Gleason7(3+4) - treatment options recommendation

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.

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.

Sorry you've joined the club! I am now 29 months post Radical Prostatectomy and just like you I was Gleason 3+4. I took the time to self-advocate(ie the CEO of my journey) over a few months of meeting with various surgeons, specialists and talking to those who've been through the various procedures. I met with Dr Leonard Marks and his impressive team out at UCLA twice. BUT mostly I drilled down deep into the various studies and statistics to filter the noise within the medical community and come to a well-reasoned and quantifiable decision. Radical Prostatectomy offered the best statistical outcome to remain on this side of the dirt over the short and long term. At 28 months my PSA levels remain at zero and I am happy with my outcome. GOOD LUCK!

if you were a patient with San Francisco’s University of California prostate cancer group they would probably recommend radiation with a 3+4 Gleason . Have you considered getting an outside opinion?

Mark C. Scholz, MD, serves as medical director of Prostate Oncology Specialists Inc. in Marina del Rey, CA, He is one of the top people in the country for treating people with prostate cancer. He would be a great source for a second opinion.

If you want to check up on him go to YouTube and look up the PCRI conferences. He always gives some really good talks about treatment.

Surgery frequently causes you to lose the ability to have an erection. With radiation you don’t normally have that issue. With a Trimix injection you can probably work around that even if you have surgery.

Radiation has replaced surgery for most people these days. You should look into the other option.

Yes but am following similar approach to reach to conclusion of the treatment option.
Have you encountered any incontinence issues with urine? This is one on my concern if I choose RALP surgery.
Even in current state I do have strong urge to go to bathroom and get few leaks if I hold long

I was in Depends for about 6 weeks post op with a progression of less frequent need to change to a dry Depend as the days progressed. The frequent retraining exercises help the progress. That said, my urine stream is slower than pre-surgery, there is a rare drip(passing gas can cause this) and with caffeine and heavy hydration my ability to put off urination has been lessened. BUT call this a rationale as most of my peers(I'm 61) seem to have similar issues with their relatively healthy prostate these days.

Any issues to expected with catheter? That is appearing to me the worst part of the procedure

The catheter is more mental gymnastics than anything else. The day mine was removed, eight days post op, I told the nurse who was removing it that friends of mine around the country think they'll be able to hear me scream when she removed it. We laughed, she yanked it out and that was it.

Very minor discomfort and that was it.