I think my signature, created just now, will show the relevant data, except that I couldn't fit as much as I wanted into it. My DRE has always been negative, and my prostate is sized "normally" for a 58 year old. My dad was diagnosed with PCa at age 60, treated with seeds, and then on recurrence initiated a long-term course of Lupron, which didn't do much for his QOL. He was on Lupron 15 years or so, and died last year (a couple of years after ceasing Lupron) of other causes at age 89. The JHU reading of my biopsy noted a left side showing "small focus of atypical glands, suspicious for carcinoma...Separate high-grade prostatic intraepithelial neoplasia."
My urologist here told me the volume makes me intermediate risk, but I can't find how to differentiate between low level and high level intermediate.
My MSKCC nomogram notes a 66% probabililty of the cancer being contained. Other risk index values are more favorable.
I've scheduled RALP with Dr. James Porter at Swedish in Seattle next month, and he comes highly recommended both on this board and by personal acquaintances. He told me he suspects one nerve bundle must go, and that he should take out the local lymph nodes--two, as I recall--even though the nomogram suggests a 3% risk of spread to the nodes. I'm wondering, based on readings, a number of questions:
1) Given my apparent risk of escape outside the capsule, how should I weigh SBRT or another RT vs surgery, open or robotic, by a highly skilled surgeon?
2) Should I request an MRI and nerve mapping?
3) Are there other aspects to low grade, high-volume Gleason 6 (which seems a little unusual) that I need to make a sound decision?
I certainly want to live a full life, but continence and erectile function are important to me. I'm in good shape, physically active, and have no current problems in those departments.
Thanks so much. This is a remarkable group! I've had one previous post but lurk quite a bit and admire the culture and ethos here.
PSA: 7/13 3.57; 8/14 4.06; 3/15 5.57; 5/15 6.28
Local biopsy, samples 5/19/15: right prostate Gleason 3+3, maximum extent 1.3 cm, , involving 6 of 7 cores and 85% of specimen. Left prostate: ASAP.
Second reading by Epstein's group at JHU 6/08/15: Right side Gleason 3+3 involving seven cores (100% of five, discontinuously involving 60% of one, and 1% of a fragment); PNI noted.