This is an update to my husband's diagnosis on February 20, 2007 - PSA
3.5 (actually 3.14 taken two days before the positive biopsy, albeit
at a different lab), overall gleason 3+4 (80% 3's, 20% 4's in the mid;
gleason 3+3 in the base). I'm posting this as I was requested to
provided an update when we had reached a treatment decision.

Over the past month, we have met with a new urologist, a medical
oncologist and three radiation oncologists. One of the radiation
oncologists was at Loma Linda University Medical Center and the other
two were here in town. None of the doctors felt that a bone scan or CT
scan was necessary. The new urologist felt that Paul was not a
candidate for surgery (weight, hypertension etc.). We didn't
particularly care because we weren't considering surgery anyway.

The medical oncologist felt that Paul would do well with IMRT. This
was corroborated by the two radiation oncologists here in town. One of
them has the only tomotherapy (CT guided IMRT) machine in the state.
He felt that would be an appropriate treatment for Paul. The other
local radiation oncologist uses ultrasound guided IMRT.

Our final decision is proton therapy at Loma Linda. We went there for
a consult last week and were very impressed. Paul is a candidate for
"proton only" treatment (They do combined proton/photon treatment in
more advanced cases). He was given a start date of April 2. The local
rad onc's (one of whom did his residency at LL but left after that)
both felt that LL would be a good choice but that THEY could do just
as well with IMRT in its various forms.

The bottom line, as far as we're concerned, is that people from all
over the country (and the world, for that matter), go to Loma Linda
for proton treatment (LL has treated 8,000+ prostate cancer patients
over the course of 16 years). They don't come to Las Vegas. That's it;
on April 1, we're going to LL for a nine week course of proton
treatment.

Because Paul has an artificial right hip, the treatment plan will be
slightly different than the standard. Instead of 44 treatments, he
will receive 42. Instead of lateral right treatments (They normally
alternate left/right, left/right etc.), he will receive 2/3 of the
treatments from the lateral left (non-operated side) and 1/3 of the
treatments from the rear. The plan could have been designed to come
into the right side at a different angle so as to avoid the hip
prosthesis, but the rad onc felt it was simpler to do it as I
described. This puts Paul at a higher risk for rectal bleeding down
the road, but so be it. That risk would probably hold for all forms of
radiation.

Carol