Posted 9/18/2014 3:09 PM (GMT -6)
I'm not sure I understand the delay in having a biopsy to at least confirm the Gleason score. If you have SVI, you're high risk . This is the reason why I elected RP: to find out the extent of my cancer and get it out of my body to the extent possible. I was Gleason 9 and knew I would probably need ADT and SRT. As a Gleason 6 or 7 it's not so clear in you're case, but it seems odd that a gl6 or 7 would have SVI but as you say, your PCa may have just started to move beyond the capsule and is still curable with some type of radiation. Your decision depends as usual on how much you are willing to endure in terms of recovery and SEs from the various treatment modalities. I never went the mpMRI route just the trans rectal bx which got the Gleason score right with only six samples, but of course did not disclose my pathology. Only RP can do this!
DOB January 1944 (age 70)
1981: prostatitis corrected with meds.
2000-2013 BPH treated with finasteride & tamsulosin; also low T treated with androgel
PSA history: Nominal / Est. Adjustment for finasteride effect
2001- 2009 0.4-.6 / .8-1.2
11/2011 2.2 / 4.4
8/2012 2.7 / 5.4
2/2013 5.5/ 11.0
4/2013 6.1/ 12.2
5/2013 6.6/ 13.2
11/2013 0.1/ na
1/2014 0.2/ na
4/2014 0.3/ na
6/2013 Bx/Dx: PCa Gleason 4+4=8 (Bostwick), 2nd opinion 4+5= 9(Johns Hopkins), 2/6 cores on right positive, 10% & 40%, DRE neg. (Stage PT1c)
7/2013 Bone scan and 1.5T pelvic MRI, negative for PCa
9/7/13 open RRP, Johns Hopkins, Ted Schaeffer MD PhD. No complications
9/9/13 Pathology: 33G, Gleason 9, both nerves spared, SVI+, EPE+ and 4mm + margin at base (Gl7), 10 lymph nodes dissected, all negative for PCa (Stage upgraded to PT3bN0M0)
9/20/13 Foley and staples removed, no complications
5/14/14 First Three month Lupron shot (22.5 mg.)
5/20/14 3T pelvic MRI negative for PCa
6/4/14 Started 38 sessions of IMRT/IGRT, total 68.2 Gy to prostate bed only
7/11/14 Started taking Megestrol Acetate for hot flashes and Flomax for urinary frequency.
Side Effects of treatments:
RRP: Incontinence: one pad per day for 13 weeks post op, none thereafter
ED: some pre op, total ED post op. Tried Viagra and VED
ADT: Hot flashes, mild fatigue, constipation, diarrhea, urinary frequency
SRT: None until about a week before the end, then diarrhea, anal pain, blood from severed hemorrhoids, fatigue.