@jc76

Thanks for sharing your thoughts. I have complete confidence in my team at UCLA. My urologist is a national leader in the prostate cancer field, so I had no reason to question his biopsy approach. Too, he recommended active surveillance rather than intervention when first diagnosed because at Gleason 6/7 with a low Oncotype score (his choice over the Decipher test) the odds of progression to aggressive disease were low. All medical decisions are based on statistics, and in my case no matter how low the odds, my progression to Gleason 9 was 100%. No point in using questioning whether a therapeutic window was missed earlier on, I must forge forward.

Treatment plan is for MRI-guided SBRT delivered as an excelerated 5 treatment (every other day for 5 treatments) with convincing data documenting equivalent outcomes and side effects compared to the more standard extended low dose regimen. I had a Prostox (MiraDx) genetic test documenting I was at low risk for late toxicities from high-dose radiation.

Thanks for sharing your input with the SpaceOAR procedure. While I did not find the transrectal biopsies painful, I am going to request mild sedation. I believe it is simply a low dose of Valium (diazepam) given before the procedure to supplement the local anesthesia given by level
of anxiety and associated depression as I head into therapy.