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Third SBRT Opinion Worth It?
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Me:
Age 50, Gleason 7 (3 + 4), 0.56 intermediate risk, 6/12 cores, PSA 6.68, PSMA showed no metastasis to lymph nodes or bones, cystoscopy showed no obvious issues.
My dilemma:
The surgeon who did my biopsy recommended treatment (RP or RT), as did two separate ROs, all local to me in Louisville, KY. I'm leaning ever so slightly towards radiation but it's not a done deal.
The first RO suggested a 9-week course and the second RO recommended a 4-week course, both with 6 mos. testosterone blocker. Both ROs recommended against SBRT/Cyberknife due to existing issues (frequent urination, weak stream). Before seeing the second RO, the urologist at that center suggested that I might be a candidate for Cyberknife. Based on that, I decided to initiate a visit to MD Anderson for a tie-breaker, mainly thinking the MR-Linac might be an even better option than Cyberknife.
Now that both ROs here have frowned on SBRT, I'm not sure about traveling to Houston. I don't think it would be feasible for me to get a 'regular' course of treatment (RT or RP) there, but I guess it might be worth having them tell me for sure MR-Linac is not a good option.
I'm open to wisdom, experience, and informed opinions. Thanks.
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I have similar condition, PSA 8.3, age 67, .32 intermediate risk, one sample from two biopsies (total 31 needle samples) that had 5% 4, (3+4). I decided on SBRT with MRI guide, 28 days of 250 Gy. The doctor said I will not need gel due to the accuracy of the Trubeam equipment. He also said with the minimal cancer present I will not need to take testerone therapy. Plan on starting end of the month. For me it was either radiation or monitoring. The idea of more biopsies and no testerone therapy solidified the SBRT choice.
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2 Reactions@jeffmarc Did your brother at 78 have a biopsy & MRI before SBRT? If he did have a biopsy, how long did he wait before SBRT? I read that after biopsy, the prostate would have inflammation for weeks, may be too close with other organs that could be accidentally rsdiated. I had my biopsy few weeks ago, G7 (3+4), positive on 8 of 14 cores, unfavorable intermediate. I'm waiting for date of either RP or SBRT; I'm more inclined to (feel more comfortable with) SBRT that was your brother:s choice too.
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1 ReactionMy brother was actually 77 when he had the biopsy. Surgery was a few months later. it is recommended that the surgery be delayed 4 to 8 weeks to reduce or eliminate the Inflammation. Not a long wait, considering how slow prostate cancer normally grows. Also, people are usually put on ADT before having radiation so that stops their cancer from growing.
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2 ReactionsMy MD Anderson biopsy (re)analysis results just posted in MyChart and their findings are essentially the same as the first lab. Six out of twelve cores were positive, four Gleason 7 (3 + 4) and two Gleason 6.
The only differences are that MD Anderson gave slightly lower percentages of Grade 4 in two cores (20% vs. 30% and 5% vs 20%) and noted "a few atypical glands: suspicious for prostatic adenocarcinoma" in a seventh core not identified in the original analysis.
So what’s your game plan - active surveillance or treatment?
Treatment, still deciding on which route.
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