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Radiology oncologist consult two days prior, here's the take away
Another in depth DRE(pun intended(ouch) Based on my situation he thinks my best chance at beating this is EBRT for 5 weeks, followed by permanent seed implants, with an option for additional hormone therapy,2 weeks prior on Casodex and then 6 months of Lupron injections. The hormone optional, depending if I want to "throw the kitchen sink" at it(his phrasing), but not essential. I have to decide if the potential side effects are worth the potential benefits of adding the hormone therapy. I've heard just Casodex for a few months would be sufficient?
I do not have an enlarged prostate but his thinking was it will start to weaken and kill the cancer cells right away and aid in the radiation to follow.
So what are your thoughts on adding the hormone therapy as a 3-prong approach?
I had asked him, if I were a good candidate for surgery would he tell me. His answer surprised me. He referred me to the grimm study on prostate cancer(poor choice of name for this doc), that is supposedly unbiased, showing this 2 or 3 prong radiation approach is superior to surgery for survival rates and less side effects for all, unless your at the two ends of the spectrum, meaning active surveillance or too late and hormone is it
One of my fears is having surgery with finding positive margins, due to the degree of cancer throughout my prostate(8 cores+ both sides, apex involvement along with the perineural invasion, requiring salvage radiation, compounding the worst side effects of both.
One of my fears with this approach, I already have nocturnia and a low flow and these problems increase after seed implant. I guess I would need clearance from my Uro that I would be a good candidate. The RO did say that any flow problems if bad enough need to be corrected first, would the IPSS score tell me that?
He has done over 4,000 seed implants, he states, the advances in technology have increased dramatically allowing for ever more precise targeting of the prostate, resulting in less damage to surrounding organs.
What do you think?
2ND OPINION on pathology report PSA 2.9 2007 5 in 2011 5.6 recently 8 of 12 cores positive
A) Left Base: Benign prostatic glands and stroma.
B) Left Mid: Prostatic adenocarcinoma, Gleason score
3+3=6, measuring 2mm (10% of the tissue).
C) Left Apex: Prostatic adenocarcinoma, Gleason score
3+3=6, measuring 7mm (40% of the tissue).
D) Left Base Lat: Benign prostatic glands and stroma.
E) Left Lat Mid: Prostatic adenocarcinoma, Gleason score
3+3=6, measuring 2.5mm (20% of the tissue).
F) Left Lat Apex: Prostatic adenocarcinoma, Gleason score
3+3=6, measuring 1mm (7% of the tissue).
G) Right Base: Prostatic adenocarcinoma, Gleason score
3+4=7, measuring 4mm (30% of the tissue).
H) Right Mid: Small focus of atypical glands.
I) Right Apex: Prostatic adenocarcinoma, Gleason score
3+4=7, measuring 5mm (40% of the tissue).
J) Right Lat Base: Prostatic adencarcinoma, Gleason score
3+3=6, measuring 3mm (30% of the tissue).
K) Right Lat Mid: Small focus of atypical glands.
L) Right Lat Apex: Prostatic adenocarcinoma, Gleason
score 3+3=6, measuring 1mm (5% of the tissue).
Comments: Perineural invasion is seen in these biopsies.
Eight of twelve tissue cores are involved with
adenocarcinoma.
I had 6 months of hormone therapy in conjunction with salvage radiation. The therapy consisted of 2 (3 month) Lupron treatments with some Casodex in the beginning of treatment. It has been 10 months since I started and my hot flashes are now abating. My Testosterone is also now at a normal level. My side effects were loss of libido, slightly foggy mind and the worst were the hot flashes. The studies I read indicated that hormone and radiation therapy used together is much more effective. By the way, my PSA was 0. Hope it stays that way.
You say ......He referred me to the grimm study on prostate cancer(poor choice of name for this doc), that is supposedly unbiased, showing this 2 or 3 prong radiation approach is superior to surgery for survival rates and less side effects for all.....
Dr Peter Grimm is well known in the cyberspace discussion groups. He and his partner Dr Blasko specialise in brachytherapy and have long held the view that the results from brachtherapy are superior to any other therapy. Together they have authored many studies to demonstrate this view, which is not universally shared. As you know, there are no definitive studies that demonstrate that brachytherapy, with or without adjuvant therapies, is superior to other therapies. Dr Grimm's site is Prostate Cancer Treatment Center (PCTC).
There is a Radiation Oncology group within a 2-3 hour drive that touts the latest in technology. How much of the following marketing is based on fact how much is hype?
"For more than 40 years the evolution of radiation delivery technologies has been based upon a single objective: maximize the dose to the tumor while minimizing the dose to surrounding normal tissue. Today the most advanced beam technology available is DART using all methods of 4D IG-IMRT and the Dattoli Cancer Center was the first facility in America to offer it to patients.
More patients with prostate cancer have been treated with DART at Dattoli Cancer Center than any other center in the world by fourfold. Moreover, DCC boasts having the most sophisticated technologies to achieve DART, providing every patient with a cutting edge experience.
DART may also referred to as "Smart Beam" technology because of its extraordinary ability to cast thousands of precisely targeted radiation "beamlets" or "microbeams,"on a 360-degree radius, not only into the prostate, plus a carefully delineated margin, but also in escalating doses directly into the tumor(-s) while de-escalating doses to the urethra. A unique treatment blueprint is mapped out in advance for each patient. With computer planning and three-dimensional imaging techniques, it is possible to more accurately deliver radiation to satisfy pre-defined dose specifications to the tumor while avoiding nearby healthy tissue. Thus, the risk of damaging the bowel, bladder, rectum and other organs is significantly reduced. At the same time, the cancer-killing dose of radiation is maximized on the designated target"
