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Nearing decision time: what treatment?

Posted by TommyG @tdgillett, May 30 6:08am

Most recent biopsy showed 4+3 in 2 areas and 3+3 in another. See my profile for fuller info (80 yo, good health, large prostate 114 cc, BPH but with a fairly low IPSS score, PET shows PCa NOT metastasized, Artera AI forecasts very low % of risk--"with standard of care treatment," etc.)
After a series of local consults (I am in a city with a cancer center of excellence) and opinions from others via Zoom at Mem Sloan Kettering and another prostate center (Scionti), I'm thinking my best option is to deal with this in 2 steps: first, some form of ablation to reduce my prostate size (and target areas of the gland where cancer shows on the PET) and then to reassess in 6 months for PSA and MRI to see if I need to plan another procedure to deal with whatever is left. The 2 MRIs I have had to date do not show the actual cancer lesions, but the needle samples have shown them in certain zones, confirmed by the PET scan. I'm leaning in the direction of hi-fu at this point, but other BPH treatments are under consideration. TULSA won't work for me because of a hip replacement in 2024.
I value the depth and breadth of experience on this forum and welcome thoughts about how this tentative plan sounds. I realize the approach I'm considering may have a higher possibility of recurrence, but even RP doesn't guarantee a clear future. I'm grateful for the collective wisdom on this forum!

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

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Jeff Marchi | @jeffmarc | Jul 17 10:52am
In reply to @tdgillett "Thanks to all who have weighed in on my situation. My wife and I have come..." + (show)
Profile picture for TommyG @tdgillett

Thanks to all who have weighed in on my situation. My wife and I have come to a decision after many consultations with my local urologists/RO and hematologist, as well as my PCP. For an array of reasons--no clear lesions on 2 MRIs, no metastases on PSMA-PET, low PSA density (.04-.06), large prostate (114 cc), age 80, "normal" PSA (5.1, 7.6, 4.5) in recent months, Artera and Decipher not alarming, BPH not causing unacceptable symptoms--I will have PSAs in August and December and an MRI in early 2027 with a possible PET scan following the MRI. We'll see what happens with this approach and adjust if/when we need to do so. I'm still entertaining the possibility of some form of ablation to reduce the size of my prostate so that if/when I decide on treatment, radiation options are included (prostate too large for radiation or focal therapies at this time). And who knows, maybe another treatment that matches my PCa and profile will emerge in the meantime!

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@tdgillett
With a prostate that large, you probably are not going to be able to get radiation. Have they given you antibiotics at all? That can help some people with BPH but I guess you need to ask the doctor what they think.

Going on ADT can also shrink your prostate. It may not be something you really want to do, but it may help a lot. Another thing to talk to the doctor about.

Getting the size of that prostate down, can give you a lot more options.

I know one guy that had a huge prostate. Had a PSA of 50 and multiple biopsies showed nothing.. Ended up dying of a totally different type of cancer.

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jim18 | @jim18 | Jul 17 11:48am
In reply to @tdgillett "Thanks to all who have weighed in on my situation. My wife and I have come..." + (show)
Profile picture for TommyG @tdgillett

Thanks to all who have weighed in on my situation. My wife and I have come to a decision after many consultations with my local urologists/RO and hematologist, as well as my PCP. For an array of reasons--no clear lesions on 2 MRIs, no metastases on PSMA-PET, low PSA density (.04-.06), large prostate (114 cc), age 80, "normal" PSA (5.1, 7.6, 4.5) in recent months, Artera and Decipher not alarming, BPH not causing unacceptable symptoms--I will have PSAs in August and December and an MRI in early 2027 with a possible PET scan following the MRI. We'll see what happens with this approach and adjust if/when we need to do so. I'm still entertaining the possibility of some form of ablation to reduce the size of my prostate so that if/when I decide on treatment, radiation options are included (prostate too large for radiation or focal therapies at this time). And who knows, maybe another treatment that matches my PCa and profile will emerge in the meantime!

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@tdgillett If you decide to treat you might look into the Aquablation for prostate cancer trials (GG3 or below, T2 or below) where both issues can be taken care of in one treatment. Not a candidate so I have not investigated the downsides of this treatment. Just saw that this trial is enrolling.

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