterior spine of T7, suspicious for facet arthropathy, who has been referred for evaluation for radiotherapy. "

I'm set up for a PMSA- pet next Wed to try to resolve the rib and any other issues, but he at present wants me to start this treatment without delay/ASAP:

"we would likely recommend ST-ADT (6 months) with brachytherapy boost (HDR 15 Gy) and IMRT to the elective pelvis, prostate and SVs to 50.4 Gy in 28 fractions."

I've spoken to 2 surgeons, but without the mri, prolaris, proximity to s.v. and left nerve bundle, and current psa of 16 known to them. They said I was a good candidate and didn't elucidate much more. Have one more consult arranged with Dechet at Huntsman Wed. as well.

To the question finally: I'm soliciting opinions on choices and any anecdotals from guys with similar stats. I roll both ways on any given day, but think I'm leaning towards RT I think. I'm pretty fit and active and want to be able to continue to be. And as we all know, this is scary stuff. Thanks in advance for any help and I appreciate all of you and this site very much!

[Tall_Allen]

Say hello to Skyler Johnson for me. I like him too.

Brachy boost therapy has the highest record of success, if you are not metastatic on your PSMA PET scan. It does carry a moderate risk of urinary side effects, though. If no metastases, you can also consider HDR brachy monotherapy (Gamma West in SLC would be a good place to go for that therapy). Unlike seeds, HDR brachy can reach into the seminal vesicles. If your pelvic lymph nodes require radiation, you will need external beam radiation and ADT with it. SBRT monotherapy is also a good option (it can reach the seminal vesicles and the pelvic lymph nodes).

You may want to discuss the following clinical trial with Dr. Johnson - he may want to enroll Huntsman as a site for it.

clinicaltrials.gov/ct2/show...

Please report back when you get the results of your PSMA PET scan.

[aceace12]

good luck, we are on here for your support.....

[Murk]

PSMA PET scans are not accurate enough today to predict whether the Cancer has gone beyond the Prostate. If you knew and were 100% certain, then RP would be a very viable and IMO a very valid option. If it has then you will need additional treatment. Thus the reason why many go with the SBRT / Brachy boost path with good reason.

[cpl901 in reply to Murk]

I was told that on PSMA PET scan my tumor didnt go out of the prostate. True that the image is not so precise ?

Is it true that what is seen on MRI is bigger than it is in reality or is it the opposite ?

[Murk in reply to cpl901]

I've been told that these PET Scans are not very sensitive. They are weak in that they do not show initial or precise detailed cancer info. They only show obvious cancers. Some Health Care systems won't even cover / pay for these tests.

I had RP and the post results showed the the PCa had not escaped and wasn't found in Lymph Nodes or anywhere outside of the Prostate. But my highly rated Johns Hopkins Urologist still told me I had a 50/50 chance of being cured since my Gleason was so high and aggressive (5+5).

I will add that these boards are very negative on RP but if my luck prevails and I am clear my side effects are nothing, absolutley nothing! Everything works as before and I am short of three years from operation...

[Murk in reply to Murk]

I should add that my MRI and Biopsy indicated a Gleason score of 5+5 but when the post RP biopsy was completed (both by Dr Epstein), they down grated my Prostate Gleason findings to 5+4. So not sure on how to answer your second part of the question but this indicates a lesser finding.

[Tony666]

listen to tall Allen. It sounds like there is a reasonable chance that there are micromets that have escaped which means that removing the prostate won’t cure you. You need something systemic like the rt protocol they are suggesting. I only wonder if you might need more than 6 months adt.