Targeted Treatment Options - Tulsa Pro and MRI-Guided SBRT Options

Upon initial "diagnosis" I was very attracted to the ablation strategies as opposed to surgery. However, the research urologist whom I consulted about a clinical trial ruled me out due to that same gleason score--4+3, meaning that in this site you had more grade 4 than grade 3 cells in at least one of your biopsies. Based on what I've read, I would also be further concerned by your low PSA. The reason is because I understand that low PSA for a given grade of cancer might be associated with more aggressive cancer. So I ended up going with surgery, and even then the post-surgical biopsy found positive margins, meaning that the cancer extended to the edge of what was removed intact (in one small area.)
MRI/ultrasound-guided ablation is more targeted and therefore has less side effects, but the researcher (who did not do my surgery) noted that he had seen more long term complications from radiation than from surgery. Of course, things are always changing, but I considered this my best advice and reluctantly proceeded directly to surgery.
One other thing that I found interesting is that these radiation setups are hugely expensive, and so, while the outcomes are not (or not yet?) better for many patients, those who have invested in these setups have a compelling interest in seeing them widely used. The same thing happened with open vs robotic surgery--no better outcomes for robotic, at significantly higher cost, but once a new generation of surgeons trained on the robots [RALP, ] they have become increasingly prevalent. And yes, that's what I had. Thank you, medicare.
Of course, at some point I may need radiation as well, and once the prostate is gone apparently it's a lot harder to target!

Thanks for your reply! I haven't yet (through my research) uncovered a correlation between low PSA for a given grade of cancer and more aggressive cancer, but I'll definitely follow-up on that. May I ask how long ago you had your procedure? I'm assuming it was a RP and not surgery targeted to just a lesion?
Yes, there have been many new developments relative to PC in just the last five years. Unfortunately, that means there's not long term study data to assess the longer term implications of the newer treatment options. I'm still considering all options but still leaning toward targeted treatment versus something more radical. Maybe I'll live long enough to see how good my decision turns out...
Hope you are doing well. Thanks again!

I am currently waiting on my first Proton radiation treatment of five at Mayo Phoenix to start on April 17. You like me have unfavorable intermediate risk prostate cancer. I did not want surgery. My PSA was 2.9 and my biopsy showed 4-3 Gleason with some 3-4 all confined to the prostate on one side at the base. I would have preferred to get the Mridian Viewray but there are no centers nearby. Nearest is in California. I would have liked to do the HIFU but the doctor who did my transperineal biopsy said I had too many calcifications to try it and did not want me to be a guinea pig. That is why I chose radiation. I am 73 and 7 months old so if the treatment gives me 15 years I am now almost 89 and wonder what life will be like at that age.

Consider the following quote: "Although it would be desirable to detect the small proportion of high-grade cancers — cancers that are likely to be life threatening — in men with low PSA levels, the identification of such cancers will require the development of new biomarkers, because high-grade cancers actually produce less PSA than low-grade cancers, after correction for cancer volume.7 The increasing prevalence of high-grade cancer with increasing PSA levels reflects the finding that higher-grade cancers are more often larger in volume than low-grade cancers, and the PSA level is directly related to the volume of the cancer.7" from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474980/. The reference is 7. Partin AW, Carter HB, Chan DW, et al. Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia. J Urol. 1990;143:747–52. [PubMed] [Google Scholar] (That's old, but it should get you started if you want to research this.)
So, you told me 1) there was just one lesion identified, 2) yet that one lesion was 4+3, and 3) your PSA was under 4. It's surprising that you even got an MRI and biopsy with your low PSA, yet there it is--higher grade cancer than most cancers that are found--usually 3+3 or 3+4.
I guess on the other hand, if there really is just one lesion, that's a better situation for targeting. What I would say is that so far only one lesion has been identified.... And yes, may you live long and prosper 🙂
My RALP was February 2022.

Thanks Mikewo. Sounds like we had a very similar diagnosis. Best wishes in your treatment!

Maverick 75: I finished my fifth and final treatment with the Mridian Viewray machine in February. My PSA was 10.2 with 3+4 tumors. I had considered Radiation and prostate removal. In terms of radiation, the margins used with the type of radiation are a big deal . The Mridian Viewray uses 2 mm margins based on a recent randomized trial. The wider, the margins, the more the healthy tissue is impacted. You will find that other forms of radiation use 4-6 mm. I looked at a great number of choices, and would make the same decision again.

Where did you have it done. Was Space Oars used with the treatment.

I had my treatment done at the Orlando cancer center by a doctor Kaitlin Christopherson. I did have Spaceoar and I am glad that I did that. it basically gives you an extra half inch of space between your rectum and your prostate.

Looks like you have several months under your belt since the procedure. Mind if I ask of any side effects you experienced and what type of monitoring protocol you are now under?

Maverick75: After the 4th treatment my urine flow was more constrained, so I started taking Flomax which my RO had prescribed ahead of time, just in case. My urine flow improved as a result of the Flomax within a day or two. I am still on it but probably will get off of it over the next couple of weeks and my RO said I could manage that myself as I see fit. I have been a bit more tired but nothing that has restricted my activities. My next appointment with my RO is in June to check my PSA and she made a point of saying do nothing to raise my PSA...sex, bicycle riding...