Diagnosed in August this year with 4+3 and 3+4 PC. However Last PSA was 4.7. Trying to decide on treatment options. I am in the Boston area and have access to Cyberknife, Ethos Varian, or Retzius Prosectomy. 72 years old. I would prefer SBRT but without ADT as I had polio at 1 years old. My muscle mass is very weak in my left leg, do worried 4-6 mo of ADT would cause too much damage. Heard outcomes are good for SBRT without ADT.
Any advice? Wife is pushing surgery, but I am not sure.
Thanks
Suggest you put case details in your HU bio. Have you had PSMA-PET/CT scan? What is the staging? eg T1 M1 etc. I guess you are a candidate for RP, but that has its risks and possibility of CTC/escape leading to ADT anyway.
thanks. Had a Pet/CT scan. Localized to prostate. I will look into filling out the bio.
Thanks. Will do the bio. I agree about the ADT. Oncologist though it would be marginally beneficial in my case. But recommended 4 months Orgovyx just to be safe
Yeah I too suggest filling out your profile to get more and precise feedback. I will say not having ADT treatment with any going forward option except RP just lowers your percentage of success.
Just filled out Bio with test results. Thanks
It does seem all treatments have side-effects, ranging from lesser to more serious. Pick your poison as a friend puts it. Surgery is not often supported on this platform. I do not recommend treatments but after careful consultations based on two MRIs I chose surgery - the very procedure I strived hard to avoid. That was nearly nine years ago - I was otherwise healthy and fit 58 YO. Although my cancer had spread outside of the gland I remain grateful I had the primary tumor burden removed. My continence and sexual functions recovered very well. I did have salvage RT and that left me with ureter strictures and ED challenges.
Here are some questions to ask yourself to help you decide:
prostatecancer.news/2017/12...
What your wife probably doesn't understand is that for men with unfavorable risk PCa radiation results are better then the "just cut it out" mentality that is often the first reaction, because radiation treats a margin outside of the prostate. You can see the difference here:
prostatecancer.news/2018/10...
In Boston, I think you should talk to Irving Kaplan at Beth Israel:
findadoc.bidmc.org/Details/731
Thanks. I met with Irving Kaplan. He is the one that said he did not recommend ADT treatment in my case. Unfortunately he just retired and I was assigned a new doctor Dr. Joseph Aronovitz, MD He assured me they were very good ay Cyberknife treatment. He suggested that I try Orgovyx for a month and see if I have side effects. My oncologist at Beth Israel Dr Bubley also retired at the same time. Added to stress levels. They are booking Cyberknife out to January now, only device in Boston?
You think the small amount of 4+3 is okay to consider no ADT? Just your opinion
Gregg
TA. I read through the report on outcomes. I have a hard time deciphering the language. Can you summarize for me in plain english? I am an architect in life, new to the world of oncology terminology
The bottom line is results of SBRT for intermediate risk were excellent. If you want me to explain specific comments, what were the comments?
Does this study done in 2018 showing that surgery on unfavorable intermediate 4+3 has a 53% chance of no reoccurrence? And SBRT is 97%. Thanks
Offering a thought. When I pondered my primary treatment decision ten years ago, I too looked at lots of data. Here is how I see the results you summarized. Seems logical that treatment gets all the cancer if all the cancer is within the treatment field. The stats you share suggest for 97% of the SBRT patients their cancer was fully confined in the treatment field. Whereas, for the surgical patients only 53% had cancer confined to the treatment field. Interesting! As a side note, with surgery and looking for a PSA nadir of <0.010 as best indicator, success can be determined quickly, as soon as 30-60 days, given the 2-3 day half-life of PSA. With RT this is not the case and add ADT, determining recurrence is more challenging and takes much longer. Hope this is helpful in some way. All the best!
That is from the MSK nomogram (which is constantly updated). In fact, I just updated the article. It shows that 54% of a typical unfavorable intermediate risk patient were progression-free after 5 years and 38% after 10 years (average about 46% after 7.5 years). I defined "typical" to mean: PSA=6.0, T1c, GS 4+3, 67% cancerous cores. You can use the link below to find out what it would be for you.
mskcc.org/nomograms/prostat...
The 7-year PSA-recurrence free survival after 7 years was 85% for unfavorable intermediate risk patients (almost double the progression-free survival after surgery).
Is it possible to send my Pathology Report to you? I would like your opinion on Using Cyberknife (Beth Israel) vs Ethos (Dana Farber). I tried to use your predictive link, but I don't see where the Classification is indicated (T1a as an example) I appreciate the candid opinion as the surgeons just say they are the gold standard with RP.
Gregg
PM me for my email address. LOL@surgeons say they are the gold standard with RP
Stage is probably T1a or T2a unless you were told differently when your doctor did the DRE.
CyberKnife is more convenient (5 treatments) vs Ethos. They will both get the job done.
Sorry, How do I PM to you?
I think 4-6 months of ADT provides extra insurance.
You might ask your urologist about a DECIPHER genomic test to better determine the nature of your disease, in terms of how aggressive it is.
I have asked for this test. No response from Dana Farber on ordering both decifer or Alera?
At your age, I'd only look at RT. Yes, there are side effects as well but not at the onset and not nearly what's possible with RP. The surgeon makes the difference in RP more so than RT which is typically guided via CNC/Mapping via scans of the prostate. RT gets a much wider treatment field purposely whereas RP obviously just involves the removal of the organ and some of the tissue surrounding it. My surgeon did frozen slides during my procedure which promised me negative margins/lymph node involvement/etc. I'm one of the lucky ones 34 months later with complete sexual function(@ 8 months post RP, except for the loss of semen..I still do have some ejaculate however), 100% urinary control and my MSK nomogram BCR free rates are; 86% at 5 years, 76% at 7, 65% at 10 and a 15 year PCSM survival rate is 97%. with intermediate/unfavorable pathology. To date, I'm still <.01, voiding like a 20 year old and sleeping all night long. Something I didn't do for 4 years....ugh. Seriously, I used to dread 9pm when we'd get ready to go to bed. I knew what I was in for. Now, I'm prepping the sheets at 8pm! I'm very happy with my progress and realistically if I make 10 years without BCR I'll consider my choice a very good one. Good luck to you sir!!
I live in Boston and at the age of 70 was diagnosed 3+4, 50% 6 of 12 cores positive, intermediate unfavorable.
Decided on Cyberknife at Beth Israel but did not want ADT
So had five treatments very easy and little side effects, had a PSA of 9.3 prior to treatment and after treatment 30 days later went to 1.4. Had next PSA after six months and down to 0.4.
I am now 74 and last three years my six month PSA have been less than 0.1 and have had few side effects. I have been very happy with my decision for Cyberknife treatment w/o ADT.
Not sure you will have same results but I could not be happier with the choice I made
I had Dr. Joseph Aronovitz, MD , he was excellent as was his whole team and my experience!
Thanks very much for the response. still on the table for me. I like the cyberknife approach. The RT at MGH preferred the 28 session lower radiation approach. From what I read SBRT is better for PC. Due to tie 4+3 in one of my cores most RO suggest 4 mo. of Orgovyx.
A Second opinion on the biopsy slides is recommended.
Perhaps genetic testing to determine the current varieties of PCa cells would be helpful? Ask your oncologist.
From what I've seen, RT is currently preferred in most cases, however I've not kept current since treatment.
I avoided HT with a similar PSA; HT is easy to give, however every treatment including HT does damage. PCa cells just aren't different enough from normal cells to make it easy to kill them without harming the rest of your body. The ideal would be just enough treatment, however we don't have a 100% sensitive and accurate way to know how much that is.
Recommend Dr. Mulhall's latest video; he's a sexual medicine clinician who sees and treats the aftermath of treatments.
I have ordered the Artera and PosTox tests. The Artera takes 3-4 weeks. May be outside my decision window.
Thanks
Update on the two tests. The PosTox test shows that I would have a low toxicity to SBRT and very High toxicity using CFRT (low dose over 20 sessions).
The Artera test came back with the result that Hormone Therapy would have no benefit.
Not sure how you get a second reading of the pathology.
Ultrahypofractional RT and ADT for Int. Risk PC 
SBRT vs EBRT
Decision Time
ADT duration for high risk with Cribriform
