It is a horrible thing to be diagnosed as high risk, especially at 56 when your urinary and sexual function is doing just fine.
First - please do not rush into treatment. Even high risk prostate cancer is a slow growing cancer. Men who take more than 3 months to make a decision have the same outcomes as those who take less time. Time will allow your inflamed mind to cool off enough to allow for more thoughtful decision making. The first reaction, and because the first doctor we all saw was a urologist, is "just cut it out." Unfortunately, with high risk disease, that is usually a suboptimal approach.
Cleveland Clinic is a great resource. I agree with John T that 400 surgeries is a bare minimum. You have Stephenson and Tendulkar at Cleveland Clinic. You also have Jay Ciezki doing brachytherapy, and Kevin Stephans doing SBRT. Because of your Gleason 8, they may prefer a combination of radiation therapies along with adjuvant hormone therapies. It has the best cure rates for high risk, higher than surgery. But side effects are higher too. Another good choice for brachytherapy combined with external beam (brachy boost therapy) would be Gregory Merrick at Wheeling Hospital (WV), and Alvaro Martinez in Detroit.
Salvage becomes an important consideration for men with high risk PC, particularly if surgery was the primary therapy. You can see for yourself in the nomogram below, that the odds of surgery being successful (i.e., that it is organ confined) is only about
33%. Salvage radiation, with all its extra side effects is successful in about
half the cases. That would get your odds of a cure up to about
In contrast, your odds of a cure using brachy boost therapy is about
There certainly are
salvage therapies available if primary radiation fails. Salvage surgery is probably the worst of those options, but there are many more. You can read about
As you can see from the table at the bottom, those salvage therapies are curative in 50-80% of cases, which would bring your expected cure rate above 90% if you start with brachy boost therapy.
Two important diagnostic precautions:
• It is especially important that you get your biopsy results confirmed by Epstein's lab at Johns Hopkins. It's a pretty standard thing to do and costs $250. Just call your urologist and have him overnight the slides.
• I think it's a good idea for high risk guys to go beyond the bone scan to rule out distant metastases. With your low PSA, a bone scan isn't likely to show anything anyway. NIH has just begun a clinical trial of a really great new PET scan for high risk guys like you. It is free, including travel and accommodations to D.C. You have to have surgery scheduled (which you currently do) or agree to a follow-up biopsy. Here are the contact details - just call the contact yourself:/clinicaltrials.gov/ct2/show/NCT03181867
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