Gleason7(3+4) - treatment options recommendation

I agree but even a RP can leave behind cancer cells .
Additionally , if NanoKnfe fails after say 5 years there are numerous salvage treatments sttill available , including a repeat NanoKnife .
In Canada the procedure runs between $ 23,000 and $ 25,000 Can

Looks like you might have left off your message as you were about to say more. Not sure you noticed but those three dots in the bottom right allow you to edit your message again after you’ve posted.

I’d be interested in hearing what more you had to say.

Hey. Any thoughts on TULSA procedure?

I had salvage prostatectomy after failed LDR brachytherapy with Dr. Ash Ross at Northwestern Medicine in Chicago. It’s a delicate high-risk procedure and Dr. Ross is only one of 4 or 5 surgeons in the US that has done hundreds of these surgeries with good outcomes.

Nine months after surgery, I have zero incontinance and hope to regain full sexual function in the future.

Never give up!

It’s not commonly done but I’ve had it after failed brachytherapy. Very few patients quality. Low BMI and excellent shape and health (other than PCa) are a must and you have to be free of co-morbidities. I needed the catheter to be in place for 3 long weeks and it took another 6 weeks to feel like my old self.

3 weeks? I don't know how you did it, although you didn't have a choice. After 8 days I was absolutely going bonkers with the catheter. Bladder spasms were the worst. And carrying around "my little friend" everywhere I went was comical at best. I ended up putting it in a Target bag. One day my wife saw me carrying the Target bag and said "wow, what you can get nowadays at Target!" 🙂

3 weeks was tough. I counted the days.

Bladder spasms were the worst. Do you remember me mentioning them in the write up that I gave you? They sucked!

Your wife sounds like she’s got a great sense of humor and is a keeper.

How many weeks post surgery are you now? I’ve lost track. And how are you feeling?
Did you get your pathology report and is it still the same Gleason score as before?
Have you had a post surgical PSA reading yet?

Hello my online friend!
I am now 2 weeks 2 days post-surgery. I feel better every day, started doing a lot of outside stuff lately. I got my pathology report back and I am in the high-risk category, my "score" as the surgeon put it went from 5 to 3. My Gleason was a couple of 9's and a couple of 7's. There was one positive lymph node which worries him. He could not save one side of the nerves due to cancer involvement. He removed the prostate, vas deferens, lymph nodes, seminal vesicles, and one or two other things I forgot the names of. He has me scheduled for my first PSA test at 6 weeks, a meeting with a radiation oncologist at 8 weeks, and a 2nd PSA test at 12 weeks.

The only negatives two weeks out are the incontinence (not that bad, but noticeable) and one of the incisions is still ouchy. I also get tired pretty easily, but I think that is to be expected for a few more weeks of recovery. My energy just seems to fade in and out all day, and by 9pm I am really, really tired. Couldn't even watch my Buffalo Bills get their heads handed to them Sunday night! LOL

So, all in all, recovering as expected, pathology not so great which has the doc worried, and waiting for the next "Adventure in Prostate Land." 🙂

For the benefit of the other form members, I’m giving a short reply, but will also send you a private message.

It sounds like you are about where I was two weeks post surgery. I think it took me about six weeks to feel less fatigued, and more close to normal.

Sorry about the bad news on the grade group and Gleason scores. That’s exactly what happened to me and he could only do nerve sparing on one side. I also had two suspicious lymph nodes; one of them was removed during RP and tested positive for PCa and the other was far too risky to reach during surgery so they had to go after with radiation once I was healed.

It took me about 7 months to become totally continant and not need a pad anymore. Pelvic therapy helped.

Stay positive! It is a journey we’re both on, but not necessarily one with a dead end.

Do you know what your clinical stage is? Are you T3b which means it actually spread to the Seminal vesicles? Did the doctor mention you had cribriform or intraductal those are significant issues.

If you show even 1 Gleason 9 you are Gleason 9. The 7’s don’t count any longer.

Some people live long lives even with Gleason 9. I know people that have gotten off all drugs after being undetectable for a long time, even though they are Gleason nine.

With the cancer you have, you should be getting PSA tests monthly.

Where are you being treated? You should have a Genito Urinary Oncologist treating you. They specialize in prostate cancer, which medical oncologist can’t quite do. This is very important with your level of cancer. If you need help finding one, let me know. I work with somebody that has contacts all over the country.

If you are being treated at a Mayo clinic, then you are probably getting the best medicine can offer.

You don’t mention it, but are you on Lupron or an equivalent drug like Orgovyx. With Gleason 9 you should be on it for 24 months according t according NCCN. You probably should be on a secondary drug as well, has that been discussed? Ask your doctor about it.