I was diagnosed in 2011 via biopsy because of suspicious PSA. Results: very low to low risk. Was monitored every 6 mos. Five biopsies and 3 MRIs over 7 yrs. Last biopsy used fusion guided MRI. It showed an increase in cancer. And, with rising PSA, urologist recommended treatment. Have met with second urologist who concurred. Am meeting with radiation oncologists from Hopkins and a local hospital. Using the National Comprehensive Cancer Network (NCCN) guidelines (check it out), one radiation oncologist recommended hormones, beam and seeds over the next 3-4 months. Btw, I'm 69 and live outside of Baltimore City. Four strong recommendations: make sure you get a MRI fusion guided biopsy - it's targeted to suspicious areas on the prostate unlike the shotgun approach of a regular biopsy. Second, read the NCCN guidelines. Three, read Patrick Walsh's book "Surviving Prostate Cancer, 4th ed." Four, get second opinions from urologists, radiation oncologists, and medical oncologists. Good luck to all.
From AS to treatment: I was diagnosed... - Prostate Cancer A...
From AS to treatment
What did the fusion biopsy show? Brachy boost therapy is only merited for unfavorable risk prostate cancer.
Fusion biopsy showed cancer that I suspect was there but not captured via reg biopsy or MRI. Change in Gleason from 3+3 to 3+4. According to latest NCCN guidelines, hormones, beam AND seeds are appropriate for my situation. Interestingly, these guidelines were just updated 8-15!
You misread the latest NCCN guidelines. PROS-6 clearly shows that for men with "favorable intermediate risk" PC the only acceptable options are EBRT OR brachytherapy alone. This is explained in the following article:
pcnrv.blogspot.com/2017/05/...
RTOG 0232 was a randomized clinical trial that proved that oncological outcomes were exactly the same for favorable intermediate risk patients who received brachytherapy alone or a brachy boost, but the urinary side effects were worse:
pcnrv.blogspot.com/2016/09/...
Because of PSA = 22, uro and rad doc said PROS 8 or 9 (with 4 out of 8 cores showing cancer; one core 70%). And, latest info I've read indicates that ADT, IMRT (25 fractions, 45Gy), with brachy boost (39 seeds) is an appropriate treatment plan.
Have completed all with possibility of 1 more injection of Lupron (hate, hate, hate it) for 3 mos.
After that, then, I assume routine monitoring (PSA, testosterone, scans). Other likely follow up procedures?
Other things you think I should be asking?
Glad you're on this site. Read all your posts.
You can get proton radiation in Baltimore at U of MD.
It all sounds complicated! Appropriate treatment depends on the results of the biopsy. I also wonder if the MRI will pick up and local spread and if you've had a nuclear bone scan or CT to eliminate metastases.
It sound like you're shopping around to find the best opinion and the best treatment. That has it's merits but you can overdo it. The more opinions you get and the more you read the more options might appeal to you. You might get to think there might be even other options that are even better, when to stop?
Things were much simpler for me, my dangerous biopsy showed I had cancer, MRI and bone scan showed it was confined to the prostate. A multi-disciplinary team looked at my results and gave me a choice of either external radiation or surgery. I looked up the pros and cons of each and chose surgery.
Neither surgery nor radiation are without their consequences. If you elect for radiation proton beam is the least damaging.
However if you find a good surgeon well experienced at carrying out robotic assisted nerve sparing surgery and start a rehabilitation program it's possible to get a good quality if life.
Good luck
Edinbmore ......Much like Tim, my decision was a clear choice. 9 out of 12 biopsy core samples came back with cancer. Enough said - get it out of me.
That was 2 years ago. Robotic surgery with a relatively smooth and quick recovery. Resulted with A few months of requiring pads for leakage, and I was able to obtain erections after the catheter was out.
Do I sometimes regret, acting so quickly in my decision - Yes, I do. But when I go in for my blood work and my PSA level is at >0.1,
It reafirms my decision.
The choice is personal, and I feel blessed that my decision worked out for me....I hope that your reasearch efforts brings you to a succesful and healthy conclusion!
Appreciate the good wishes, man. It's quite an ordeal, isn't it? But, this, too, will pass. Glad you're doing well.
One can never go wrong with second opinion. Mine is this wk. Frankly, I assume it will support/confirm previous radiation oncologist's recommendation. Next decision is which doc at which hospital. Glad you're good with your choice. Great!
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Hello to all from someone with RP, ADT, and IMRT
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Bottoming and Cancer Metastasizing
No treatment. No faith. No hope.
So unsure what to do...
Newly diagnosed scared and confused. 
