Third SBRT Opinion Worth It?

I have similar condition, PSA 8.3, age 67, .32 intermediate risk, one sample from two biopsies (total 31 needle samples) that had 5% 4, (3+4). I decided on SBRT with MRI guide, 28 days of 250 Gy. The doctor said I will not need gel due to the accuracy of the Trubeam equipment. He also said with the minimal cancer present I will not need to take testerone therapy. Plan on starting end of the month. For me it was either radiation or monitoring. The idea of more biopsies and no testerone therapy solidified the SBRT choice.

@jeffmarc Did your brother at 78 have a biopsy & MRI before SBRT? If he did have a biopsy, how long did he wait before SBRT? I read that after biopsy, the prostate would have inflammation for weeks, may be too close with other organs that could be accidentally rsdiated. I had my biopsy few weeks ago, G7 (3+4), positive on 8 of 14 cores, unfavorable intermediate. I'm waiting for date of either RP or SBRT; I'm more inclined to (feel more comfortable with) SBRT that was your brother:s choice too.

My brother was actually 77 when he had the biopsy. Surgery was a few months later. it is recommended that the surgery be delayed 4 to 8 weeks to reduce or eliminate the Inflammation. Not a long wait, considering how slow prostate cancer normally grows. Also, people are usually put on ADT before having radiation so that stops their cancer from growing.

My MD Anderson biopsy (re)analysis results just posted in MyChart and their findings are essentially the same as the first lab. Six out of twelve cores were positive, four Gleason 7 (3 + 4) and two Gleason 6.

The only differences are that MD Anderson gave slightly lower percentages of Grade 4 in two cores (20% vs. 30% and 5% vs 20%) and noted "a few atypical glands: suspicious for prostatic adenocarcinoma" in a seventh core not identified in the original analysis.

So what’s your game plan - active surveillance or treatment?

Treatment, still deciding on which route.

@vircet First Gleason 3 + 4 = 7 IS NOT UNFAVOURABLE INTERMEDATE . Gleason 4 + 3 = 7 is . And yes you have to wait several months 4 to 6 usually befforee for example a 2nd Confirmatoory Biopsy or other treatments . It allows for the swelling etc to get back to normal .
If you are considering radiation , consider the 5 Session Monotherapy SBRT treatment - Mon-Wed-Fri and Mon - Wed the next week . No hormones . Insist on a rectum spacer , SpaceOr even though with the MRI Guided , not the UT Guided machine you can get smaller margins down to 2mm as opposed to 5mm .
Good Luck.
p.s. Have to purchased and studied the highly recommended book on prostate cancer by Dr. Patrick Walsh " Guide to Surviving Prostate Cancer " .? or watched the the U - Tube videos by Dr. Mark Scholz or read the PROTEC T Report .?

@psychometric, thanks for the update. Keep us in the loop on your decision process! How is the Oxybutynin prescription working? Do you think that its helping your LUTS? Were you able to discuss that concern with MD Anderson?

I haven't noticed much difference so far after starting Oxybutynin. The prescribing urologist didn't mention how long it would take to see a change, but one of the ROs said it might take a couple of weeks (I'm on day 10).

My urologist and RO appointments at MD Anderson are both on March 31st. I'm actively compiling a list of general and RP/RT-specific questions.

Sounds like you're making good progress and collecting enough information to give you confidence as you move forward. Regarding Oxybutynin, an NIH article stated that many patients start to experience the effects in 2 weeks, with the full effect in a month. The most frequent side effect was a dry mouth, with the interesting caution to brush your teeth more frequently because the dry mouth increases the risk of decay. Keep us up to date as you learn more!

Best wishes!