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  • #16
    Actually, that makes sense because Kwon is one of handful of specialists who performs salvage surgery. He and Drs. Patel and Eastham are mentioned again and again, so there must not be many others.

    I look at it this way. A tiny number of radiation patients still have cancer in their prostates, and are appropriate for these specialists. Of course, most of the ones these providers select to operate on have not experienced spread.

    These observations in no way vitiate my opinion that few of those who have recurrence after radiation have prostate confined cancer.

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    • #17
      That’s not what my family doctor tells me. He says he has several patients with failed RT and shared the horror stories.

      I would like to say that 0% of men having a prostatectomy will have recurrence in their prostate, but the video proves me wrong because some men who had a prostatectomy still have a prostate that was never removed according to Kwon.

      YOB 1957

      DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.

      3/6/19. Post surgery Pathology Report - Grade Group 4 Intraductal Carcinoma
      T3aNO, <1 mm non focal EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.
      7 Nodes, SV, SM, PNI, and BNI were negative.
      LVI and Cribriform pattern present.
      Decipher .86 High Risk.

      Post Surgery PSA
      3/25/19 .03. (25 days)
      4/25/19 <.03. (2 months)
      5/25/19 <.02 (3 months)
      9/10/2019. <.02 (7 months)
      11/27/2019. <.02. T < 3 (9 months)
      5/19/2020. <.02 (15 months)
      11/2/2020. <.02 (21 months)
      5/11/2021. <.02 T <3 (27 months)
      8/25/2021. <.02 T <3 (30 months)
      12/6/2021. <.02 T <3 (33 months)


      3 Part Modality Treatment Completed

      2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic, Dr. Kaouk, surgery #41 in US.
      ART - 7/25/-9/25 2019 (78 Gy, yes, I glow in the dark).
      ADT - 5/19- 5/21 Eligard and Casodex.

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      • #18
        Originally posted by rick View Post
        Hi I had a biopsy they found 3=4 =7 in one of 15 cores with <1% 4 my PS!I has been around 5 my urologist wants to do to remove the prostate he said not to watch it because I could have more cancer that was not picked up in the biopsy ..So I went to a Radiologist for a second opinion. He said I was barely a stage 2 and we could watch and wait or we could do beam radiation with out any follow up hormone therapy . Because I got 2 different opinion I went to see a urology oncologist he wants to put me on a hormone casudex to stop cancer growth. I am really confused be cause I can not get an agreement between 3 doctors any thoughts on this
        I am about 6 months in to active survellience (AS) and it is harder than I thought it would be. My doctors all indicated active survellience would be a good idea. Primarily because the cancer was low grade based on the genetic research and Dr. Epstein's grading of 3+3 in all areas. For me the AS program was to take another PSA at February one in July along with a digital exam and do a transperenial biopsy a year out from the first one and see where we are. I think the long term plan was psa twice a year and biopsy once a year. I was hoping to substitute MP MRI's but he said they have a 17% inaccuracy rate.

        I am pretty good a procrasitination (It may be my superpower) but this one has been a challenge. Some days I freak out wondering what is really happening in the cancer in my prostate. But my most respected doctor/friend said "go with the program". And he would tell me if he thought differently.

        The doctors, for me, pointed out that prostrate cancer moves slow and they are discovering new treatments all the time so delay is in your favor to a certain extent.

        However, from a personal psyche standpoint, the prospect of the science being wrong or the MRI missing something is hard to handle when I think about it.

        Unfortunately, my personal urologist left but I am now seeing a urlologist at Henry Ford who kind of pioneered the Davinci robotic surgery and has done thousands of surgeries. He didn't recommend surgery. He was ok with AS and kind of left me with a "we will see how you hold up". Which I think he was talking about the waiting and wondering angst. So I got that advise from someone who makes their living doing surgeries (who fortunately doesn't need the money from what my other friend doctor said )

        I think you should at least have Epstein read your slide and see if he agrees with the 3+4 in less that 1% That seems really low to me. I hate to say that but at that level it almost looks like a cover your ass kind of low? Sorry if that sounds bad. But maybe they want to throw that 1% in there just in case? Would hate to make a decision on wrong information. So second opinion would be nice.

        I have had 3 different sets of doctors read my slides. Epstein graded it lowest 3+3 both sets of local oncologists found small amounts of 3+4.so it is very subjective.

        But, everyone here knows a lot more than me about the situation and what to do. And I am still confused and worried about what to do also.

        i am trying AS and hoping we got it right. But it is a bit un-nerving to be honest.

        I don't have any advice but I just thought i would throw in what the AS course is for me and hope my experience as to what that is like, can help with your decision.

        Of course I wish you and everyone else here the best of luck.

        PSA History:
        1/22/10 1.7
        12/9/11 1.61
        2/1/14 1.90
        6/5/15 1.57
        6/20/16 1.93
        1/31/18 1.86
        9/16/19 2.33
        7/16/21 2.3
        7/16/21 2.24
        01/10/2022 2.2

        Biopsy 9/2021 slides read by local urology group
        unfelt small leasion found in 3 sectors
        I. Gle 3+3 (SUP Grp 1) .5mm involving(1% & PIN)
        K. a Gle 3+4 (SUP Grp 2)2 mm involving(10%)
        L. Gle 3+4 (SUP Grp 2)1.5 mm involving(5% patchy)
        Gle 3+4

        Decipher score .26 Low Risk

        Johns Hopkins, Dr. Epstein read of slides 10/14/2021
        I. Small focus of prostatic adenocarcinoma, Gleason Score 3+3 (group 1), involving less than 5% of one (1) core

        K. Gle 3+3 (group 1), involving 10% of one (1) core

        L. , Gle 3+3 (group 1), discont. involving 20% of one (1) core

        Henry Ford read of slides:
        I. Gleason score 3+3=6 (Group 1), involving 1% of the length of one core (0.5 mm tumor focus)
        K.Gleason score 3+4=7 ( Group 2), involving up to 10% of the length of one core (1.5 mm tumor focus); Percentage of Gleason pattern 4 = 5%
        L. Gleason score 3+4=7 (Group 2), involving
        10% of the length of one core (2 mm tumor focus); Percentage of Gleason pattern 4 = 5%

        Multi Parametric MRI 12/10/2021 results:
        MPRESSION:
        1. No index lesion identified. Patient's known prostate cancer may not be
        visualized due to small size and/or low-grade. Overall, MRI findings
        compatible with PI RADS 2 abnormality (low likelihood of clinically
        significant prostate cancer).
        2. Prostate volume of 48.0 cc. PSA density of 0.04 ng/mL/mL.
        AS for now transpereneal biopsy next fall

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