Info overload

Posted by sjorgie @sjorgie, Aug 20 5:23pm

I had a message almost complete on here and then whatever I pushed sent it ? ? ?
Take 2 - much shorter I hope.
My husband had a biopsy in 9/24. 14 cores all positive. 3 + 3 Gleason’s on 12 of them 3 + 4 on one with 15% of the 4. Both sides of gland. SA by urologist was recommended. Favorable Intermediate. 3/ 25 - MRI. P - rads 5 both sides. Abuts rectal wall and an inconclusive lymph node. 4/25 - special PET scan for prostate. No metastasis seen. 5/25 - MRI guided biopsy. 19 of 20 positive. 16 at 3 + 3 and 3 at 3 + 4 and one not rated but with intraductal carcinoma found. Met with RO and Surgical Urologist Oncologist. Frustrating, long experience with what I felt was sugar coating until the Surgical Urologist. I’m pretty good at research and from the MRI results and especially with the guided biopsy with intraductal found, I kept finding research that showed it was an aggressive cancer. My husband is one of the most calm, laid back people I know and I’ve been way more worried than him. “I’ll worry when I need to” The Surgeon was very clear that his cancer is considered aggressive and he will probably need to do a trifecta of treatment. (Surgery, Radiation, and Hormone) Surgery is on 9/4.
I’m on research overload and would like some feedback or answers.
* Is cribriform same as intraductal.? Both mention it pushes to aggressive grade.
*. His PSA has never been really high. The highest was a 5.1 and the last was 4.7 and the gland can’t be felt during an exam. Any ideas as to why so low with aggressive grade?
* Talking about Salvage Radiation after surgery healing. How long out?
* There is such little info on intraductal and I’m afraid that there are things we (I) don’t know that may influence choices. I’m not trusting the health care system in general as the only one who said that with the intraductal factor, the best chance for recovery was with removal.
* Mostly I just need some support from people with a similar experience with PC for right now as we navigate this chapter. Tomorrow is a new day and most days I’m okay enough.

Thanks for reading this long, unedited purge of my brain.

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bens1 | @bens1 | Aug 21 7:01am

So many good answers from these guys so the only thing I would add is that if you do use radiation, at all, you may want to ask for an MRI guided radiation machine which would be either the Mridian or the Elekta Unity. Here is a link to an article on the subject of the Mirage trial regarding MRI guided radiation machines.
https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt

heavyphil | @heavyphil | Aug 21 7:59am

All of the comments here are excellent and all urge treatment sooner rather than later. I agree
The thing that jumps out at me from the biopsy is the lesion abutting the rectum. This is a serious consideration as far as any type of radiation is concerned.
Even with the most accurate machines, How close can they get to that lesion and destroy it without destroying the rectum?
Usually a gel spacer is used but can they get it precisely between the lesion and the rectum? These spacers are by no means a guarantee of anything; they move, settle, shift and sometimes separate, making gaps in the barrier.
If it were me, and this is only an opinion - not medical advice - I would want an excellent urologist/oncologist surgeon in conjunction with a colorectal surgeon, who might want to scrub in and perform whatever procedure is necessary to get rid of the lesion and preserve the integrity of the rectum.
Phil