So I thought I would bring all up to date on my research since my last post.
I have met with a local radiological oncologist (Dr. Lipzstein); a Cyberknife specialist (Dr. Katz) and this morning had my MSK consult with Dr. Koutcher. I have also read "Invasion of the Prostate Snatchers" and Walsh's "Surviving Prostate Cancer". I have also re-connected and consulted with my primary as well have talked to many people who have gone through treatment.
about the MSK consult. You see a screening urologist who has your slides re-read (though my re-read wasn't available at the time of the consult), does a full examination and then engages in an conversation with you talking about the various treatments appropriate and, if you decide to seek treatment with MSK, will coordinate and then turn your case over to the appropriate oncologist or surgeon. Dr. Koutcher is a self-proclaimed conservative in his approach to treatment and we began by discussing active surveillance.
Active Surveillance - MSK has over 1000 patients in their AS protocol which requires an upfront biopsy, PSA' s every 3 months and an annual biopsy. 1/3 of their patients end up receiving a definitive treatment within 5 years and and ~5% of their active surveillance patients "miss the window" and have their cancer metastasize. Best curative modality for me, in his opinion was open RP because of my age and the 25-yrs of outcome data with this treatment. He recommend Dr. James Eastham, Chief of Urology Surgery and someone who performs 300 procedures/yr. We discussed robotic surgery and the quicker recovery and less blood loss - but he claims that side effects are no different from open RP, about 50/50 for ED but there is only about 5 years of data on efficacy and so, his conservative nature leans towards open RP. Then we went on to radiation. He leaned towards IMRT because of the 15-years of data and indicated that the ED was similar to RP with small % chance of urinary and/or rectal side effects. Recommended the MSK guru, Dr. Zelefsky or Marissa Kollmeier for the procedure. Finally LDR Brachy was 4th choice with lower ED (35%) but likely urinary burning for a year. When asked about SBRT didn't believe that MSK was using it for prostate cancer.
MSK sets up an online account for you where you can do things like leave non-urgent questions for your doctor, make appointments and see you bills.
What has my head spinning a bit was that I was fairly certain that I had ruled out AS, surgery and IMRT before this session, and these were recommendations #1, 2 &3. AS because of wanting to avoid the unpleasant biopsies and the chance of missing the cure window. Surgery because I'm just knife adverse and don't want to deal with the recuperation process ruled out because, out of convenience I would seek treatment locally in a facility that uses IGRT and I have some concerns about the long-term effect of the 48 daily CT Scans (to line up the radiation arm) that I'll receive.
Cyberknife seems promising but only 5 yrs or so of data makes me hesitant. Also a little more inconvenient than brachy.
So, by my process of elimination, it may be LDR Brachy at MSK for me - but I've not yet locked in my final answer and would welcome any insight.