I wanted to address why an MRI is not in your best interest at this time
. Every doctor will have his own imaging requirements. For any kind of external beam therapy, fiducials are necessary, and the plan imaging should be done with the fiducials in place. Some surgeons like imaging to help them understand individual anatomy (only a conventional MRI or CT would be necessary for this) to help plan their attack, others find it unnecessary. LDR brachytherapists don't implant fiducials, so any recent MRI will do. You are always better off letting the treating doctor dictate what further diagnostics/imaging he needs.
I'll ignore the comments referencing logo - since I have him on ignore, I have no idea what he said and don't care to know. I don't speak Gibberish, only English.
I want you to understand that my opinion about
too many cooks spoiling the soup is based on actual real world experience from men in my PC support groups and visits to doctors. I'll illustrate with a few cases:
1. Patient with intermediate risk PC sent to a brachytherapist only by his MO. No discussion of surgery, SBRT, HDR-BT. The same MO never refers men to SBRT, but only to the more expensive IMRT. When that IMRT RO of his retired and turned the practice over to the brachytherapist, the MO stopped referring for any external beam at all.
2. Patient with low risk PC sent for a bone scan by his MO. Bone scan revealed many spots. Patient took tranquilizers and couldn't sleep while all were investigated. None were due to cancer, of course.
3. Patient with a single 6-core biopsy, 3 positive cores, 2 of the 3 were GS 3+4. Patient was told by his MO that AS would be safe with only mpMRI and CDUS. Two years later, he still has not had a confirmatory biopsy. (this is very risky, imho).
4. Patient with high-risk PC (one core w/ GS9) was told by his MO not to participate in the high-risk trial of SBRT. Patient ignored that advice, luckily, had no side effects of treatment and his PSA is undetectable 2 years later.
5. Patient with recurrent PC after prostatectomy was referred to a brachytherapy RO by the MO who always refers to him. The RO told him his slowly rising PSA (now over 0.3) did not need treatment, and to come back after his PSADT accelerates.
6. One patient was told to wait until his post-RP PSA rose over 2.0 and then go for a C-11 Choline PET scan in Arizona. And this was recently, after Axumin became widely available in this area, and PSMA-based PET scan became available experimentally.
7.One patient, who failed salvage radiation, was sent to Arizona for that PET scan. It showed multiple mets to the abdomen and ribs. When an SBRT RO told the patient that radiation was not only futile but could be dangerous, the MO found an RO willing to do it anyway. The patient had new mets appear almost immediately afterwards.
8. One MO actually wrote a book about
how surgery should not be used for localized PC - talk about
I won't say who the MO is, but I suggest caution in using a doctor who is not qualified to make treatment calls.
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