4 + 3 = 7: Should I involve a prostate cancer specialist?

Posted by rex5789 @rex5789, Feb 19, 2023

I am unused to blog/discussion groups...just diagnosed with 4 + 3 = 7, PSA 4.08 (2018 was 1.59)... I am 77, super active, mission trip to Cent America next week, work my own wood on 35 acres and involved in establishing Charter schools. Parents lived till 95 & 86. Have an appointment in Ashland WI tomorrow-I do not note my radiologist/oncologist is a prostrate specialist. Am I correct that this is an important issue. I can travel anywhere. Thanks!

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@dirtdancer

Medicare now covers a PET scan. I strongly and highly recommend you get one. Once you personally see the results of a pet scan, the value is incredible. I’ve had aggressive, advanced invasive, prostate cancer for 15 years and had almost every treatment option. The pet scan gave me the best and most comprehensive view of all the different cancer in my body. The spread of bone cancer was very interesting. Doctors do not treat bone cancer until it becomes painful, they usually just let it spread. Which I have been fighting against but too little avail. I should actually start a discussion on bone cancer and its treatments .
My first treatments were a ADT and Lupron- followed by HDR Brachytherapy and 44 radiations.
My cancer has never disappeared- only been restrained. So personally I am in favor of over treating. Living thru this is a pain.

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I agree that the PET scan is a wonderful tool. I disagree with your comment about cancer spreading to the bones and not being treated until it’s painful. I am treated at Mayo Rochester and when the scan showed a spot in my hip I was immediately treated with SBRT treatment to that spot before it spread. My doctors take an aggressive approach in treating my cancer for which I am thankful.

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@jap57

I agree that the PET scan is a wonderful tool. I disagree with your comment about cancer spreading to the bones and not being treated until it’s painful. I am treated at Mayo Rochester and when the scan showed a spot in my hip I was immediately treated with SBRT treatment to that spot before it spread. My doctors take an aggressive approach in treating my cancer for which I am thankful.

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My doctors (plural) have told me repeatedly they aren’t treating my bone cancer until it becomes painful. I have 27 different spots… thank you for your comment. I will dig deeper here.

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Congrats on being so active and doing Charity works. You know your Gleason score so I assume you have a Urologist/Surgeon. You should listen to him. PCa has lots of different options to treat. He should explain surgical options as well as recommend an Oncologist as Radiation is an option to treat. Non treatment is an option but for someone like you you may live to 100 and treatment seems reasonable. There are pros and cons for each. I went thru surgery at 60 yo last year. I have recovered fine. My friend who is 68 opted for radiation as he was concerned with incontinence issues as a side effect of surgery. I did not experience incontinence thankfully with my surgery. Good Luck with whatever you decide.

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Off to Mayo Clinic! So close and so worth it. Hyatt House is a good hotel to stay at. My husband is 4 weeks past surgery and is regaining continence. We were told side effects from surgery are immediate and recover slowly , radiation side effects may come later after many years.

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You are starting a journey--of learning as well as doing. The fact that you found this forum indicates you are taking the learning aspect seriously. Now you have a diagnosis (which probably means you've had a biopsy, hopefully also a good multiparameter MRI with good interpretation, and obviously you've checked your PSA at least once.)
Your 4+3 score indicates that you have at least one spot with "intermediate unfavorable" grade cancer. This does not mean that you don't have worse cancer somewhere else (that's where an mpMRI adds some input.) Your low PSA is not necessarily a positive thing, given that the cancer is there. That's something your good medical counsel can help with.
So now you are going to focus on treatment options, which for you no longer include watchful waiting, so that will be focal ablation (zapping the known spots either with radiation or something else, like cold, laser, etc.), surgery, or more aggressive radiation.
Since surgeons focus on surgery, radiologists on radiation (and sometimes other ablation strategies), and oncologists usually focus on chemotherapies, finding the right people to consult is certainly part of choosing the right treatment options. I was counseled to ask pointed questions (after doing my research before the appointment) including how many people have you treated (with what stage of cancer,) what are the statistics for quality of life among those you've treated, etc. It turns out that those who are more expert like to share their statistics :-). Who knew!

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@bens1

My RO told me that the normal procedure is to cover the whole prostate and that the millimeters beyond that can affect healthy tissue. Picking the radiation machines that limits those millimeters made sense to me. Some machines set margins greater than 4 mm, the MRIdian margins were set to 2 mm for me. MRI shows a clearer picture of healthy tissue, CT less so. I am not a dr but that’s what I have heard and so far my side effects are minimal from the MRIdian.

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I'm considering MR-Linac, too. Now that it's been awhile since your MR-Linac treatment, how have your post-treatment side effects been long-term?

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@itsaquarter23

I'm considering MR-Linac, too. Now that it's been awhile since your MR-Linac treatment, how have your post-treatment side effects been long-term?

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@Beachcomber20 I have had no side effects long term so far.

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@curious10

Off to Mayo Clinic! So close and so worth it. Hyatt House is a good hotel to stay at. My husband is 4 weeks past surgery and is regaining continence. We were told side effects from surgery are immediate and recover slowly , radiation side effects may come later after many years.

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My experience with Mayo has been phenomenal! And now, my wife is having surgery Thursday to hopefully resolve herr diverticulitis. They are the best!

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