My dad is 76. His PSA in Oct 2023-2.x, Aug 2024-10.x, then a repeat on Sept 2024-13.x. He had a MRI in Nov 2024 and found a 26mm left base to apex posteromedial PZ PI-RADS 5 lesion. Prostate capsule is intact, and no seminal vesicle invasion. He had a biopsy in Jan 2025, It showed intraductal carcinoma involving all of his left sided cores and no definitive invasive carcinoma was identified in any of the cores. Cores on the right are all benign. He just had the PSMA PET/CT scan last Thursday and we are still waiting for result but there does not appear to be evidence of metastatic disease from MRI and biopsy so far according to his doctor at UT Southwestern who did the biopsy.
We met with his doctor today and discuss treatment options. He recommended surgery is the best in his case because intraductal carcinoma is usually associated with high risk aggressive PCa. Radiation might not work well with intraductal carcinoma.
Since I read a lot on different forums, I did ask this doctor who's rather young how many RALP have he done? I told him everyone on discussion forum suggest surgeon that has done over 1000s. He admitted he's rather young himself and even he did surgery regularly, but he does not have 1000s of RALP. I felt bad to ask, but I think this is important to know. He seemed ok and not offended by it. I didn't see his reaction though since I was on speaker phone while my parents were in the clinic. Anyway, he did refer us to another doctor at UT Southwestern that we can met that's chair of urology and did a lot of RALPs for sure, He also referred us to radiation oncologist and see what they think about my dad's case as well. I asked it will be a while before we can make appointments and see these 2 new drs. He said it will be ok. They usually wait 3-4 months after biopsy to do surgery to let the prostate heal. So far, my dad is able to see the other more experienced doctor who did lots of RALP on 3/27. As for radiation oncologist, we will have to wait till that department call us to schedule.
I am a very concerned daughter here. Try to read lots of posts and do my own research. Please give comments, advices, or your experience. I hope what we are doing so far is right. If anyone older in the 70s and had surgery done, please share your experience as well if you don't mind. Thank you everyone in advance.
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The extent of the invasiveness of intraductal is still somewhat of a mystery, best as I can tell. A urologist I spoke to once said it tends to stay in the prostate, since it spreads through the prostate ducts. So that is good in a way. And the old rule was to use surgery to remove it because although it is not inclined to go out of the prostate, when it does, it has a negative prognosis. Supposedly. But it is not "ductal cancer" which is a more serious cancer. best as I can tell. The two are not related. I don't think. Supposedly i had some intraductal according to a second opinion on my biopsy by Epstein's company at John's Hopkins. Tulsa Pro didn't kill it. Radiation may have. I guess we'll find out but so far so good, four years later. I don't think there is any substantive finding that radiation is ineffective against it.
Thank you for your reply Xavier. The young doctor that we talked is leading the CAPTAIN trail for Tulsa Pro vs RALP, so I did ask him if my dad's case would be suitable for Tulsa Pro. He said probably not because Tulsa is more for low or intermediate risk patients. While with intraductal carcinoma, my dad is considered as high risk case. Yes, the research that I did kinda pointing surgery will be the best option for IDC-P if confined inside prostate, but we are worrying about his age for the surgery. That's the reason why we wanted to talk to another more experienced doctor with prostate cancer and did lots of RALP and also radiation oncologist.
At 76 I would be inclined to use radiation. Radiation is so precise now. That's just my personal feeling. I know there are some studies that seem to show an advantage to surgery but I would definitely choose radiation.
Hi Kiki...I talked to you on another forum. Along with Xavier I too was diagnosed with IDC and have found it a mystery among clinical professionals! Like a lot of things "PC" there always seems to be conflicting results/opinions and a bit of a grey area. My uro knew next to nothing about it and my surgeon simply said he has seen it many times and it never made a difference in recurrence and/or a metastatic situation in his career of 24 years and over 1200 procedures. I also saw a MO after my surgery who basically said the same thing as my surgeon. The only comment my surgeon and MO made that I see a bit of consistency in is that when it is found in very low PSA situations it tends to be more aggressive and it almost always accompanies pattern 4 disease.
With a significant amount of high-grade disease on one side of the prostate and a rapidly growing PSA I would be weary of positive margins and adverse findings with RP. RT would be a better choice in his situation in my opinion along with his age, comorbidities(his other issue). The only negative I've read on RT treatment was that of SBRT use on IDC patients? It will be interesting to hear the results of your Dads PSMA scan and what the RO has to say. You're a dear for taking care of Dad! Also, if he has any sons they might want to make sure to keep an eye on their PSA's.
From my readings, and take this as strictly an observation over the last 3 years after being diagnosed with IDC, PSA's lower than 3 seem to harbor more aggressive disease and worse outcomes. Now, keep this in mind; Prostate and tumor volume obviously plays a role in this as well. So again, studies/opinions seem to vary on this topic of the combination of aggressive disease and lower PSA's. I wish I had better answers but these guys on here are a wealth of information and I'm sure they will provide their experience as well.
Scroll down to paragraph "Clinical Importance Of IDC-P"
Like I said, I would never disregard any form of treatment from what I read about PC treatments since for every opinion you can find a counter opinion for sure. In defense of RT and IDC, I just wonder how many patients that have been treated via RT and actually had IDC within their prostates but never knew it and were treated successfully? Another bit I read is that a large percentage of IDC is found post surgery in pathology and not in biopsy. Again, no clue if that's true or not.
From my experience with PC, with all of the variables and opinions it seems like the worst PC is the type that escapes treatment. I've read 3+4's with LN involvement with an overall worse end-result than G9's that are contained/treated.
From this article, it seems to point out RALP would be the best option for IDC-P while radiation or hormone therapy might not respond to it too well, like less effective? That is kinda what I read some other articles as well, but honestly, I think I read quite many that I don't even remember which one. The young doctor that we had appt this week said the same which is why he recommend the surgery. Seriously, all the unknowns and this mysterious IDC-P are not helping to calm my anxiety. 😓
Don, we met with radiation oncologist today. He recommended SBRT (with local anesthesia to plant 3 small seeds in prostate and gel between prostate and rectum, then MRI for radiation planning and then 5 sessions of radiation - 1 per week). He said he successfully treated localized cancer with IDC features, just not pure IDC without invasive carcinoma like my dad has. He said my dad's case is very uncommon but he thinks SBRT would work for him. He said we cannot exclude micro size cancer that might be somewhere else not able to be detected by PSMA PET, so he will also add 2 years of hormone therapy which we don't really want. However all these are just his suggestions. We are still going to meet with an more experience dr with prostate cancer and RALP end of this month. But here's an update as of now. 😅
That sounds like a great treatment plan for a fella his age! As far as the HT goes, these guys on here know some tips/tricks to make it a bit easier. And your RO sounds on-point with the micro-mets comment since NO drx can ever rule that out even with PSMA scans. So no matter the treatment, that is always a possibility. Once again, thanks for helping your Dad and thanks for the update!!
Yes, the RO suggested HT regardless we choose RALP or SBRT. For HT, I worried about side effects. The main medication my dad is currently taking already causing high blood pressure, and he does has a dilated aorta that dr is monitoring, so definitely worried about what bad heart related side effects HT might cause.
Last year I visited UTSouthwestern because of rising psa and psma pet scan results. In summer I had a biopsy. The doctor did not recommended Tulsa Pro or surgery because I had a previous laser ablation that did not work. They recommended sbrt and since it required long stays in Dallas (I am from Puerto Rico) I decided to give a try the treatment locally. My appointment with the radiologist at 3:30 pm was delayed until 8:15pm and several things happened that I knew that it was better for me to fly to UTS. They had a everything scheduled for a 2 day to do spaceoar, psma pet scan and . I returned a week later for 2 treatments of sbrt and waited another week for 3 more. My first psa was low I am very satisfied with the humane treatment at uts. Wait a see what recommendations they give you
Thank you for your reply, Flapr. The last time you had PSMA PET scan at UTSW, how long did it take to receive result on MyChart? My dad did it last Thursday and as of now still nothing yet.
That's good to know. Thank you. Hope my dad will get his results soon. All these waiting for test results, and then waiting to schedule appointments are not helping the anxiety about the whole issue.
May I know which doctor(s) you see at UTSW? It just seems like all appointments with doctors there are usually scheduled a month or more out.
It's a good idea to add to his/your bio information. To save time glean data from your posts above and add that to your (his) bio. You've come to the right place for information and Camaraderie. Keep posting and btw KIKI you're a wonderful daughter. Regards to you and Dad.
side note: Sometimes Greek women use the nickname Kiki from the/their word/name for Sunday, which in Greek is "Κυριακή" pronounced Ky-ri-aki.....
Thank you. I will try to add my dad's info in my profile bios. He is not on any forum, but I want to educate myself so I can help him and my mom through this new health issue.
My name is actually Karen. I used KikiBoo as my username long time ago on other baby forum when I first have kids. I think my husband and me picked the name out from a Japanese animation, "Kiki's Delivery Service" which we thought it's cute name.
Give both your Mom and your Dad hugs and kisses tomorrow for Valentine's Day. Also make sure the boss and the kids give you the same. Seems very unusual to get your kids through a Japanese delivery service LOL.
Thank you John! Happy Valentine's Day to you and your loved ones as well!
LOL. My husband think the little girl in the animation fit me. Both start with the letter "K" so I used the name on different forums. Such long time ago. 😂
IDC-p is an adverse feature associated with poor results for patients diagnosed with PCa. Now before you fall on the floor, hold onto the chair for a little while because you'll immediately question what does that mean exactly?
Nothing, and everything!!!
First and foremost the entire diagnosis is key. Just like other adverse features such as ECE, PNI, SVI, High PSA, Gleason 7+, family history, general health, etc.
For the IDC-p, it's problematic because it's not a stratification element that has treatment designed to address it. It is a cellular characteristic, and when identified, those patients who had it and we're tracked showed poor progression characteristics vs others amongst their risk group than those who didn't have it. Again, what? Well, for those patients identified with it, had a higher chance of failing first line therapy. A higher chance for failing their second line therapy as well and possibility for distant mets at some point. It "IS" an aggressive trait. I could post dozens of links and studies but it's info that's out there for anyone to see. Search Intraductal and Prostate Cancer...
Now... The other question to ask is what can be done to help mitigate those (negative) possibilities?
The single best answer to offer is to get to a Major Cancer Center and one rated in Excellence! Travel if you must, but get to one of the top 5 in the country! It is there you'll obtain the very best in diagnosis, treatment and care. Ali g with cutting edge trials or treatment if necessary. They track their patients over time and in numbers that local Oncologists don't do, can't do. No offense! So even if you're deeply involved with your team now, it doesn't hurt to get a 2nd opinion!
Don't make a decision until you do...
Remember though that 10yr survival for newly diagnosed patients is almost 100% (98%). And 15yr survival not far off those numbers. PCa today is treated more like a chronic condition than one with immediate end points. So keep that in mind. Your dad @ 76 is already beating the odds, and QOL is as an important decision as therapy is. No decision is easy!
I was 54 In 2004-5 my diagnosis was PSA 6.9 and gleason 3+4. Had 8 weeks of EBRT. Though in 2021 I had a BCR with intraductal in 2 or 3 cores…Had consulted with MSK and NYU langone. MSK wanted to give me HD Brachytherapy and i declined . I didn’t want more radiation…Had thought of doing cryotherapy and declined…From 2021 to now I have had only 6 weeks of ADT (firmagon).
Similar to what others have said my intraductal continues to be contained in the prostate via last MRI ( i believe latest one in 2023 or early 2024) Today I have no symptoms…
As far as you having intraductal now , my concern would be having surgery at 76…Whether or not either treatment will eliminate it, I would wonder if the SEs of radiation would be less than surgery…
At age 54 my radiation treatment 8 weeks (15 minutes a day) went very well. Of course there are many options available today in using radiation for Pca.
Thank you for your reply. I am also concerning my dad having surgery 76. We are currently going to UT Southwestern in Dallas, Texas. The doctor who did my dad's biopsy which I also asked him about TULSA-Pro which I think he leads a trial to investigate TULSA vs RALP. However, he said intraductal carcinoma is consider high risk so it's not suitable for TULSA which is for low or intermediate risk patients. My dad is referred to a more experienced RALP surgeon which we are scheduled to meet end of March. In the mean time, we are also referred to radiation oncologist that we will meet in early March to see what he thinks about his case. However, the first doctor recommend RALP and he stated radiation or hormone therapy might not be as effective. My dad is really leaning towards surgery himself, but I think we should meet all the doctors and gather more information first. We also just got his PSMA PET scan results which everything is confined inside the prostate and no spread. That's good news at least.
When you have BCR in 2021, did the cores only show intraductal carcinoma but no invasive carcinoma? In my dad's biospy this Jan, his doctor took 15 cores (3 from area of interest from left, 6 more on the left and 6 on the right). All 9 cores on the left side showed intraductal carcinoma but no invasive carcinoma, and all 6 cores on the right were benign. He had enlarged prostate (about 50cc) for years, so his flow is slow. Other than that, no symptoms. Only triggered investigation last year because PSA was 10 and 13 in Aug and Sept. Previous year was 2 something.
I notice you keep mentioning Tulsa Pro. Just drop that option. It doesn't work. It microwaves his prostate but doesn't get rid of the cancer. Just telling you.
Thank you Xavier. Yes, the doctor said it's for lower risk patients only. We would be seeing radiation oncologist to see his opinion early March and an experience surgeon end of March as the plan for now. Would try to see any cancellation that we can see the surgeon earlier. Waiting is very stressful.
one core states suspicious for “perineural invasion intraductal.” another core “predominantly perineural invasion”…my RO is looking at how my PSA is “behaving” Right now it’s 2.3. By living with it now for 20 years I’m not interested in having an “aggressive” treatment. A Medical oncologist could likely be more aggressive…Every body will respond differently. At 76 there are options which may or may not be effective…
The reason why i suggest radiation because there are possibly less SEs and 2) if any cancer is outside in his body then surgery would not be effective.
Interesting that I was told the same about Tulsa Pro from a prominent MD at Yale…
Yes, intraductal is an aggressive cancer but it is also mysterious in that their is no definite SOC. Most of the docs who I have consulted with didn’t make much of it. That is why I feel that your dad may look it just as Pca alone. And decide what is best to treat Pca at 76…with the least amount of SEs..
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What is meant by very low PSA situations? 
New to Forum
I'm new here. I've been diagnosed with prostate cancer.
New biopsy: now G4+3
"Pros and Cons of Various Forms of Radiation Therapy vs Radical Prostatectomy for Men in Their 50s"
