Gleason7(3+4) - treatment options recommendation

Manojsmishra - I would definitely agree with your assessment. You are one year older than I was when diagnosed with prostate cancer (2 1/2 years ago). After the doctors found lesions from an MRI, I was praying that my cancer would be Gleason 6. Unfortunately, my prostate cancer was Gleason 7 (4+3). For me and my #1 person goal (30+ years of prostate cancer free life to spend with family and friends), I decided that a robotically assisted radical prostatectomy was the only viable option. Based on my research, this decision would not have changed based on Gleason score alone. I wanted a procedure that could physically remove all known prostate cancer, clearly define margins, remove surrounding lymph nodes, allow for a full pathology to be performed, and get a Gleason Score that is based on the entire prostate, seminal vesicles, and lymph nodes. My research found far too many men who's cancer was upgraded after their post surgery pathology. I was unwilling to trust scanning tools to guide non-invasive treatments. Our scanning technology is amazing, but definitely not perfect. Cancer is tricky and you never really know what your situation is or will be. For me, physical removal and pathology provided the best chance to understand my cancer and allowed for more backup plans, if the cancer was found outside the prostate/seminal vesicles & lymph nodes.

Glad you are already in the Mayo system. I did a lot of research and chose Mayo-Rochester and Doctor Igor Frank. An amazing hospital, staff, and doctor. I am over 2 1/2 years out with no bio-chemical reoccurrence, no incontinence, and no erectile function. Please note, it takes about 12-18 months to get everything back to normal. For me, the worst part of the surgery was the catheter and referred shoulder pain. Both of these were gong after the catheter was removed (7 days after surgery). After the catheter was removed, recovery went well was very manageable. (no help needed from my wife at that point).

Best of luck and I pray all goes well with your treatment plan!

Jim

Thanks for this. I'm just diagnosed in late July, Gleason 7=4+3, older than you guys at 66. PET scan says there has been NO spread. I'm having a hard time deciding between surgery and radiation, probably choosing surgery. I have one complication, an irregular heartbeat. I had an EKG the other day to see whether that makes any difference in choosing a treatment. It was helpful to read about your experience.

My brother had a 4+3 with no spread and had five SBRT sessions, which seems to have completely eradicated the cancer. Much better chance of getting an erection after radiation than after surgery. If it is not spread outside, the prostate radiation does make sense.

If you have an irregular heartbeat, you should stay away from abiraterone. I had 2 Afib events 15 years before starting abiraterone, was on for 2 1/2 years and had three afib events while on it. After the third one, my oncologist pulled me off of it and put me on Nubeqa.

I have had both surgery and radiation and neither of them caused a problem with my heart rate.

Learned on Jan. 01 that my PSA was at 12.4 (had not been to a dr in over 20 years...). Had MRI that showed PiRads 4. Biopsy in mid-March that confirmed cancer with a 4+3 Gleason and cancer was contained within the prostate. Had a Pet scan PSMA in early August that showed some cancer in nearby lymph nodes. Thought --- possible that the biopsy (18 core samples taken and the prostate had holes poked in it AND the then some cancer cells leaked out?) If the cancer was still contained I might have leaned toward surgery with any necessary radiation afterwards. Got the Eligard shot for hormone treatment on Aug. 27 and will begin 28 radiation treatments on Sept 09 at Mayo Rochester.
Will turn 68 on Sept 06 am in very good overall health except for ulcerative esophagitis that has constricted the esophagus to half its normal diameter - 4 endoscopies with the last 3 attempting balloon dilation but not lasting after 30 days or so.
Did a virtual call with Mayo nutritionist and inquired about 'natural remedies' such as alkaline water / low, low sugar diet / mushrooms / vitamins / high vitamin C IV's / colon or liver cleanses, etc. - they had nothing, saying 'no studies have supported those anecdotal tales'.
The body is a wonderful creation that God made. I would LOVE to fight this cancer with all natural, homeopathic options as I believe God's cure would be better than man's cure which involves harming the body first in an attempt to get the poison out.
Wishing all much success with a minimum amount of severe and lasting side effects!

You did the right thing with all the treatments you had. Homeopathic medicine probably won’t help at all, but there is something you can do besides medical procedures.

Going vegetarian or vegan has enabled many people with prostate cancer to stop it from growing. You could probably eat a little chicken or fish, but you wanna stay away from red meat completely. if you search the web, you can find more information about the diet affecting prostate cancer. I’m sure there are webinars from the PCRI on YouTube. I have seen many webinars about how diet affects prostate cancer, and some of them are on YouTube.

In Australia, they make a super broccoli soup that can prevent your DNA from changing something that also helps stop cancer progression. Broccoli is one of those vegetables that really helps with stopping the progression of prostate cancer.

@anosmic1
I am 77 was 76 when diagnosed. PSA was within normal but was rising each PSA tests.

When in doubt get a second opinion. Has anyone told you about the Decipher test? It can determine the aggressiveness of your cancer and your risk level. You had a PET Scan (PSMA) so no spread is very positive. My R/O also did the bone scan.

I am a heart failure patient at Mayo Jacksonville and have a ICD/Pacemaker. I am on medication for PVCs and irregular heartbeat. Medications have really helped. Surgery will be far more stress on your body than radiation.

Surgery is and should be described as serious. Surgery is far more intrusive than radiaion treatments. You do not feel a thing during radiation and many new and great radiation treatments out there today that offer really good cure rates.

Radiation side affects come after a while as the radiation is targeting your prostrate and is being damaged. Some will get noticeable side affects like frequent urnination, increase need, some fatique (mine was very minor).

My advice talk to your urolgist and R/O about the pros and cons of surgery and radiation. Still in doubt get a second opinion from an experienced institution with latest research and treatment facilities and methods. A lot of second opinons can be done electronically with the second opinion using your tests results to give you a second opinion.

I would definitely get the Decipher regardless of picking surgery or radiation. Why? I was diagnosed as intermediate based on my biopsies. The Decipher test came back as low risks. It changed my treatments from radiation and hormone treatments to radiation only. My tests and diagnoses procedures were done at Mayo Jacksonville. My second opinion was done at UFHPTI. UFHPTI used my already done tests and it was done my me signing a medical waiver for them to get my medical information. I then met with them.

kevinsabin, 20 years and you got back to the doctor just in time to save yourself. Another five years and you'd be in trouble,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10915943/#:~:text=Emerging%20evidence%20suggests%20a%20link,growth%20and%20enhancing%20immune%20surveillance.
https://pubmed.ncbi.nlm.nih.gov/32768949/
Likewise, wishing you a great doctor and lots of luck.

When I was getting my 29 Proton treatments at UFHPTI a few months back (no ADT by choice as I too had low risk Decipher results), there was a man there who had an interesting tale.

Younger than I am at 71, he had not heard of proton therapy and was actually on the operating table back in his home town for a prostatectomy when they discovered a heart condition that led to them stopping the procedure before going in. A friend of his told him about proton therapy in Jacksonville at UFHPTI and that's where he ended up and a very happy camper as a result.

Everyone diagnosed with Prostate Cancer should read the book, "Invasion of the Prostate Snatchers." You can find it on Amazon. And send for the free packet of materials on Proton Therapy from UFHPTI by filling out their online contact form. Whether you choose proton therapy or not, you will have armed yourself with more information.

@5galloncan
UFHPTI is a great institution for proton radiation. I had Dr. Mendenhall who stated he does over 50% of the prostrate treatments. The faicility is outstanding with 5 gantries all with the lasted proton radiation equipment.

When those who are seeking radiation treatments in Jacksonville area I always refer to UFHPTI as Mayo Jacksonville does not have proton radiation. The treatments as UFHPTI are very professtional prior to, during, and after. The staff is very courteous and friendly. I had the Blue team for my treatments and they did every thing they could to make me feel comfortable. I would end my treatments each day when they gave me my next day arrival time (which was always within 30 minutes of my requested time) saying, "Same bat time, Same bat place, Same bat team. We all would get a good laugh.

When I finished treatments the entire day time blue team came up to me and hugged me saying stop by to say high on your follow ups. I really gave that chime a big swing.

I too had Dr. Mendenhall and Gantry 1 (Blue). Both excellent. I stayed 5 minutes away at Third & Main, which was also safe, very convenient and affordable. All around, a very good experience and highly recommended.