Newly diagnosed and looking for treatment advice.

Posted by quaddick @quaddick, Sep 23 12:19pm

Hi, everyone. I’m 66 years old and am newly diagnosed with prostate cancer. I currently have no continence or erectile dysfunction, I take no medications, and am healthy otherwise. I haven’t decided on a treatment yet. My cancer is localized to the gland and is low intermediate risk (3+4), so my options range from active surveillance to RP. I’d prefer a one and done treatment, and after lots of online research, I’m leaning towards SBRT. I’d like to avoid ADT if possible, but am worried by my high risk Decipher score of 0.81.
Also, I’ve heard of the Prostox test for predicting urinary problems years down the line from SBRT and IMRT. My radiation oncologist is reluctant to order it for me, because it’s not yet vetted by the FDA. From what I can gather, it’s a legitimate test and Dr. Scholz of the Prostate Cancer Research Institute(many of you are probably aware of PCRI- excellent you tube channel) has positive things to say about it. I am sexually active and still enjoy it, but I am more worried by chronic incontinence as I enjoy lots of outdoor activities.
I would appreciate advice from this community before I make a decision.
Thanks!

My stats:
>PSA 13 bounces up down between 9 and 14 for last few years
>MRI: A 2.2 cm PI-RADS 5 lesion posterior lateral left peripheral zone at the mid gland. An additional
0.6 cm PI-RADS 3 lesion right lateral peripheral zone at the mid gland. No pelvic metastatic disease
findings
>targeted biopsy report: A. Prostate, lesion 1, biopsy: Adenocarcinoma of the prostate, Grade Group 2
(Gleason Score 3+4 = 7/10), in 3 of 3 cores, involving 45% of needle core by volume, Gleason pattern
4 comprises 15% of tumor volume. Perineural invasion is identified. B. Prostate, lesion 2, biopsy:
Adenocarcinoma of the prostate, Grade Group 1 (Gleason Score 3+3 = 6/10), in 1 of 3 cores, involving
5% of needle core by volume. Perineural invasion is not identified.
>Psma pet scan: Mildly tracer avid prostate malignancy. No definite tracer avid nodal or distant
metastases. Clinical stage T1c
>Decipher score .81 high risk

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

steveduke | @steveduke | Oct 11 12:12pm

Yes, This is precisely why my marrow team asked me to Stop for 2 weeks while they studied and tried to determine impact. They eventually (as I wrote) determined that I could go ahead. The radiation could very well lower my”factory” production even further, and also possibly cause mutations, new or dormant, to surface. Not good. However, waiting and watching wasn’t really in the cards but I could have and then I’d have a race to see what eventually kills me, LOL. So - yes. There are risks. I am getting a spacer to protect the intestines and they’re implanting markers for guidance. My Radiation Oncologist is on board and one of the “ringers” they’ve brought on board recently who has all he latest knowledge etc. The conversation you want to have is about risk.