Since our last update about a month ago, there have been a number of significant developments.

Based on the results of Paul’s mapping biopsy, Dr. Crawford does not believe he is a suitable candidate for targeted focal therapy based both on the number of tumors in his prostate as well as their proximity.  Of the 65 cores in the biopsy, 13 cores tested positive for cancer with a Gleason score of 7 (6 cores were 3+4, 6 cores were 4+3 and 1 core was a 4+4).

These results effectively push Paul from a “low risk” to “intermediate risk” and he is coming to terms with the fact that his entire prostate needs to be treated or removed in order to save his life. It’s a bitter pill to swallow given that our intention was to to postpone treatment as long as possible and to use more holistic alternative cancer treatments whenever possible. However, the overriding priority now is to treat the cancer before it spreads.

In the next few weeks, Paul will be undergoing additional medical testing as well as meeting with a variety of medical professionals to explore both surgical and radiation treatment options.

1. On January 30th, Paul will have a bone scan and a CT scan to determine if the cancer has metastasized beyond his prostate to lymph nodes or bones. Yes, it sounds scary. But it is a standard test for patients who are expected to live for more than 5 years, and we’re hopeful that it will turn up nothing and clear the way for either radiation or surgery.
2. We’ve already had a preliminary meeting with Dr. Thomas Pugh, a radiologist/oncologist specializing in urologic cancers. Dr. Pugh will make a radiology recommendation based on the results of Paul’s bone scan and CT. Radiation options include:
   • External beam radiation. This delivers high-energy X-rays to the prostate gland from outside the body. Typical radiation treatment consists of five treatments a week over an eight-week period although newer technologies such as SBRC (also referred to as CyberKnife) use higher doses of radiation resulting in fewer treatments.
   • Radioactive seed implants. This procedure, called brachytherapy, involves making an incision under general anesthesia to implant pellets into the prostate gland that release low doses of radiation slowly over a period of months. About 40 to 150 rice-size seeds are implanted, and they lose their radioactivity over the course of a year.
   • Androgen deprivation therapy is also recommended along with radiation treatment as it significantly improves outcomes.
3. At the end of January, Paul is reconvening with Dr. Gary Kirsh in Cincinnati.  Dr. Kirsh is very familiar with Paul’s case and has treated thousands of men using both surgery and radiation. He’ll be an excellent resource to help us evaluate treatment options.
4. In early February, Paul will be evaluating surgical options including an open incision radical prostatectomy (recommended by Dr. Crawford) or a newer robot assisted prostatectomy, performed through five or six tiny “keyhole” cuts in the lower abdomen. Surgeons manipulate robot-like fingers through these small incisions to remove the prostate and surrounding lymph nodes without having to cut through as much healthy tissue. The main advantage of this robot-assisted prostatectomy: generally a shorter hospital stay and faster recuperation time.