That is very good news! That confirms or at least creates a high suspicion that your elevated PSA is a result of chronic prostatitis rather than high risk PC. I suspected as much because your PSA was so out of line with your biopsy results. The chronic prostatitis has caused glandular atrophy and scarring. The nodular hypertrophy in the TZ is causing blockage that is probably.further increasing your PSA.
Did you send Epstein any slides from the area suspected by the MRI as having prostatitis? He should be able to see the cellular changes due to that. That would confirm it.
The reason that is great news (in spite of meaning that you probably have prostatitis), is because, it probably also means that you do not have high risk PC, but only favorable intermediate risk PC. That means that any therapy, including CyberKnife, should work just fine for you. It also means that adjuvant treatments like adjuvant ADT with radiation or adjuvant radiation after surgery are useless.
The advantage of surgery would be that all sources of PSA will be removed (prostatitis, PC and TZ blockage). With any luck, that would give you undetectable PSAs and the confidence that comes with that. Conversely, with radiation you may always have the chronic prostatitis as well. That means that your PSA might continue to be elevated, and you would have no way of using PSA as a tool to assure that the radiation was successful.
Of course, this is all up to you. If you want to be treated as a high risk patient (which your PSA taken as is indicates), you can be. You may also be able to convince your doctors to treat you as a favorable intermediate risk patients, which may increase your therapeutic options and decrease the risk of side effects from treatment. I think you should point that MRI finding (and if possible Epstein's finding on the slides from the chronically inflamed area) to your doctors and
open up this discussion with them.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEsmy PC blog