Stage 3a, Group 9, just discovered. Dr. gave options but have question

Do you have the 2023 edition of the book? I’m a stage three prostate cancer patient and I recall that it addressed stage 3 thoroughly. Some of the information related to treatment options and side effects is spread out over several chapters.

I had Gleason 9 with extracapular extension and perinueral involvement. Dr. Ash Ross from Northwestern Medicine in Chicago did salvage prostatectomy and removed my prostate, Seminal vesicles, one nerve bundle, and all the lymph nodes he could reach.

What’s your situation? if it’s at all similar to mine, I can relate what I know to you and also point to areas in the book that might be helpful assuming you’ve got the latest edition.

Bob

The book just came today? I have vas deferens involvement, nerve involvement, and fatty tissue as well. The MRI did not see any pelvic area lymph node involvement.

I really don't have anything medical to add to the many excellent comments already provided on this thread regarding treatment. However, I would suggest that being reasonably confident with whatever treatment path you choose will be important to your emotional well being as you deal with the PC. In light of that, as you educate yourself and try to decide on a treatment plan I'd suggest if you're not completely in agreement with whatever treatment plan you're considering, then I'd recommend getting a 2nd or even 3rd opinion (preferably from a recognized cancer center of excellence). It might give you an additional degree of confidence in whatever path you choose so you can be at peace with it. Whatever you do, you really don't want to have any regrets later. Best wishes to you and yours.

Hopefully your book is the revised and updated fifth edition. It should say so on the cover in the upper right hand corner. If it’s not the latest edition, I’d return it and get the latest edition. A lot of things have changed since the fourth edition.

What is your Gleason score?
What stage number / letters are you?
What treatment are they recommending for you?

I am a T3a, Group5, and had 5 positives on the biopsy. Two were 7, 3 were 9.

I will check the edition when I get inside.

I believe I got the edition of his book prior to 2021, If he has updated it I will definitely seek it out. His older version had only 2 or 3 pages that were all negative on the subject briefly and nothing more.

Since then, I have learned much more about Stage 3 including my own personal experience which is negative PSA 4 years post surgery. I remain on top of all the information available as one never knows. Thank you for the heads' up on the newer addition. Progress is constantly being made in the field and I am convinced things are looking up overall.

I just ordered it from Amazon and it is Version 5

That’s absolutely awesome if your PSA is remaining undetectable. Right now mine is also undetectable, but I am on ORGOVYX and Zytiga (abiraterone acetate) for 24 months.

My medical oncologist and radiation oncologist both told me that I would’ve been incurable just 5 years ago. Thankfully things have advanced for both of us!

Just wondering, if its already in the fatty tissue outside the prostate, what is the point of RP? Its not like they can take a ton of extra tissue out just to make sure because the prostate is only millimeters away from other important things (not like breast cancer).

I think you need to do some book reading FAST.

Also do not assume that the person guiding you is only motivated purely by your optimal survival. Sorry to say but that is my experience.

Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.

And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Many of them are more dangerous than the cancer.