Gleason7(3+4) - treatment options recommendation

I’ve seen it mentioned in forums, but know nothing about it. Can you share a link or something? Also is it covered by insurance?

@manojsmishra You are at a great center of excellence with Mayo but just as a reference point NOT ALL photon radiation machines are alike. The margins around the mridian machine, which has a built in MRI so the RO treats what they can see in real time, are about 2mm while most other radiation machines, including proton, are 3-5 mm. The wider the margin the more healthy tissue exposure to radiation. Machines that do not have built in MRI use wider margins because of that MRI issue and potential motion. You might want to google the mirage randomized trial which compares NON-built in radiation to built in MRI machines like the mridian and the elekta.

Respectfully, focal treatment is still experimental. I was the local poster boy for local therapy in Chicago. I was treated for low-grade Gleason 6 prostate cancer. The problem was there was no metric to decide if 1.) the treatment was successful, and 2.) my rising PSA after reaching nadir was the result of a RT “bounce”, and 3.) at what point should investigation of possible recurrence take place.

The result was that focal treatment failed and I now have Stage 4 locally metastatic prostate cancer all because I was a sucker for a sales pitch for unproven treatment.

Thank you for sharing that. That's my concern about too tight a focus with radiation. Current imaging can't see isolated cancer cells, so if your radiation therapy is so focused that it hits only the cancer they can see, what about the cancer they can't?

It must be a very difficult decision. I'm guessing (as a layperson) that they take things into account like Gleason score, speed of growth, PSA, number of sites, etc before deciding on recommending photon vs proton and tight vs loose focus for radiation. There's probably no "right" answer, just a complex balancing act between risks and side-effects. I'm so sorry that it didn't work out for you.

There's also a tendency to over-apply new technology -- it's a very human response. The Gartner Group has a "Hype cycle" curve showing how new things (like generative AI) initially get overused, then there's a backlash, then they settle in somewhere in the middle where they're genuinely useful (but not the answer to everything). I'm sure that applies to new medical breakthroughs as well, though at least they tend to be tempered by formal studies and peer review.

In my case, I'm a victim of a different part of the Hype cycle, the "Trough of Disillusionment", where the CDC and many other health authorities had recommended stopping routine PSA screening for people without known risk factors because patients were being overtreated for small PSA rises.

I think we're on the Slope of Enlightenment now, where the medical community is finally realising that the problem was never testing PSA, but just how they responded to it (especially since we've had such a big rise in PCa that's already advanced at first diagnosis since the screening decreased).

It's not covered by insurance .
For info , Google : William Thomas " Niagara Now " - NanoKnife in Germany also Prof. Dr. Mark Emberton London England , North Toronto NanoKnife , Beverly Hills Clinic, Toronto , plus NanoKnife Australia - There are numerous sites listed here .
It is only considered experimental in the Medicak Field because they require 20 years post procedure data for the FDA to offically approve . Literally thousands worldwide have successfully had the procedure . It's an in-and -out the same day procedure .

What year did you have the NanoKnife procedure and what was your Gleason score at the time

I'm confused . You had Focal Therapy , yet you felt your increase in PSA may be attributed to to your procedure .
PSA bounce is a result of Radiation Treatment - Not focal therapy .

Respectfully, let me clarify:

For the record, I confused Nanoknife (which uses electroporation to kill cancer cells using electricity) with Cycberknife which, according to their website delivers, targeted highly focused radiation. As I understand it both can be used for focal treatment of prostate cancer.

When radiation is used as the primary treatment for PCa the PSA drops until it hits its lowest post, referred in clinical terms as a nadir. It is not uncommon for the PSA to rise temporarily 18-24 after treatment. This is called a “bounce”. If treatment is successful the PSA hits a new nadir. Many professionals in the medical community consider that treatment has failed if PSA rises 2 points above the nadir or on consecutive tests.

Speaking not as a doctor but as an engineer that worked on medical devices I see potential for cure in some prostate cancer patients. I considered it in 2020 when I was originally diagnosed and my insurance wouldn’t cover the procedure. As with any other treatment, careful monitoring of PSA post treatment is critical to detect Biochemical Recurrence before it becomes a serious issue.

I received focal treatment in the form of low dose brachytherapy. My peak PSA was about 7.0 prior to treatment. I was sold on the premise that I’d be cured without risking incontinance or ED. The doctor had no established post treatment guidelines for PSA levels. As a result I was blindsided when after a steady then rapid rise is PSA I was diagnosed with Stage 4 Gleason 9 PCa. I hope that patients receiving treatment with Nanoknife have a care team that avoids the same as I had.

Here’s a link to reasonably recent published study on Nanoknife: https://www.mdpi.com/2072-6694/16/12/2178

Good luck to you on your journey.

Thank you — that's how I read your original post, even if some of the terminology might have been unfamiliar.

If I understand correctly, you had very focussed radiation treatment to your prostate on the promise it would prevent most side-effects, it didn't catch all the cancer, the doctors misinterpreted the PSA rise afterwards, and now it has metastasised (stage 4).

I'm so sorry for your experience. It's great that there are excellent treatments to control our advanced prostate cancer now and possibly even let us live out our full lives, but it's still not somewhere anyone wants to end up.