Treatment options for locally advanced prostate cancer?
I have recently been diagnosed with locally advanced prostate cancer in December 2023. I had an MRI that diagnosed my PC with a Gleason 9 stage 4a. My decipher score came back very high with a score of one. My PSA at diagnosis was 26.87 and more than doubled over a two month period while I waited for my initial appointment. I’ve also tested positive for the BRAC1 gene. My PSMA Pet scan showed a very enlarged lymph node in my pelvic region with no other spread to other parts of my body. However my MO has told me I probably have microscopic disease that involves other lymph nodes in my pelvic region. My bone scan showed no metastasis. I’m currently taking Orgovyx + Abiraterone that I’ll have to be on for two years. I’m currently trying to weigh my treatment options. My questions to the group are:
1) What type of treatment did group members with locally advance PC pursue, particularly if a lymph node was in involved?
2)Has anyone with a Gleason score of 9 with local spread had surgery and what has the outcome/side-effects been?
3)I’m looking into Radiation options and my radiation oncologist is recommending IMRT that will include a boost to the lymph node that’s involved. If I moved forward with IMRT and it fails, will I be able to do salvage radiation afterwards? Or are my options limited with this type of therapy?
4) I’ve also been looking into Brachytherapy in conjunction with IMRT and have a virtual consult with a radiation oncologist at UCLA next week. Has anyone selected this form of therapy with a lymph node involvement and what has been the sequence of both therapies and the success rate?
5) Finally, because my cancer is so aggressive I was thinking of doing chemotherapy after I finished my selected radiation treatment for the purpose of killing off any microscopic disease. Has anyone tried this following radiation?
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My husband has advanced prostate cancer. He is doing fairly well. His PSA level has dropped from a high of 1200 to 0.17. We are thrilled about that! He is often very tired and sleepy, however. We pray a lot and feel that he is getting good care here in the UK. Thank you for your comment!
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1 ReactionTom, I know it's a couple of years later, but my 83 year old, otherwise healthy husband was just diagnosed with Advanced prostate cancer, Gleason 9, no metastases but outside the prostate capsule, in seminal vesicle. He is being treated at Northwestern. Urologist is William Lin and Radiation Oncologist is John Kalapurakal. Recommended treatment is ADT hormone therapy plus 44 radiation treatments. Did you work with either of these doctors? Did you have radiation? If so, how were the side effects. Neither doctor thinks surgery is appropriate for my husband. Thanks. Hope you are on the mend since 2024.
@tom57 Not sure I replied directly to you, Tom. My husband is being seen by Dr. Kalapurakal a Northwestern - he is a radiation oncologist. He has recommended a lot of treatment: Bicalutamide, Orgovyx, some kind of shot (maybe Lupron) and 44 radiation sessions. Sorry if I'm repeating. Wondering who you were treated by at NW, if you were pleased, and how you are doing now. Thanks.