1. < Prostate Cancer

Surgery or SBRT PSA 4.4; T1c.

Posted by jaygk @jaygk, Apr 25 2:41pm

Hello, I am a 65 Year old male, ALL 12 sections biopsy positive. 11 sections Gleason 6, 1 Gleason 7 (3 + 4). Clinical state T1c. The 7 is on the outside. Cancer has not spread outside of the prostate and is no perineural invasion.

Met with the surgeon (uses robotic da Vinci) who prides himself on nerve sparing. However was told my changes of nerve sparing are decreased since all 12 sections positive.
Met with radiologist for SBRT (CyberKnife) consult. I would need the space OAR gel . I also have severe diverticulosis and generate approx. 15 polyps per year on my annual colonoscopy. So, I am worried about the radiation bleed over into the rectum and its effect on any future treatment I would need regarding those 2 conditions. Meeting with my gastroenterologist next week to get his option.

I understand both methods are very effective 90%+ so that is a blessing. I am a good candidate for both...also a blessing.

I am concerned about urinary continence and ED and am on the fence about which treatment to select.

My question is what have been your Dr. recommendations and what have been the experiences you have had for surgery (da Vinci) and radiation (SBRT CyberKnife) in particular and what have been your ED and urinary continence results.
Thanks, Jay

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

jeff Marchi | @jeffmarc | Apr 26 12:12pm
In reply to @jaygk "Thanks for the reply. No one mentioned a decimeter test. Are there problems with the biopsy..." + (show)
@jaygk

Thanks for the reply. No one mentioned a decimeter test. Are there problems with the biopsy results at times?
I had an MRI and CT scan as well as the biopsy.
There are not CCOE close by. I have seen a urologist, surgeon, radiologist, and a urologist oncologist. The surgeon is highly known in this area and does most of the RARP in Northern Kentucky. We met with him for 45 min asking all the questions I could think of.
I am somewhat unusual since low intermediate by all 12 sections positive
I ordered the book. It will arrive tomorrow.

Jump to this post

I can find no evidence of a decimeter test being available. I think he meant to say decipher test.

REPLY
jaygk | @jaygk | Apr 26 1:53pm
In reply to @jeffmarc "The thing is the cyber knife results are not equal. They can bluff you into thinking..." + (show)
@jeffmarc

The thing is the cyber knife results are not equal. They can bluff you into thinking they are, but there is a Significant difference In the width of their beams and nearby tissue that gets touched. You can spend a few minutes looking into it and will find that is what the facts are.

If you had to go a distance from home to get treatment you could get free housing with multiple different groups that help cancer patients with free hotel rooms when they are getting treatment. It would be a maximum of 5 treatments if it hasn’t escaped the prostate.

Yes, ED could happen some time after Radiation. At worst, you could use Trimix, An injection into the penis gives a solid Erection. If you are on ADT, your desire for sex will be greatly reduced, which may be more of a problem?

Incontinence problems are something that many of us live with. There’s no way of knowing how your body will react to surgery or radiation, There is so much variation, but frequently a little leaking occurs, I don’t think there’s anything they can do to reduce the chance of problems, maybe the SpaceOAR can help a little, but it is designed to protect the rectum. There are things you can do when it is a problem. There’s a couple of different pills that help a lot if you just leak a little no, Gemtesa and Myrbetriq. And there are a few different other techniques urologists use. One of the latest (ProACT) surgically inserts a couple of balloons around the bladder neck,, they can remotely increase and decrease the Pressure to end the leakage.

Jump to this post

Jeff do you know where MRI guides SBRT is available. I saw UCLA and Tampa. Not sure if Cleveland Clinic of Ohio state has them.

I also read that if MRI SBRT not available, lower dose 28 treatments may result in less radiation affects outside the prostate ?

REPLY
1 reply
rider51 | @rider51 | Apr 26 2:25pm
In reply to @jaygk "Thanks for the reply. No one mentioned a decimeter test. Are there problems with the biopsy..." + (show)
@jaygk

Thanks for the reply. No one mentioned a decimeter test. Are there problems with the biopsy results at times?
I had an MRI and CT scan as well as the biopsy.
There are not CCOE close by. I have seen a urologist, surgeon, radiologist, and a urologist oncologist. The surgeon is highly known in this area and does most of the RARP in Northern Kentucky. We met with him for 45 min asking all the questions I could think of.
I am somewhat unusual since low intermediate by all 12 sections positive
I ordered the book. It will arrive tomorrow.

Jump to this post

I know many feel strongly that it is really important to be treated at a CCOE, but my experience has been a bit different. I was under the care of a CCOE for many years and although they were monitoring my PSA and did MRI's and biopsies, they did not utilize the latest diagnostic tests that could have, and in hindsight should have, been used for my case.
The CCOE I was at seemed to have a high volume, one game plan approach to diagnosis and that did not include the latest urine and blood based tests that look for biomarkers of prostate cancer. It was only after I changed to a urology group in my home city that my cancer was found thanks to use of one of those tests (ExoDx though the EpiSwitch PSE test is another excellent diagnostic screening test).

After the determination that I did have prostate cancer I had to decide whether to return to the CCOE for the surgery or continue with the group that was so instrumental in finding the cancer very early. I elected to continue with the local group and had a RALP. The surgery was performed by two surgeons - one did the first portion and the other did the second portion and both were in the operating room the entire time. I don't know how common it is to have a team do the procedure, but in my case I was very reassured going into the surgery with their combined experience and training and I am very pleased with the results.

Everyone needs to decide for themselves where to seek care, and treatment if required, and my point in passing this along is just to offer another point of view to the widely held belief that a CCOE is always the best decision.

You have found a great resource for information at this forum and the contributors here have a lot of experience and information to offer. All the best to you as you move through this process.

REPLY
retireditguy | @retireditguy | Apr 26 2:31pm
In reply to @jaygk "Thanks for the reply. No one mentioned a decimeter test. Are there problems with the biopsy..." + (show)
@jaygk

Thanks for the reply. No one mentioned a decimeter test. Are there problems with the biopsy results at times?
I had an MRI and CT scan as well as the biopsy.
There are not CCOE close by. I have seen a urologist, surgeon, radiologist, and a urologist oncologist. The surgeon is highly known in this area and does most of the RARP in Northern Kentucky. We met with him for 45 min asking all the questions I could think of.
I am somewhat unusual since low intermediate by all 12 sections positive
I ordered the book. It will arrive tomorrow.

Jump to this post

Sorry, I misspoke. As @jeffmarc correctly pointed out below I meant to say decipher test. As far as a second opinion on the biopsy results, I'm not a medical professional but my understanding is sometimes a second opinion of the biopsy tissue can differ from the first opinion. In your case, since you only had one 3+4=7 it might be worth having a second set of eyes examine the tissue. If the second opinion only found 3+3=6, then it'd be time for a third opinion. You can query "biopsy second opinion" on this website and you'll find a lot of hits. In my case I had multiple 3+4=7 instances and the lab was at a CCOE so I didn't bother. Best wishes.

REPLY
edinmaryland | @edinmaryland | Apr 26 2:52pm

to your concern about incontinence, SBRT can result in incontinence but seemly less of a chance that RARP.
If you go with RARP, find a physical therapist that specializes in pelvic floor training for males following RP and begin the treatment one to two months prior to the surgery. This is supported by research.
Goonewardene S.S., Gillatt D., Persad R. A systematic review of PFE pre-prostatectomy. J. Robot. Surg. 2018;12:397–400. doi: 10.1007/s11701-018-0803-8. [DOI] [PubMed] [Google Scholar]

REPLY
jeff Marchi | @jeffmarc | Apr 26 3:54pm
In reply to @jaygk "Jeff do you know where MRI guides SBRT is available. I saw UCLA and Tampa. Not..." + (show)
@jaygk

Jeff do you know where MRI guides SBRT is available. I saw UCLA and Tampa. Not sure if Cleveland Clinic of Ohio state has them.

I also read that if MRI SBRT not available, lower dose 28 treatments may result in less radiation affects outside the prostate ?

Jump to this post

I’m sorry, a list I have never seen.

REPLY
jaygk | @jaygk | Apr 26 5:22pm

Thanks.

I watched at video by Dr. Mack Roach where he states the MRI guided SBRT study is not accurate and he feels no better than CT SBRT. A lot of information to take in.

I also watched the recommended video of Alex and Dr Schulz Radiation vs Surgery. Very eye opening.

REPLY
heavyphil | @heavyphil | Apr 27 5:01pm
In reply to @jaygk "Thanks for the reply. No one mentioned a decimeter test. Are there problems with the biopsy..." + (show)
@jaygk

Thanks for the reply. No one mentioned a decimeter test. Are there problems with the biopsy results at times?
I had an MRI and CT scan as well as the biopsy.
There are not CCOE close by. I have seen a urologist, surgeon, radiologist, and a urologist oncologist. The surgeon is highly known in this area and does most of the RARP in Northern Kentucky. We met with him for 45 min asking all the questions I could think of.
I am somewhat unusual since low intermediate by all 12 sections positive
I ordered the book. It will arrive tomorrow.

Jump to this post

Do you have a Decipher score with that Low Intermediate? Could bump it up or down a notch and help you decide on best treatment approach.
Phil

REPLY
jaygk | @jaygk | Apr 27 7:27pm

No, my urologist never mentioned decipher score. I got an opinion from urologist oncologist and he stated I was a low intermediate.
Is that done using the existing biopsy data? Or is further analysis needed?

REPLY
dpfbanks | @dpfbanks | Apr 27 9:05pm
In reply to @jaygk "Thanks for the reply. No one mentioned a decimeter test. Are there problems with the biopsy..." + (show)
@jaygk

Thanks for the reply. No one mentioned a decimeter test. Are there problems with the biopsy results at times?
I had an MRI and CT scan as well as the biopsy.
There are not CCOE close by. I have seen a urologist, surgeon, radiologist, and a urologist oncologist. The surgeon is highly known in this area and does most of the RARP in Northern Kentucky. We met with him for 45 min asking all the questions I could think of.
I am somewhat unusual since low intermediate by all 12 sections positive
I ordered the book. It will arrive tomorrow.

Jump to this post

45 minutes!! Fantastic.

REPLY
View MoreView Less
Please sign in or register to post a reply.