1. < Prostate Cancer

Gleason7(3+4) - treatment options recommendation

Posted by manojsmishra @manojsmishra, Aug 25 3:42pm

Got recently diagnosed with Gleason group 2, 7(3+4). Was in state of shock to know about the cancer.
I’m 56 year old and fortunately I’m with Mayo care since last decade.
Recommendation for me is to have prostatectomy as radiation therapy has long term implications. Took outside opinion also and same recommendation. But not sure how to deal post procedure with urge to urinate situation currently there.
Biggest thing is I’m hoping there is no recurrence occurring after this. Any suggestion/recommendation?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

VancouverIslandHiker | @vancouverislandhiker | Aug 28 10:35am
In reply to @ecurb "You can diminish your PSA anxiety by eating lots of mushrooms a few days before the..." + (show)
@ecurb

You can diminish your PSA anxiety by eating lots of mushrooms a few days before the PSA check. Works for me. Mine is < .01. Look it up: MUSHROOMS lowers PSA.

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Thats interesting . Any types of mushrooms , or ? Can I fry them and put onto a steak or something ? How do you eat them and what type? The local farmers here produce the regular type and many varieties of 'wild' mushrooms I notice at the market . We are in Mushroom season now to about January on the Island here now . Thanks for your help Sir ! James on Vancouver Island .

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VancouverIslandHiker | @vancouverislandhiker | Aug 28 11:12am
In reply to @heavyphil "Yup, that fear and anxiety NEVER goes away even if it’s ZERO. I was on pins..." + (show)
@heavyphil

Yup, that fear and anxiety NEVER goes away even if it’s ZERO.
I was on pins and needles for 5 yrs watching my PSA slowly creep upwards. Now that I have been put on Orgovyx and am scheduled for 25 radiation sessions I actually feel better!
To fiddle while Rome is burning is the worst for me. Of course, what if the PSA starts to climb again after all this??! My wife begs me to stop projecting but it sure ain’t easy…
Best of luck - the trend IS your friend!

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Thanks for the help . Those 25 External Beam Radiation ( EBRT) you have scheduled will work ! I found with my 22 sessions it did indeed work , as I am at 0.056 now from 0.14 ( next PSa test is in 2.5 weeks) ....but remember the radiation will knock it down almost immediately , but the lasting effects of radiation it seems to take at least 6-9 months . thats when it seems to kill off the most cells . So , radiation of Pelvic area bed is very good , it just takes time . Let me know how your are doing when you take it . Im interested and hopeful for you . The radiation itself is easy ... you get a little bit of a jury bladder and bowel though - so bring Imodium with you and , get lots of walking and exercise in on the days you have radiation. Seems to help with fatigue and effectiveness ! God Bless Sir ! James on Vancouver Island

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jeffmarc | @jeffmarc | Aug 28 12:24pm
In reply to @manojsmishra "Today I met with doctor for focal therapy treatment option. It seems this is offered to..." + (show)
@manojsmishra

Today I met with doctor for focal therapy treatment option. It seems this is offered to selected patients that qualify in certain criteria. I fall in this category but this is HIFU(Hi intensity Focal Ultrasound) offered as clinical trial.
This does not give me comfort on the treatment outcomes but if any one went this route, I’ll be interested in learning their experience

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Radiation is a safe procedure which has fewer side effects for most people than surgery. Urgency to pee is not a common problem after treatment. Incontinence can be a problem after a few years, but not always.

You should speak to a radiation oncologist, and a urologist who does surgery. Maybe even multiple radiation oncologist to get different opinions.

Have you had a PSMA PET scan to see if the cancer has spread outside the prostate? Urgency to pee could be due to spread.

You have a lot of good options.

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ecurb | @ecurb | Aug 28 12:26pm
In reply to @vancouverislandhiker "Thats interesting . Any types of mushrooms , or ? Can I fry them and put..." + (show)
@vancouverislandhiker

Thats interesting . Any types of mushrooms , or ? Can I fry them and put onto a steak or something ? How do you eat them and what type? The local farmers here produce the regular type and many varieties of 'wild' mushrooms I notice at the market . We are in Mushroom season now to about January on the Island here now . Thanks for your help Sir ! James on Vancouver Island .

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I eat a mixture of all of them, even porta bello sandwiches. Google it for more specifics.

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manojsmishra | @manojsmishra | Aug 28 12:56pm
In reply to @jeffmarc "Radiation is a safe procedure which has fewer side effects for most people than surgery. Urgency..." + (show)
@jeffmarc

Radiation is a safe procedure which has fewer side effects for most people than surgery. Urgency to pee is not a common problem after treatment. Incontinence can be a problem after a few years, but not always.

You should speak to a radiation oncologist, and a urologist who does surgery. Maybe even multiple radiation oncologist to get different opinions.

Have you had a PSMA PET scan to see if the cancer has spread outside the prostate? Urgency to pee could be due to spread.

You have a lot of good options.

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Thanks for sharing this. Even I was not leaning on this option due to it being clinical trial and I did not want my body to volunteer to it being high risk option

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mulberry | @mulberry | Aug 28 1:37pm
In reply to @vancouverislandhiker "Thanks Sir . I have talked to some Operation guys that have had 0.008 ( bottom..." + (show)
@vancouverislandhiker

Thanks Sir . I have talked to some Operation guys that have had 0.008 ( bottom of readings and unreadable) for years and years , but most have a trace after surgery , you are right . A year ago, I elected to have the external beam radiation, 22 sessions, and I really didn't get any reaction until about the seventh month level. Then it started to go down from 0.14, 0.072, 0.056. Now, in 2 1/2 weeks I'll get another one. Battle is keeping my head straight and not getting too much anxiety. I'm going for a sauna this morning here on Vancouver Island, and talking with the boys up there at the Aquatic Center, and then some yardwork and then, I have a hike planned with my wife at 4 PM with the dogs for about 3 1/2 hours. Keeping busy helps. The exercise is great and the fresh air. While I was getting the 22 sessions of radiation, I would walk for 8 to 10 km each day. Yes I was tired, but it kept my mind active and I went through a ton of neighbourhoods and areas in Victoria area. Yes, you have time and I think because you are a 3+4 I think you said, you have plenty of options. Depending on the type of four cell, I don't think you have too much to worry about. You said you were Group 2-7 ? With a PSA of 3+4 = 7 . I understand the PSA , But the Group 2-7 we dont use too much in Canada - what is the groupings all about ? From my Prostate support group, the vast majority of patients with 3+4 Gleeson have responded very well to the operation and the radiation. I think the trick here is catching it early when your PSA velocity starts to rise. God Bless Sir . James on Vancouver Island .

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Very nice description of your life in beautiful Victoria!

Regarding: " but most have a trace after surgery , you are right . "

Last week my surgeon explained why my first post-surgery PSA of 0.009 was not "undetectable" as I thought. He said that when the surgeon separates the prostate tissue from the bladder neck, the prostate tissue is "torn away" from the bladder neck and some of the BENIGN prostate cells remain behind on the bladder neck. (In my case, the cancer was not near the bladder neck) These benign cells naturally generate a small trace of PSA. My next PSA test will be in three months and if that PSA remains at or near 0.009 that will be my unique baseline against which future bi-annual PSA tests which be compared.
But if my PSA level has risen significantly higher than the 0.009, that would indicate that prostate cancer cells remain somewhere in my body and further diagnostics and treatments would be considered.
His explanation made such perfect sense, I thought I'd share it with the brethren.
Best of luck on your journey(s).

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jeffmarc | @jeffmarc | Aug 28 2:05pm
In reply to @manojsmishra "Today I met with doctor for focal therapy treatment option. It seems this is offered to..." + (show)
@manojsmishra

Today I met with doctor for focal therapy treatment option. It seems this is offered to selected patients that qualify in certain criteria. I fall in this category but this is HIFU(Hi intensity Focal Ultrasound) offered as clinical trial.
This does not give me comfort on the treatment outcomes but if any one went this route, I’ll be interested in learning their experience

Jump to this post

A friend of mine had HIFU a few years ago, and they didn’t get all of the cancer. He’s been struggling with rising PSA for a few years and using ADT drugs off and on to control it.

He always had an option of going back for a second treatment, but for some reason didn’t want to do it.

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clandeboye1 | @clandeboye1 | Aug 28 2:59pm
In reply to @manojsmishra "@vancouverislandhiker First of all thank you for your kind words. I am glad to know that..." + (show)
@manojsmishra

@vancouverislandhiker
First of all thank you for your kind words. I am glad to know that my writing style is appreciated.
In case of prostatectomy the PSA should be flat like upto 0.1 but it will never be zero. That question I did ask my U/O after my biopsy results review. Looking at what you shared I don’t think you need to worry
At my age group generally prostatectomy most patients opt for but I want
To evaluate all options first. I am also hearing that Gleason G2 now are also candidate for surveillance something I’ll check with my doctors also

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Yes thousands patients with Gleason 3 + 4 = 7 are on active surveillance and many for years.
5 Years + +
Consult on your case with your Urologist .

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1 reply
heavyphil | @heavyphil | Aug 28 3:16pm
In reply to @vancouverislandhiker "Thanks for the help . Those 25 External Beam Radiation ( EBRT) you have scheduled will..." + (show)
@vancouverislandhiker

Thanks for the help . Those 25 External Beam Radiation ( EBRT) you have scheduled will work ! I found with my 22 sessions it did indeed work , as I am at 0.056 now from 0.14 ( next PSa test is in 2.5 weeks) ....but remember the radiation will knock it down almost immediately , but the lasting effects of radiation it seems to take at least 6-9 months . thats when it seems to kill off the most cells . So , radiation of Pelvic area bed is very good , it just takes time . Let me know how your are doing when you take it . Im interested and hopeful for you . The radiation itself is easy ... you get a little bit of a jury bladder and bowel though - so bring Imodium with you and , get lots of walking and exercise in on the days you have radiation. Seems to help with fatigue and effectiveness ! God Bless Sir ! James on Vancouver Island

Jump to this post

Hey James, thanks for the info! The non-gassy diet is gonna be the hardest thing for me as I eat tons of corn, beans, cauliflower,etc. Constipation usually follows if I don’t ever since my surgery 5 yrs ago. No DR has been able to shed any light on this but I recently found the term ‘anismus’ which is a pelvic floor disorder sometimes caused by pelvic surgery….duh?? No one ever knew this?!
But I guess the radiation will fix that from what I’ve heard from you and others😂.
BTW, we visited Vancouver for the 85 World’s Fair -just a spectacular city! Did not get over to the Island due to some ferry issues they were having but I’ve heard it’s sort of a paradise on earth. So keep on hiking and soaking up all that natural beauty and positivity - it’s better than any drug or treatment devised by man.
Phil

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heavyphil | @heavyphil | Aug 28 3:28pm
In reply to @pmclarksr "Is there anybody with a 4+3 Gleason score who chose Cyberknife? I’d like to know thoughts..." + (show)
@pmclarksr

Is there anybody with a 4+3 Gleason score who chose Cyberknife? I’d like to know thoughts and results. Thanks

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Hey bud, my friend had two 4+3 cores, low Decipher score.
He just finished 3 months ago and is doing great. A little impotence more than he imagined but I am sure it will improve.
At age 73 and about 48 yrs of marriage I think some slow down here is to be expected, no?
In my case, I had surgery at age 64 with a very robust sex life and after that -ZIP! Like they pulled the plug on my manhood - but I had one half of the gland almost solid 4+3 and told the surgeon to spare nothing - just get the f****ing cancer out! He did, I’m still alive…not so bad….

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