T3a & mulling over options after latest MRI suggest treatment needed

T3 means serious radical treatment is required.

Active surveillance should stress ACTIVE 2 years was way to long.

Private treatment has all the good kit but it lacks oversight and tends to be one specialist rather than the large MDTs you get on the NHS.

So why not do both, make sure your private specialist is on the NHS too And takes your case to the MDT meetings? That's what mine did.

Edited by member 13 Oct 2024 at 09:06  | Reason: Not specified

I was T3a, although classed as very high risk due to PSA of 58.

I went for HDR boost, a protocol where half the radiotherapy is done as external beam (16x3Gy or 23x2Gy fractions/sessions), and the other half as a single 15Gy HDR brachytherapy fraction/session. This is done with hormone therapy. My #1 priority was getting rid of the cancer first time, and my #2 priority was minimising side effects. There is an option with this treatment to also treat all the pelvic lymph nodes at a low dose, on the basis that even though no mets were found in them, that's the next place mets would likely go, and if there are tiny mets there already which didn't show on the scan (micro-mets), this will zap those too. I took this option too.

HDR boost is a good protocol in terms of treatment dose verses side effects. It gets a high effective dose into the prostate (and can also into the seminal vesicles T3b, but that's not relevant in your case), while also covering the area outside the prostate at a lower dose. However, due to the lower dose outside the prostate which can still mop up micro-mets, it seems to have fewer side effects considering the higher effective dose into the prostate than external beam alone can do.

It might be that with only one high risk factor in your case (T3a), this might be considered over-kill in your case, and that's something to discuss with the oncologist. I had two right risk factors (T3a and PSA level).

I don’t think anyone let him down. He had two years of a great quality of life with no ED or incontinence issues or other side sides from hormone treatments while on AS. In Jan an MRI was immediately ordered when the PSA jumped and was clear. Then his PSA was monitored to see if it stayed up or it could have been a bad PSA number and then the PSA fell twice giving credence that the Jan PSA number might have been bad. Then August (January to August with two PSA drops is not a long time) his PSA rises back and another MRI is immediately ordered and it is found. Sounds to me like AS worked. It may have barely left capsule with no lymph no involvement. A PSMA Pet should be ordered next, also genomic Decipher testing. Until surgery mine was supposed to be contained in the capsule, but during surgery I had positive margins, but fortunately my Surgeon sent the tissue to Pathology while I was on the operating table under anesthesia and so he was able to go back in and cut more and final pathology was negative margin.

Andy,

i am considered pT3a after my surgery in August. I was told that although my Extraprostatic  Extension (EPE) was found during surgery if seen earlier it still would not have necessarily ruled out surgery. Depending how far out positive margins on the side might have gone out could have impacted nerve sparing on that one side during surgery. My final Gleason after surgery is 7 (4+3), and awaiting PSA at end of month. I ended up with negative margins and my Surgeon is optimistic about not needing adjuvant Radiation Treatment (ART) plus hormone treatment. I certainly still have Salvage Radiation Treatment (SRT) available if needed. Although salvage Surgery after radiation can be done, it is much more difficult and usually only certain skilled surgeons familiar with it and not many will fo it. That is also why I chose Surgery to have the salvage radiation in reserve. Good luck 

Spot on, Ned.

Hope all continues to go well with you. 

Peter

Hi Andy,

I'm in the US, but my PC was at a very similar stage to yours. My PSA on initial diagnosis (last May) was also exactly 12.7. My MRI showed the cancer had broken through the capsule and described "Gross EPE" along the right side of the prostate with other tissues clear (T3aN0M0). My biopsy came back Gleason 9 (4 + 5). I ended up having DaVinci RP here in New York and now at 7 weeks out, I'm 99.9% dry, am able to get erections unaided and my first post surgery PSA just came back at <0.02. In short, I'm very happy with my results.

Of course surgery has higher risks of ED and incontinence than radiation but it is nice to know that if recurrence occurs down the road following it, you still have radiation treatment available to you. How old are you? How is your general health?

Also, just to mention, I did meet with a radiologist as well prior to deciding between surgery vs radiation. As Adrian56 mentioned, I was told if I did go with radiation treatment it would have to be the wider beam, (25??) session type. I was told I would NOT be a candidate for the higher dose 5 day treatment (Cyberknife) (which I believe is SABR).

We'll have to agree to disagree on this one Ned.🙂

According to the National Institute for Health and Care Excellence (NICE) guidelines, a multiparametric MRI (mpMRI) is recommended for people with prostate cancer who are being managed with active surveillance at 12–18 months.

It was two and a half years, before Andy had his follow up MRI. Maybe it wouldn't have shown disease progression, but that doesn't alter the fact that it was at least a year later than it should be. Active surveillance isn't just about PSA checks, which we all know can be unreliable.

In my case, whilst I was AS it had been recommended that I had a 6 month follow up MRI. They forgot to book it. When I eventually got a follow up scan, it was 14 months late, and clearly showed significant disease progression. AS should be proactive and not just reactive to PSA results. Had I not chased them up my disease could have easily become metastatic.

Edited by member 13 Oct 2024 at 19:08  | Reason: Additional text

Hello again mate.

If they decide that you are suitable for this treatment, to me, that would be a good path to take. 

In answer to your question, all my treatment has been NHS. Generally, I have been very satisfied and impressed by the service. However, during COVID, one or two mistakes were made with my active surveillance, which in my opinion, allowed my disease to progress unchecked, leaving me at more risk of recurrence.

Da Vinci is basically keyhole robotic prostatectomy.

Edited by member 15 Oct 2024 at 05:48  | Reason: Additional text

Hello mate.

As you say that was was from 2018.

Since then, after trials, it's being introduced as an approved treatment. In fact, there is research now being conducted to see if its safe enough to have only 2 SABR sessions for low grade PCa and further research testing it on higher grade cancer. 

It seems to be advancing very quickly, probably because it is much more cost efficent.

I started a conversation on the two session trial yesterday.

https://community.prostatecanceruk.org/posts/t31027-Recent-research-into-SABR-being-effective-after-only-two-sessions-s#post300684

Edited by member 15 Oct 2024 at 12:25  | Reason: Additional text