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My local urologist was very personable and for months told me what I wanted to hear. He was leading me down a dark hole. My new urologist at UCLA was not as personable but laid out the facts. He was great. An excellent surgeon. He was more like a mechanic. My point in responding is to let others know that picking a urologist (surgeon) should not be based on personality.
I am 68 years old and have recently been diagnosed with Gleason 7a (3+4), PSA = 9.1. A more detailed description complete with an abstract of the biopsy report is available on Yananow under the category "uncommon, experimental", and the name "RICK E E".
I have been offered the opportunity to be involved in a clinical trial . If I am able to "pass" the various tests listed below and can show that I indeed have "unifocal" prostate cancer, I will then have just the tumor removed leaving the balance (maybe 2/3? of the prostate) intact and functional. I feel that if I don't avail myself of this opportuninty now it may have passed me by forever.
I also feel that I should treat this cancer NOW especially since there is a relatively small component that is grade 4. This newer therapy is a much less radical approach than we have seen in the past. If this cancer was Gleason 6 (3+3) I might take the watch and wait route.
Tests that I would be scheduled to have include : "a pelvic phased array coil and injection of contrast dye to perform : Dynamic Contrast Enhanced MRI (DCE-MRI)" and an "MR Elastography" + an "11C-choline PET/CT" + an "Ultrasound Elastography" + a "Three-dimentional transperineal mapping saturation biopsy", NONE of which would be available under standard protocol for any prostate procedure in Canada that I'm aware of. The ONLY diagnosis available in standard protocol are DRE, PSA and a possible CAT scan along with a bone scan and this leads to the ONLY therapy procedures available that I'm aware of on the standard protocol are RP, EBRT, or Brachytherapy which will all be whole gland therapies. It is my understanding that any so-called "focal" therapy is considered "experimental" in Canada and may also be in some other countries as well . If these tests were to confirm "unifocal", intraprostatic cancer in less than half of one "lobe", I would be implanted with the prescribed amount of LDR seeds required to ablate the focal tumor only (plus a "surgical margin") while leaving the balance of the gland intact and functional with hopefully decreased morbidity/side effects. There are numerous follow-ups involved such as future PSA tests every three months, MRI's once a year for the next two years, and one further saturation biopsy two years down the road.
My question is simply this : Does this regimen sound like a sound approach or am I leaving too much to chance in regards to a possible recurrence later on? Any input would be valued.