I've been taking propecia for years - probably close to 12 years - for hair loss. It seems to have worked and I didn't really lose more.
Anyhow - as you may know I've now have a dx @ 49 years old with G9 (4+5) in one core (10% to 40% involved, depending on pathology report) out of 13 samples - the rest were benign. My PSA is 3.56 (yep, low, but I'm sure that's due to the propecia).
So I've read a lot about the studies around finasteride and the ups and downs, first they said it causes high grade pc, then they said it doesn't.
From what I'm understanding, and I could be way off, due to the much smaller prostate from the propecia, it can make the biopsy cells look more aggressive - something about them being nests of cells tightly together, where as in a normal prostate they would be more spread out and not as aggressive looking?
I'm keeping my fingers crossed that this is all found early - they had to do an MRI to even find where to target the biopsy since I'd already had one come back negative last year. They also say it's in the middle, so I'm hoping for it to be contained. The only item I'm really worried about is that it's a 9 and chances for it coming back after surgery are high. After reading more about finasteride, I guess I wonder if it's really a 9?
Your second pathology report was from Epstein's lab, right? They are pretty expert at reading biopsy cores, so I doubt that they'd make that mistake. Because finasteride shrinks the prostate, it is much more likely to find high Gleason grade cells hiding within its reduced volume. You're right that hyperplasia cells from BPH might diminish, which means the size of healthy cells is reduced to a more normal level, but those cells would look compact and normal under the microscope, as they should look. Higher Gleason grade cells have a characteristic distorted look and may have nuclear abnormalities as well, which, I would hope would be apparent to pathologists in Epstein's lab.
It is great that the amount of cancer is small and that it was detected far from the edge of the prostate. You should be aware that these high grade cells can migrate through veins and lymph. And it is unknown whether cutting into them may release them into general circulation.
I happened to have just pulled some numbers you may find enlightening. Dr.Bandini reports in the largest such study ever done that 5-year recurrence-free rate after robotic surgery is 53% for those with Gleason 8-10. The comparable number after CyberKnife treatment is 78%.
Thanks Allen - yep, it was read by Epstein, so you're right, I would expect they would get it right.
You've hit my fear exactly - with a 9 I keep hearing there is a high likelihood that it's in my bloodstream. So far all the test say it appears to be in the capsule, which is good. I am still leaning towards surgery - and not so much from the "get it out" feeling, and I'm not a fan of surgery by a long shot, but it just seems like there are too many variables with leaving it in - I can't get a good feeling for how extensive the cancer may be and or how truly aggressive. My PSA is low and the velocity has been very slow and steady - about .5 per year. I'm also only 49, so I have a long way to go in my book and I want options, I don't just want a 10 year survival rate, I want 20 to 30 at least
Removing it just seems to remove that variable from the mix and I would then know if it comes back that it escaped and I can then go with radiation and HT.
As far as CK - everything I read seems to say it's for G7 and under guys - I've not heard of it being used for someone like me.
Once again - thanks for the feedback - I always appreciate the input and advice!
There is a comfort to many men to having the whole prostate out to biopsy. If that gives you more peace of mind, that decision makes a lot of sense to me. I think that treating any disease is more about the whole person than just the disease.There are tests for circulating tumor cells (CTCs) but they aren't likely to detect any when your PSA is as low as yours.
The use of CK for high grade PC is not common. The first I'd heard of it was from Dr. Alan Katz in Flushing, NYC, who was one of the first CK practitioners. He told me the process is basically the same, except he treats a much wider margin outside the prostate. Because prostate cancer cells are better killed by more intense radiation treatments (biologically, this is called a low alpha/beta ratio; and the intense process is known as hypofractionation), and because rectal and other healthy tissues are more likely to survive that kind of treatment (they have a high alpha/beta ratio), CK is especially effective at killing off prostate cancer while preserving the bladder and rectum. HDR brachytherapy works similarly. I was very impressed by the five year results. Speaking to Dr. Katz, he believes that the results will be long-lasting because the PSA was driven so low by the treatment, the wide margin of treatment and the very efficient cancer cell killing.
CK was first used in 2003 and robotic prostatectomy was first used in 2000, so unfortunately, we don't really know how well either will work in 20 years. Of course, if there have been micrometastases already, none of these treatments will be curative. I wish we knew more.