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78-year-old with 2 biopsies of cancer
My 78-year-old husband has been watching his prostate cancer. PSA has gone up gradually and multiple biopsies have come back positive. The Gleason Score was 6 in the first biopsy last year. In the second, more targeted biopsy, it's a 7. What would your recommendation be? Treat it or not???? Radiation???
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Depends on the details of the Gleason 7 biopsy. Is it 3+4=7 or 4+3=7? What percentage of 4? etc...
If you could post the complete details of the biopsy, more folks here can help.
Oh, and welcome! Sorry you had to find us.
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1 ReactionDid he take a decipher test?
ADT/ radiation should be the treatment for starters. Lots of choices for medical treatments. You need to google all the pills/ shots available for the hubby. Price/ insurance should be a concern. We the people here need more info about his diagnosis. BRCA2 positive?? Etc… HAPPY EASTER time for church to pray for our nation.
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2 ReactionsHow is your husband's health otherwise? What is the longevity of his male relatives? Was it 4+3 or 3+4? What percentage was 4? How fast is PSA increasing (if it is not going up much and is still low the cancer is probably growing slowly)? All of these should go into the decision of whether to treat or not. Many men die with untreated and undiagnosed prostate cancer only found on autopsy.
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2 ReactionsI was 77 when I was diagnosed with prostate cancer (Gleason 8 and 9) so I had a similar dilemma to your husband. Since I am in pretty good shape, active and have longevity in my family, I decided to have treatments. I would recommend getting a second opinion from a cancer center as it will give your husband more confidence that he is doing the right thing. My treatment were ADT (Orgovyx) and 45 radiation treatments. I am three years out now and feel very good so I think I made the correct decision for my case. I hope your husband can find the right path for him.
My brother at 77 had SBRT radiation when he came up with 4+3 Gleason scores after six years of active surveillance.
He’s 80 now and doing fine. They did give him ADT for six months and the side effects lasted about another six months.
What percentage of tumor was found in the Gleason seven biopsies. What percentage of it was a four. Those issues can decide whether or not active surveillance might still make sense.
Look through the biopsy report. Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.
Here's everything I have from his 2 biopsies: In 2024, it was Adenocarcinoma with Gleason score of 6 (3+3) in the left lateral base and 6 (3+3) in the left lateral mid. PSA was 4.7. In 2026, his PSA was 5.73. More targeted biopsies were made from a MRI and the 50% Adenocarcinoma in the left lateral mid was a Gleason score of 7 (3+4). A targeted lesion 1 was 35% Adenocarcinoma with a Gleason score of 7 (3+4). Pathologic Stage: T1c; Capsular Penetration: 23%; Decipher Score: 0.62. What would you recommend? We also have Proton Therapy here in Knoxville, TN, and we would probably go that route versus normal Radiation. Your thoughts on that, please and thank you.
@ecurb Yes, prayed for our nation and Happy Easter to you.
@tbirddonna
Radiation could make sense. Five sessions of proton radiation could completely eliminate this problem. The only thing that concerns me is your statement of “ Capsular Penetration: 23%”.
The capsule is usually considered the prostate itself, If there’s actual penetration of the capsule, that means that the cancer has gotten out of it. The thing is, that would make it a T3a not a T1c.
Can you explain that conundrum?.
Urologist has never said that it's outside of the prostate.