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What to ask the radiation oncologist about prostate cancer?
Prostate Cancer | Last Active: 15 hours ago | Replies (15)Comment receiving replies
Thank you Bill so much for writing , I was hoping that you will help me. Those are all great points and great ideas for tomorrow discussion !
When surgeon suggested that we talk to a specialist for localized treatment we decided to contact Stanford U. because they have TULSA. They looked into our case and told us that unfortunately the lesion is toward an outer area of the gland and in that case TULSA is not very effective. TULSA has the best results when cancer is located close to urethra since probe is placed inside urethra. They also told us that we could be good candidate for different localized treatment which we will explore, but I personally do not see how those other options beside TULSA could have any good result in our particular case. They all think that because there is one single core with crazy pathology that localized treatment is an option. BUT, I am so scared of IDC and cribriform 🙁 and their weird resistance. TULSA sounded possibly attractive since destruction in that case is physical, literary "cooking" the tissue and not using radiation.
However I turn it over and over in my head and whatever I read, it seems that when IDC and cribriform are present, the best way is to take the whole gland out and keep the radiation as an "ace"up the sleeve for secondary treatment if needed. But since we were advised to have consultations and hear about all of the available options, we are doing it. Surgeon is not available for RP procedure till the end of summer so we have time to explore suggested options (although I do not see how we have them when they are sub optimal in our case). We also think that it is good opportunity to make acquaintance with radiologist since we might need him in the future (god forbid).
I just want to be really ready for tomorrow with good list of questions and make sure that we stay on topic since last consultation was really dilettante on our part *cringe .
Also, thank you very much for the excellent link you sent me ! It just confirms our belief that RP is the best way forward, actually the only way forward in our case.
Replies to "Thank you Bill so much for writing , I was hoping that you will help me...."
"However I turn it over and over in my head and whatever I read, it seems that when IDC and cribriform are present, the best way is to take the whole gland out and keep the radiation as an "ace"up the sleeve for secondary treatment if needed. "
If TULSA were ruled out, then RP would be my choice to allow for pathological examination for somatic alterations which would open the door for immunotherapy for a second option given that RT might not be as effective as desired. The following is from this link: https://www.mdpi.com/1422-0067/22/23/13125#:~:text=Abstract,prevalence%20of%20germline%20BRCA2%20mutations.
"The vast majority of IDC-P tumors result from adjacent high-grade invasive cancer via the retrograde spreading of tumor cells into normal prostatic ducts or acini. A subset of IDC-P tumors is rarely derived from the de novo intraductal proliferation of premalignant cells. The presence of IDC-P in biopsy or surgical specimens is significantly associated with aggressive pathologic features, such as high Gleason grade, large tumor volume, and advanced tumor stage, and with poor clinical courses, including earlier biochemical recurrence, distant metastasis, and worse survival outcomes. These architectural and behavioral features of IDC-P may be driven by specific molecular properties. Notably, IDC-P possesses distinct genomic profiles, including higher rates of TMPRSS2–ERG gene fusions and PTEN loss, increased percentage of genomic instability, and higher prevalence of germline BRCA2 mutations. Considering that IDC-P tumors are usually resistant to conventional therapies for prostate cancer, further studies should be performed to develop optimal therapeutic strategies based on distinct genomic features, such as treatment with immune checkpoint blockades or poly (adenosine diphosphate–ribose) polymerase inhibitors for patients harboring increased genomic instability or BRCA2 mutations, as well as genetic counseling with genetic testing. Patient-derived xenografts and tumor organoid models can be the promising in vitro platforms for investigating the molecular features of IDC-P tumor.
Bill
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Your age may also be a factor in your surgeon's recommendations that you also consult a radiation oncologist. The other thought is that they advising a slower, deliberative process before deciding on a treatment decision rather than rushing toward RP and that too is good advice regardless of what you ultimately decide.