Question about radiation candidacy
Hello Community! I am new here, recently diagnosed, and going through the difficult decision process.
Quick intro: I am 60 years old, very healthy(*) and active
I believe I have a somewhat unique situation, and that hopefully someone can help. I had an MRI which revealed a PIRADS 5 lesion, and a PIRADS 4 lesion. Based on this, I had a combination targeted and systematic biopsy. This is where things get interesting... The biopsy revealed:
- Gleason 3+3 on the PIRADS 5 lesion
- No cancer on the PIRADS 4 lesion
- 3+3 on five other cores, and 3+4 on another (so 7 of 14 cores positive).
My urologist classified me as "unfavorable intermediate" due not to the Gleason scores, but the fact that >=50% of cores came back positive.
I am particularly interested in MRI-guided SBRT. My question: would I be a candidate for this when my cancer appears to be spread out my prostate, AND most of the positive cores did not show up on the MRI? I mean, if the tumors did not turn up on the MRI, how would they know where to aim the radiation?
I thank you all in advance, and wish everyone well!
(*) truth be told, I am *physically* healthy. I am having a difficult time reconciling the fact that I feel great with being told that I am sick. Anyone else?
Sorry, I was not clear. I meant to say "my cancer appears to be spread *throughout* my prostate". (That is, there is no evidence of ECE nor metastasis).
Still, my questions remain:
- Why would the targeted results from the PIRADS 4/5 turn up fairly benign?
- Why did the areas of my prostate that yielded positive cores look ok on the MRI?
All the best!My husband's first biopsy differed quite a bit on cancerous cores and their associated Gleason score than the second biopsy (a year later). It was explained by sampling. The samples taken may not be truly representative of the cancer present in the prostate. Another biopsy that punches different areas of the lesion may result in a different outcome.
This is my first post. I completed the MRI guided LINAC 5 fraction at 7.25 Gy per fraction treatment at a major teaching institute with a lesion boost. I am 72 Y/O, was on AS for almost six years starting at PSA 4+ with five biopsies over 5 years with 81 cores (of all types TRUS, Trans P, inside an MRI). A few cores on the fifth biopsy progressed to 3+4 making it an unfavorable intermediate . The primary anterior lesion was growing and possible EPE. I had 20 years of PSA data and finally crept up to the 11 range. An ARTERA AI evaluation indicated short term hormone was unnecessary. At completion of therapy with the SBRT with MRidean LINAC over about two weeks it was essentially uneventful for any side effects. Obviously acute effects can show up later as well as long term effects. I am grateful for the technology, and educated people studying this. For me this has been the right choice.
I had SBRT with a SpaceOAR. My biopsy had one positive core of 12, 4+3=7. Although I had numerous MRIs, my understanding is that the SBRT was not guided to the specific core by the MRI. Rather, the entire prostate was radiated. 3 fiducial markers were placed, I think to set target boundaries, not to isolate the one positive core. After 2 months my PSA dropped from 15.47 to 1.00. Next PSA in about a month. Minor side effects were gone after 2 weeks and nothing new has shown up.
