44yr PSA180 Gleason9 non-metastatic. Surgery or Treatment?

Thanks for responding. I’m very nervous and confused. Yes, I’m 64 years old and perfectly healthy. My path did have cCRIBRIform. Cell pattern. I just had a PSMAPET scan two days ago and it was clear. I really don’t wanna have to take the ADT medicine side effects and long-term things. Don’t sound good to me.

Hi Jeff, when microscopic prostate cancer cells enter the bloodstream from things like epe, lvi, and svi, do the cells typically spread all over the place immediately through the blood or does it sort of creep outward from the pelvic area?

What are your last two PSA results and the dates for each? How many of the biopsy cores were positive for PCa and what percent of each core was positive? How many cores had cribriform? Does the pathology report specify large or small cribriform pattern?

I think we were all scared and confused upon diagnosis. You are on the right track being on MCC to begin to get an understanding of what your diagnosis means, what the possible treatment options are and potential side effects for each as well as a perspective on the choices made by others and their reasons for them. I was diagnosed with Gleason 9 in many cores, cribriform and EPE so I have a pretty good idea of how one feels when the diagnosis is a very high risk PCa. Take a deep breath, relax and begin to read and ask as many question as you have.
Bill

I’ve been on ADT for nine years. In general, nobody would know I’m on it except I get hot flashes now and then. Yes, I do have to exercise. I walk the track across the street twice a day every day, a mile each time. I have to take bone strengtheners. I took Fosamax For six years a pill you take once a week and now I’m on quarterly Zometa infusions. I go to the gym 2 to 3 days a week to keep my muscles in shape. I’ve never had a fatigue problem because I do all the exercising, that is critical in order to beat the fatigue.

There are worse things than ADT like dying Yeung. I’ve had prostate cancer since I was 62, I had surgery 15 years ago and It came back 3 1/2 years later so they gave me an ADT shot and two months later radiation for 7 1/2 weeks. The radiation never bothered me. I went to work right after and never had a problem with it. I’ve had two more reoccurrences, but have been undetectable for the last 22 months. I’m just waiting till the current Treatment I’m on fails and I will then move onto the next one.

I never even realized how bad ADT was because that shot before radiation didn’t affect me at all, and I only had one of them.

Don’t be afraid of ADT it can give you many many years of progression free survival.

It wasn’t till 2 1/2 years after radiation that my cancer came back that I went on Lupron For 6 1/2 years and then Orgovyx for 2.5.

Cribriform can make prostate cancer very aggressive and you are already a Gleason nine. Holding off on ADT can really shorten your lifespan. You’re not only should be on ADT but your doctor will probably also want you on an ARSI like Zytiga or a Lutamide. That is recommended with aggressive Gleason nine. To minimize the side effects try to get your doctor to put you on Nubeqa. It is quite easy compared to the other drugs. Zytiga is just like taking super ADT and is very difficult for many people.

The cancer does not immediately spread to a lot of different places for most people. In many cases, it seems to go dormant and not come back for a few years, In other cases, people get bone Mets And they can be zapped with SBRT radiation.

Everybody is different so there’s no way to say what will happen. It’s just that you should be aware that a reoccurrence has a higher probability. That’s why getting a decipher test is important so you get an idea about what your chance of a reoccurrence is.

Hi Jeff is someone had it only inside the prostate and had surgery, how does it come back? Thanks in advance for your reply.

That is without any other adverse features or spread detected in biopsy or during surgery

What are most cancer centers’ view on zapping Oligiometastatic men? Is it becoming more common?

If you have five or fewer mets then you can get SBRT radiation To treat them. But you also want to treat the prostate. Frequently that means SBRT radiation to both areas. Some doctors will do both, Others want to do IMRT to the prostate and then SBRT to the mets.

It varies a lot, what a doctor will want to do. Some might even want to do chemo, Which is what is done frequently if you have more than five mets.

The other things found in the biopsy can be a factor in what is decided would be best to do.

Thanks Jeff! My prostate is probably sitting in a freezer somewhere at the hospital, but I am interested in what they might do for me if I should develop a few bone mets at some point in the future. I see my RO every Wednesday while on radiation therapy so I’ll probably ask him next week. Thanks!