1. < Prostate Cancer

What would be best course of treatment

Posted by jeepio @jeepio, May 27 4:26pm

My MRI: Large lowADC lesion throughout the right peripheral zone with extra prostatic extension and involvement of the right neurovascular bundle categorized as a PI-RADS 5 lesion
Prostatomegaly with BPH
No evidence of local regional lymphadenopathy or osseus lesions
Right seminal vehicle containing a fluid level which may represent hemmorrage products
Petscan: findings consistent with prostate cancer but no F18 Pylarify avid metastatic disease
Biopsy: PSA 4.41 Summary Adenocarcinoma
Gleasonscore 7 ( 3+4)
Grade group 2
7 positive cores
Longest tumor involved 30%
Decipher: High risk 0.95 ( aggressive tumor)

I’m two months away from being 74
Does’nt look like I want to wait and see what happens
Generally pretty healthy
Have been looking at options; if radiation, would prefer Proton
My urologist ( not a oncologist/urologist) advises no surgery and referred me to his radiologist he works with, have not seen him yet, but they dont use proton beam.

Remember that old program on tv “ what would you do?
Hve a appoint with Mayo urologist ( wanted oncologist/urologist but since I had seen their urologist 1 time for a opinion to try to get biopsy faster, they don’t want to change ( against the rules, she said)
Hoping he’ll send me the right direction..Also. They don’t have Proton in Jacksonville yet..
Thanks for any input, love this board!
Wishing all of you strenght on this path!

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

jeepio | @jeepio | May 29 7:24am
In reply to @heavyphil "All the comments suggested are excellent. The big standout for me is that high Decipher Score...." + (show)
@heavyphil

All the comments suggested are excellent. The big standout for me is that high Decipher Score.
Was there any cribriform/IDC pattern in your biopsy?
That is tough to eradicate with radiation alone so the suggestion of ADT is a good one to weaken the cancer.
Also, you might inquire about HDR brachytherapy in conjunction with SBRT or IMRT. This is short term ( minutes to an hour) high intensity seed placement to blast the worst area since it can be resistant to external radiation alone. It is then followed by a course of SBRT (5 tx) or IMRT (25-39 tx).
Sorry to muddy the waters, but I personally am against surgery at age 74 as well and would like to see you treat this without it. Best,
Phil

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Thank you Phil
I’m new to this, have to look up the terms you mentioned.
In the meantime , appreciate the advise!

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jeepio | @jeepio | May 29 7:28am
In reply to @daveinflorida "I'm pretty sure TULSA-PRO would not be appropriate for a cancer with extra prostatic extension and..." + (show)
@daveinflorida

I'm pretty sure TULSA-PRO would not be appropriate for a cancer with extra prostatic extension and involvement of the right neurovascular bundle. I had a very small area of EPE, with no spread to other areas (yet) and my RO said focal therapy would be contraindicated as it would not cover the EPE, or in the OP's case, the nerve bundle.

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Sounds like this will be the case with me too; it’s protruded thru the wall already..
Thank you, Dave

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jeepio | @jeepio | May 29 7:30am
In reply to @brianjarvis "Your high decipher score indicates a higher risk of prostate cancer spreading and metastasis. With your..." + (show)
@brianjarvis

Your high decipher score indicates a higher risk of prostate cancer spreading and metastasis.

With your 3+4, what % were the “3” and what % were the “4”?

What were the SUVmax scores of the lesions they indicated were “consistent with prostate cancer”?

If you choose proton radiation, is there a proton center nearby?: https://www.proton-therapy.org/map/

(At 65y/o, and with a 3+4, I chose proton radiation + SpaceOAR Vue. I finished my 28 proton radiation treatments 4 years ago today. Today, it’s as if nothing ever happened - just walked in a door, got treated (28x), and walked out the door…..it’s practically back to the way it was before the prostate cancer journey started.)

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That certainly gives me hope, Brian!
Thank you!

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jeepio | @jeepio | May 29 7:32am
In reply to @surftohealth88 "Just wanted to repeat what Phil said - if you have cribriform or IDC formations RP..." + (show)
@surftohealth88

Just wanted to repeat what Phil said - if you have cribriform or IDC formations RP might be beneficial. If you are in good health (as you stated that you are), your age of 73 should not be a limiting factor for the surgery. Your Decipher points to very aggressive cancer and if it is contained in a prostate RP is viable solution if you want to have it.

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Thxs for your comments; we’ll see, it’s protruded theu the wall already..

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icorps | @icorps | May 31 7:32am

You might consider contacting Dr Sean P. Collins. He Chairs the Radiology Department at the University of Southern Florida. He treated me at Georgetown University Medstar. The physician heading a clinical trial I'm in at NCI referred to him as being a "world expert". Also has a great "gallows" sense of humor, once reassuring me about my prospects with, "I wouldn't sell your house just yet."

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