Newly diagnosed with prostate cancer: What might I be in for?

@heavyphil
I agree with the premise of the question. Those micro cells are the ones that cause the problems that cannot be picked up by imaging, which is why they either remove or they treat the entire prostate plus some.

I would like to see more studies on the microcells and biological reoccurrence so that maybe it becomes easier to make decisions related to radiation and ablation

If you are looking for guarantees, there is no saying pathology is so much better than PSMA for example. Many pathology reports are wrong, people get un-needed radiation which I can assure you does them no good, or are over treated at the get go by incorrect pathology reports. For all the alternative treatments that ablate prostate tissue, PSMA pet/ct is the determinant and replacement, plus PSMA is getting better and better.

I did not realize that PSMA PET scan was a treatment for prostate cancer,
but rather a test to see if there has been any spread of prostate cancer
outside the prostate. Is that not correct? Let me know and thank you for
your post.

A PSMA Pet/CT is to determine if it spread at this point that is all. But you won't get Tulsa, IRE or any other without it. So if thinking of one of those alternative treatments, some doctor can order PSMA Pet/CT for you, Dr Scionti in FL ordered mine but I did it local to me. There is some talk of using PSMA to ablate PCa too, but that is not in the US right now. PSMA will say where the cancer is and if they can proceed with alternative treatments or not, so likely you will encounter it depending on what you decide. They also have to check for calcium deposits with a regular CT of prostate first or before the PSMA pet, so it is a process of several imaging where they also look at size of prostate and calcium deposits. If there is calcium, it can interfere with the ultrasound beam used in Tulsa and why they do a regular CT first. I had no calcium deposits, but small ones they still can go ahead. The size is limited somewhat in that from urethra to edge of prostate has some maximum. But I had a large prostate and was ok.

@bjroc
My issue was more with the microcells that do not show up with any type of imaging and the lack of studies that give more guidance than what is out there now related to those microcells and biological reoccurrence. I would like to see more studies in that direction. I definitely was not looking for any guarantees as there are none in life, except death and taxes as they say.

@bens1
Great information to @mspotter1956. The margins are important as you mentioned. Where did you have your radiation done?

My R/O and urologist kept telling me that prostate cancer does not always show up on MRIs and biopsies and can be at celluar level and go undetected by MRIs and biopsies.

I am not sure what my margins were. My R/O at UFHPTI was quite adamant he was going to treat margins and the entire prostrate. I had 30 rounds of proton pencil beam radiation.

He did another test (beyond MRIs with contrast, Fusion/Biopsies, Decipher, bone scan, PSMA). He injected something into my prostrate via penis saying would allow a better look at lower, and back part of prostrate. This was done during the transition part of setting up treatment.

I think your real-time MRI imaging radiation treatments is state of art at this time. I know I had markers put in and they always did a low dose xray (twice each treatment) to make sure prostrate was aligned perfectly.

@bens1
I am not a medical professional but I keep coming back to what you have mentioned in your posts. Prostrate cancer can be at the microcells level. You can't do a biopsy on entire prostrate thus even a minute area may have cancer cells not being addressed unless entire prostrate is treated.

Both consultations I had (Mayo, and UFHPTI) stress would treat entire prostrate and margins to make sure they treated all areas that may have cancer celss that did not showed up on the MRIs and biopsies.

I am not sure of the very latest PSMA test can detect better but I am glad my R/O was not going to take a chance he was missing something.

Your comments are quite appropriate. I was just hearing earlier this week about someone who had a Gleason seven after biopsy then they had an RP, following the RP their Gleason score was changed to nine because somewhere in the prostate there was much more serious cancer.

This reinforces why, when doing radiation or other techniques, they really needs the whole prostate to be treated.

Potter, you have this ! .... what is your PSA over the last couple of years . The 4+3 sounds a little aggressive . Maybe start with a PSMA PET scan ? See what your up against , also contrast MRI's will help ! Have you got breast or prostate cancers in family ? your age ? In good health and active? You have 4-5 session sites in Prostate? any other health issues ? With this info I can make some recommendations . With 4+3 you dont want to "Dilly Dally" around . You need care soon! Also keep binder - every doctor and discussion goes in there , every image or procedure goes in there ( always get a copy - dont take 'no' for an answer its your image and write up !) . God Bless - you will get through this ! James

Perhaps paying taxes is easier than microcells.....

There are many directions needed, one is that estrogen levels might be to blame for some issues at least in some men for prostate issues. Sure they aren't high, but once we age the Testosterone to estrogen ratio falls into a kind of environment that a cancer might occur (informally I understand you want that ratio at least ten times the amount of testosterone in comparison to estrogen or 10:1). Sure they need to study things more, but basic looking at hormone ratios might help, better study of pathology might be helpful but that has a lot of looking at for last decades I believe though sure more can happen always. There are a lot of things to look at.