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    Old 01-05-2020, 01:46 PM   #1
    BlueHeron2020
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    Starting my PCa journey

    Hi folks, been lurking here for few weeks since I was diagnosed with prostate cancer. I have read many helpful threads and thought I would join in. As many can probably guess, my diagnosis by Urologist ended in a recommendation for prostatectomy. I am scheduled to meet a radiation oncologist next week to review radiation treatment options. I am 65 years old and in pretty good shape with a good 20+ years of life left (I hope!). So the journey begins....I am cautiously optimistic and trying to determine my next steps. Recommendations on treatment options and further medical testing would be greatly appreciated.

    One more thing, there are a lot of acronyms in the threads, is there a glossary explaining them somewhere?
    Thanks!
    __________________
    64 Yrs old, BMI 23.1, Active and healthy walker, hiker, surfer
    Hope to live 20+ more years
    2012-2019 linear PSA progression 2-6.9
    Oct 2019 3T MRI Two areas pirad 4 identified
    Dec 2019 MRI US fusion biopsy
    4/27 cores positive
    GS 6(3+3) 10% core volume random area
    GS 7(3+4) 30-40% core volume random area
    2/7 cores GS 7(3+4) core vol 10-20% target area
    Urologist recommends prostatectomy
    Radiologist recommends: TBD

     
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    Old 01-05-2020, 04:11 PM   #2
    ASAdvocate
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    Re: Starting my PCa journey

    I would recommend that you buy these two books:

    Surviving Prostate Cancer, 4th ed, by Patrick Walsh
    The Key to Prostate Cancer, by Mark Scholz

    The first book gives a comprehensive understanding of the disease; while the second presents the views of 30 prostate cancer experts on the treatments available foe men at different risk levels>

    When researching radiation, be sure to learn about SBRT/Cyberknife and proton beam therapy. Those two treatments are reporting non-recurrence rates that no others can match.

     
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    Old 01-05-2020, 04:11 PM   #3
    Steve135
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    Re: Starting my PCa journey

    Welcome 2020 sorry your here! The group of people hear have a world of information, don't be afraid to ask lots of questions prior to making your choice! At 65 you should have all the options open to you. Each comes with there very own pluses and minuses! 3+4 is the better side of 7 to be on. Cyber Knife is a great option to have today!
    steve d
    ___________
    Diag. 56 DOB 2/59 PSA 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins NP lN's 5 neg pT3a,N0
    PSA 10/16 0.1 1yr 02/7/17 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm BCR rt. SVB Casodex + Trelstar
    04/17 SRT (42)
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/19 03.2 6/19 0.34 7/19 0.06 8/19 0.08 9/19 0.056
    10/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion

     
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    Old 01-05-2020, 04:37 PM   #4
    BlueHeron2020
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    Re: Starting my PCa journey

    Quote:
    Originally Posted by ASAdvocate View Post
    I would recommend that you buy these two books:

    Surviving Prostate Cancer, 4th ed, by Patrick Walsh
    The Key to Prostate Cancer, by Mark Scholz

    The first book gives a comprehensive understanding of the disease; while the second presents the views of 30 prostate cancer experts on the treatments available foe men at different risk levels>

    When researching radiation, be sure to learn about SBRT/Cyberknife and proton beam therapy. Those two treatments are reporting non-recurrence rates that no others can match.
    Thank you ASAdvocate, I will look at those books. I believe the radiation oncologist I am visiting covers both photon and proton radiation, I will ask about Cyberknife.
    __________________
    64 Yrs old, BMI 23.1, Active and healthy walker, hiker, surfer
    Hope to live 20+ more years
    2012-2019 linear PSA progression 2-6.9
    Oct 2019 3T MRI Two areas pirad 4 identified
    Dec 2019 MRI US fusion biopsy
    4/27 cores positive
    GS 6(3+3) 10% core volume random area
    GS 7(3+4) 30-40% core volume random area
    2/7 cores GS 7(3+4) core vol 10-20% target area
    Urologist recommends prostatectomy
    Radiologist recommends: TBD

    Last edited by BlueHeron2020; 01-06-2020 at 09:26 AM.

     
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    Old 01-05-2020, 09:14 PM   #5
    guitarhillbilly
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    Re: Starting my PCa journey

    Quote:
    Originally Posted by ASAdvocate View Post
    I would recommend that you buy these two books:

    Surviving Prostate Cancer, 4th ed, by Patrick Walsh
    The Key to Prostate Cancer, by Mark Scholz

    The first book gives a comprehensive understanding of the disease; while the second presents the views of 30 prostate cancer experts on the treatments available foe men at different risk levels>

    When researching radiation, be sure to learn about SBRT/Cyberknife and proton beam therapy. Those two treatments are reporting non-recurrence rates that no others can match.

    Your books are excellent recommendations.

    Due to Biopsy Results My UR offered Surgery OR Hormone Therapy [Lupron] Plus Radiation.He explained the options in detail and I have chosen the latter.
    All the Radiation choices have their advantages and disadvantages just as surgery does.
    Proton Therapy is only offered in certain Hospitals and some Insurances will not cover the cost.[Creates logistics issues for some folks]
    Cyber Knife offers fewer treatments at Higher Doses but LONG term Studies concerning secondary cancers are but a small number.
    Any Radiation Type carries the risk of secondary cancers but also there is a risk of of PC recurrence with Surgery as well.
    The reality is we are still dealing with Cancer and even with all the advances in the last 10 years in Prostate Cancer Treatment there are still many unknowns.

    ASAdvocate is correct that each man needs to do his homework on Prostate Cancer before making any decisions .

    My UR and Radiologist uses lots of data from MSK and John Hopkins as well as MD Anderson and Mayo Clinic. They have excellent web pages with lots of Info available. Ultimately the choice is dropped in each man's lap.

    Depending upon many factors including age there is no "one size fits all" treatment plan. Some folks choose to do absolutely nothing.

     
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    Old 01-06-2020, 08:43 AM   #6
    Gary I
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    Re: Starting my PCa journey

    Quote:
    Originally Posted by ASAdvocate View Post

    When researching radiation, be sure to learn about SBRT/Cyberknife and proton beam therapy. Those two treatments are reporting non-recurrence rates that no others can match.
    The jury is still out on the "no others can match" comment. Long term, comprehensive and objective evaluations of their effects are in short supply. Still promising, however.

    Also when researching radiation be sure to inquire about the effects of hormones, ADT, and their side effects, which can play havoc with your body for the rest of your life.

    Personal in-depth research of studies will result in your best choice. We are all different, and there are no silver bullets when it comes to this disease.

    Good luck.
    __________________
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    Second 3T MRI 1/17
    RALP 7/17, G3+4, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over next 4 months
    DCFPyl PET & ercMRI @NCI - 11/17
    One inch tumor still in prostate bed
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    SRT, 2ADT, IMGT 70.2 Gy, complete 5/18
    PSA 0.066 1/20

     
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    Old 01-06-2020, 09:30 AM   #7
    BlueHeron2020
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    Re: Starting my PCa journey

    Quote:
    Originally Posted by guitarhillbilly View Post
    Your books are excellent recommendations.

    Due to Biopsy Results My UR offered Surgery OR Hormone Therapy [Lupron] Plus Radiation.He explained the options in detail and I have chosen the latter.
    All the Radiation choices have their advantages and disadvantages just as surgery does.
    Proton Therapy is only offered in certain Hospitals and some Insurances will not cover the cost.[Creates logistics issues for some folks]
    Cyber Knife offers fewer treatments at Higher Doses but LONG term Studies concerning secondary cancers are but a small number.
    Any Radiation Type carries the risk of secondary cancers but also there is a risk of of PC recurrence with Surgery as well.
    The reality is we are still dealing with Cancer and even with all the advances in the last 10 years in Prostate Cancer Treatment there are still many unknowns.

    ASAdvocate is correct that each man needs to do his homework on Prostate Cancer before making any decisions .

    My UR and Radiologist uses lots of data from MSK and John Hopkins as well as MD Anderson and Mayo Clinic. They have excellent web pages with lots of Info available. Ultimately the choice is dropped in each man's lap.

    Depending upon many factors including age there is no "one size fits all" treatment plan. Some folks choose to do absolutely nothing.
    Thanks guitarhillbilly,
    I just did some more research and I believe the oncologist I am seeing this week covers IMRT, Proton therapy, and Cyberknife. I hope to get an objective view from one place on radiation options.
    __________________
    64 Yrs old, BMI 23.1, Active and healthy walker, hiker, surfer
    Hope to live 20+ more years
    2012-2019 linear PSA progression 2-6.9
    Oct 2019 3T MRI Two areas pirad 4 identified
    Dec 2019 MRI US fusion biopsy
    4/27 cores positive
    GS 6(3+3) 10% core volume random area
    GS 7(3+4) 30-40% core volume random area
    2/7 cores GS 7(3+4) core vol 10-20% target area
    Urologist recommends prostatectomy
    Radiologist recommends: TBD

     
    Reply With Quote
    Old 01-06-2020, 09:33 AM   #8
    BlueHeron2020
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    Join Date: Jan 2020
    Location: Gulf Coast
    Posts: 16
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    Re: Starting my PCa journey

    Quote:
    Originally Posted by Gary I View Post
    The jury is still out on the "no others can match" comment. Long term, comprehensive and objective evaluations of their effects are in short supply. Still promising, however.

    Also when researching radiation be sure to inquire about the effects of hormones, ADT, and their side effects, which can play havoc with your body for the rest of your life.

    Personal in-depth research of studies will result in your best choice. We are all different, and there are no silver bullets when it comes to this disease.

    Good luck.
    Thanks Gary I,
    I was scanning Dt Patrick Walsh’s book last night and read up on hormones and ADT. Where is the Lone Ranger when I need him? (Kidding)
    __________________
    64 Yrs old, BMI 23.1, Active and healthy walker, hiker, surfer
    Hope to live 20+ more years
    2012-2019 linear PSA progression 2-6.9
    Oct 2019 3T MRI Two areas pirad 4 identified
    Dec 2019 MRI US fusion biopsy
    4/27 cores positive
    GS 6(3+3) 10% core volume random area
    GS 7(3+4) 30-40% core volume random area
    2/7 cores GS 7(3+4) core vol 10-20% target area
    Urologist recommends prostatectomy
    Radiologist recommends: TBD

     
    Reply With Quote
    Old 01-06-2020, 02:15 PM   #9
    ASAdvocate
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    Re: Starting my PCa journey

    Quote:
    Originally Posted by Gary I View Post
    The jury is still out on the "no others can match" comment. Long term, comprehensive and objective evaluations of their effects are in short supply. Still promising, however.

    Also when researching radiation be sure to inquire about the effects of hormones, ADT, and their side effects, which can play havoc with your body for the rest of your life.

    Personal in-depth research of studies will result in your best choice. We are all different, and there are no silver bullets when it comes to this disease.

    Good luck.
    ADT and other hormones are not usually involved in the primary radiation treatment for favorable intermediate risk cases, as this is.

    Of course, that could vary by practitioner, as more and more radiologists AND surgeons seem to be wanting ADT as part of their treatment plans.
    __________________
    In Active Surveillance program at Johns Hopkins since July 2009.

    Six biopsies from 2009 to 2019. Three were were positive with 5% Gleason(3+3) found.

     
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    Old 01-07-2020, 08:50 AM   #10
    Gary I
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    Re: Starting my PCa journey

    Quote:
    Originally Posted by ASAdvocate View Post
    ....as more and more radiologists AND surgeons seem to be wanting ADT as part of their treatment plans.
    Surgeons?????? That's not accurate.
    __________________
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    Second 3T MRI 1/17
    RALP 7/17, G3+4, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over next 4 months
    DCFPyl PET & ercMRI @NCI - 11/17
    One inch tumor still in prostate bed
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    SRT, 2ADT, IMGT 70.2 Gy, complete 5/18
    PSA 0.066 1/20

     
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    Old 01-07-2020, 09:27 AM   #11
    ASAdvocate
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    Re: Starting my PCa journey

    Quote:
    Originally Posted by Gary I View Post
    Surgeons?????? That's not accurate.
    These articles may clear up your confusion:

    https://www.medpagetoday.org/hematologyoncology/prostatecancer/78804?vpass=1

    https://www.urologyofva.net/articles/category/urology/2985759/intense-adt-prior-to-rp-may-improve-outcomes-in-locally-advanced-pca-renal-and-urology-news

    https://ascopubs.org/doi/abs/10.1200/JCO.2019.37.15_suppl.TPS5100?af=R
    __________________
    In Active Surveillance program at Johns Hopkins since July 2009.

    Six biopsies from 2009 to 2019. Three were were positive with 5% Gleason(3+3) found.

     
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    Old 01-07-2020, 11:22 AM   #12
    Gary I
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    Re: Starting my PCa journey

    The above were very recent clinical trials....basically initial studies. The implication that "more and more surgeons want ADT as part of their treatment plan" is incorrect and misleading...at best.
    __________________
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    Second 3T MRI 1/17
    RALP 7/17, G3+4, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over next 4 months
    DCFPyl PET & ercMRI @NCI - 11/17
    One inch tumor still in prostate bed
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    SRT, 2ADT, IMGT 70.2 Gy, complete 5/18
    PSA 0.066 1/20

     
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    Old 01-07-2020, 12:49 PM   #13
    ASAdvocate
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    Re: Starting my PCa journey

    Quote:
    Originally Posted by Gary I View Post
    The above were very recent clinical trials....basically initial studies. The implication that "more and more surgeons want ADT as part of their treatment plan" is incorrect and misleading...at best.
    I did recently read a article where the increasing use of ADT before RP was discussed. But, since I can't find it now, you win this latest round. Enjoy.
    __________________
    In Active Surveillance program at Johns Hopkins since July 2009.

    Six biopsies from 2009 to 2019. Three were were positive with 5% Gleason(3+3) found.

     
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    Old 01-08-2020, 12:52 PM   #14
    Gary I
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    Re: Starting my PCa journey

    Quote:
    Originally Posted by ASAdvocate View Post
    I did recently read a article where the increasing use of ADT before RP was discussed. But, since I can't find it now, you win this latest round. Enjoy.
    When it comes to PCa, there is no winning. Having tried AS, then endured surgery, radiation and ADT, along with reading too many studies and books to count, not to mention the support groups....I'm just trying to be as accurate as is reasonable, in an area where almost nothing is "for sure".

    Keep the faith, Harry.
    __________________
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    Second 3T MRI 1/17
    RALP 7/17, G3+4, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over next 4 months
    DCFPyl PET & ercMRI @NCI - 11/17
    One inch tumor still in prostate bed
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    SRT, 2ADT, IMGT 70.2 Gy, complete 5/18
    PSA 0.066 1/20

     
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    The following user gives a hug of support to Gary I:
    ASAdvocate (01-08-2020)
    Old 01-10-2020, 10:41 AM   #15
    guitarhillbilly
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    Re: Starting my PCa journey

    Quote:
    Originally Posted by ASAdvocate View Post
    I did recently read a article where the increasing use of ADT before RP was discussed. But, since I can't find it now, you win this latest round. Enjoy.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036454/

     
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