Me with a urological oncologist yesterday. He asked questions and when I told him that. My mother had breast cancer at 36 he said that he wanted germline testing and Decipher done on biopsy cores before moving further. In his opinion is BRCA is present, removal is the only option.
Otherwise radiation is a viable option.
(Gleason 4+3, PSA 8 clean PSMA)
Thoughts opinions appreciated.
Based on what data does he make that recommendation?
Allen, I really don't know. I have been trying to research BRCA and PCs. I knew that having the mutation increased a person’s chances of developing PCs. But he talked as if it were the worst possible scenario and removal was the only option. I had my questions prepared but that information threw me.
Even if you are BRCA+, I've seen nothing to indicate that prostatectomy does a better job at eliminating the cancer than radiation. We've learned that radiation can do a better job of eliminating riskier cancers because it treats an area outside of the prostate that surgery can't reach.
In fact, I would guess that BRCA mutations make the cancer more susceptible to killing by radiation (without increasing radiation toxicity) because the cancer then lacks any ability to self-repair after radiation causes DNA degradation. In lab studies, PARP inhibitors have been radiosensitizing, so it is a reasonable guess:
tandfonline.com/doi/full/10...
But I'm guessing, so if your doctor has actual clinical data to the contrary, that is more useful for making a decision.
You need to get second opinions from a radiation oncologist who specializes in prostate cancer and a sbrt medical oncologist and imrt medical oncologist who specialize in prostate cancer .
While TA is being properly circumspect, I think you will find the second opinions will concur with him.
Probably the best path will be drugs plus sbrt radiation.
Here is a good website to compare your odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see your odds of 10-20 yr survival, etc. based on the treatment you pick.
prostatecancerfree.org/comp...
It is best viewed on computer or just print it on paper. Not so viewable on phone.
To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.
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