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Gleason7(3+4) - treatment options recommendation
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?
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@jeffmarc
True, what the statistics now show is at least with radiation the outcomes are equal. That does not mean side affects and secondary issues it means whether the prostratce cancer was successfully treated.
I know Mayo Jacksonville does not have proton radiation for any of their cancer treatments. They are building a new cancer center that will have it. However they use the new SBRT photon radiation which is vastly been improved from intially photon radiation.
My only concern and is just my opinion not medical knowledge is that if entire prostrate is not treated you might miss small areas, or just even cancer cells that are not deteted and the direct treatments to just specific parts of prostrate might permit some cancer cells to go untreated and of course means they could start growing more and more.
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1 ReactionLast year, my brother had five sessions of SBRT at UCSF. They cooked the whole prostate even though not all cores had cancer. I think that is pretty standard for SBRT radiation. Now there are newer techniques used that don’t cook the whole prostate, and you are probably correct. They can leave stuff that spreads the cancer later.
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3 Reactions@jeffmarc
Hi Jeff,
Yes the photon radiation treatments have improved. I had a choice of photon or proton and even though the outcome predictions were the same the proton does not pass through body but stops at the margins set up by your R/O. Photon radiation treatments have drastically improved reducing side affects. The SBRT can move the beam around to keep away from organs and tissues that was not the case with early photon radiation treatments.
UFHPTI received a 25 million dollar federal grant to study long term outcomes of all types of radiation treatments. I was asked to be a participant in that study and I agreed.
The chance for cancer cells (it is at the celluar level) to continue to grow is high if present and not treated. I asked my R/O: "Do you treat just the areas that were shown positive on the biopsies or entire prostrate?'" Answer: "We treat the entire prostrate." He stated you are talking about cancer at a celluar level and no biopsie or MRI can see or determine all areas of prostrate that may have cancer cells.
I read over and over about those who had surgery to remove the prostrate thinking was the way to go as all would be gone only to have the cancer show up in other areas.
Everytime someone asked about tests I always suggest Decipher tests, PSMA, and bone scans. This can HELPp determine if any cancer cells have moved out of prostrate undetected and are growing elsewhere. Not full proof either but at least doing everything you can to determine if has gone outside of prostrate and a more agressive and different treatment.
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1 ReactionI am T3A. I have had no other drugs/treatments since the surgery.
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2 ReactionsI agree with you that whole gland treatment is less risky than targeted or focal therapy. I had focal brachytherapy in 2020 and the radiation field missed significant aggressive disease. I wasn’t monitored adequately and PCa came raging back.
The lesson is focal therapy may not get it all.
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4 ReactionsSurprising your doctor removed so much since you didn’t have seminal vesicle invasion.
You are a Gleason 9 and after radiation NCCN standards call for 24 months of ADT. I recently worked with two guys who didn’t have ADT and both of them had metastasis within a year and a half. One of them had a quite serious tumor on his femur and he was only a Gleason 7. ADT is really important to prevent recurrence.
Do you have a Genito Urinary Oncologist? With Gleason nine that is important. You need to be treated correctly to prevent reoccurrence. What type of doctor are you working with? It doesn’t sound like they are following the standards and that doesn’t protect you.
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1 ReactionOh for sure - I am living proof of that!
I guess focal therapy, once again, is both a personal choice and an option presented favorably (or not) by your treating surgeon/RO. I am sure some MD’s really like it and perhaps present it as a panacea: We only do this part now and we can always do more later.
While true, it’s the interim that scares me. What if the undetected cancer metastasizes? What if what they didn’t take out is more aggressive?
I just read @robertmizek’s post about his LDR brachytherapy nightmare and THAT scenario is exactly what worries me.
Just went back to the pathology report. I am a T3B. But the only Gleason score I can see on it is a 7. Here is the summary:
Synoptic Report
:
Specimen
Procedure: Radical prostatectomy
Tumor
Histologic Type: Acinar adenocarcinoma, conventional (usual)
Histologic Grade
Histologic Grade
Gleason Pattern: Gleason Pattern
Primary Gleason Pattern: Pattern 3: 50 %
Secondary Gleason Pattern: Pattern 4: 30 %
Tertiary Gleason Pattern: Pattern 5: 20 %
Grade: Grade group 2 (Gleason Score 3 + 4 = 7)
Intraductal Carcinoma (IDC): Not identified
Cribriform Glands: Present
Treatment Effect: No known presurgical therapy
Tumor Quantitation
Estimated Percentage of Prostate Involved by Tumor: 41 - 50%
Extraprostatic Extension (EPE): Present, nonfocal
Location of Extraprostatic Extension: Left posterior
Urinary Bladder Neck Invasion: Not identified
Seminal Vesicle Invasion: Present, bilateral
Lymphatic and / or Vascular Invasion: Present
Perineural Invasion: Present
Margins
Margin Status: Invasive carcinoma present at margin
L
inear Length of Margin(s) Involved by Carcinoma: Less than 3 mm (limited)
Focality of Margin Involvement: Unifocal
Margin(s) Involved by Invasive Carcinoma: Left seminal vesicle surgical
margin.
Margin Involvement by Invasive Carcinoma in Area of Extraprostatic
Extension (EPE): Not identified
Gleason Pattern at Margin(s) Involved by Carcinoma: Pattern 3
Regional Lymph Nodes
Regional Lymph Node Status: Tumor present in regional lymph node(s)
Number of Lymph Nodes with Tumor: 1
Number of Lymph Nodes Examined: 13
pTNM Classification (AJCC 8th Edition)
pT Category: pT3b
pN Category: pN1
Best Tumor Blocks for Future Studies
Tumor Block(s): F14
Normal Block(s): N/A
Perhaps getting a second opinion on your surgical pathology would be helpful to nail down your gleason score. 20% is a lot of tertiary pattern 5.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382533/
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1 ReactionYou said “ My Gleason was a couple of 9's and a couple of 7's.”. It sounds like your tertiary 20% of 5’s was showing up in the biopsy as some 4+5 but mostly 3+4. Margins also had involvement, along with a lymph node and seminal vesicles.
As @farmanerd says, get a 2nd opinion.
With all the issues in this report you sure should get a second opinion, I can’t imagine a GU Oncologist would not recommend you be on ADT.
You don’t want this to come back in a short time you really need to be more proactive. Your life is really dependent on top notch medical care.
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