81 Year Old male - Prostate Gleason 4+5 with T3b

More info - I had the MRI, then a biopsy, and then a PET scan. Here are results of the PET.
PROCEDURE:
The patient was evaluated with a dedicated PET/CT scanner. 5.0 mCi of
Ga68 PSMA ILLUCCIX was injected IV at 1105 hours. 63 minutes
post-injection, CT attenuation-correction images and subsequent PET
images (attenuation-corrected and emission-only images) were obtained
from skull base to mid thigh. PET, noncontrast-attenuation CT, and
fused PET/CT images were then reformatted and reviewed in the axial,
sagittal, coronal and 3-D maximum intensity projection planes.

FINDINGS:
HEAD AND NECK:
Physiologic radiotracer distribution.

CHEST:
Lungs, Pleura and Airways: No avid pulmonary nodules. Trace bilateral
pleural effusions. Mild bibasilar atelectasis. No airway narrowing or
obstruction. No pneumothorax.
Mediastinum: Ectatic ascending aorta. Coronary artery calcifications.
Trace pericardial effusion.
Lymph Nodes: No pathologically enlarged lymph nodes or lymph nodes with
abnormal activity.

ABDOMEN:
Liver and Biliary: No biliary abnormality. No abnormal activity in the
liver.
Pancreas, Spleen and Adrenals: No abnormal activity in the pancreas,
spleen, or adrenal glands.
Kidneys: No hydronephrosis or calculus.

ABDOMEN AND PELVIS:
Bowel: No small bowel or colonic dilatation. Scattered colonic
diverticulosis without evidence of acute diverticulitis. Physiologic
activity present in bowel loops.
Vessels: No aneurysm. Moderate-severe calcific atherosclerosis.
Lymph Nodes: No pathologically enlarged lymph n1odes or lymph nodes
with abnormal activity.
Peritoneum and Retroperitoneum: No intraperitoneal free air, ascites or
peritoneal mass. No significant retroperitoneal abnormality.

PELVIS:
Genitourinary: Focal uptake in the left hemiprostate, SUV max 9.3
(fused axial image 154), with suspected invasion of the inferior aspect
of the left seminal vesicle (fused axial image 150). No hydroureter.
Radiotracer activity along the bilateral ureters, compatible with
physiologic urinary activity.

Body Wall: Right inguinal hernia containing a short segment of small
bowel, without bowel obstruction. No masses or hemorrhage.
Bones: No acute fracture or vertebral end plate destruction. No
PSMA-avid lytic or blastic lesion. Scattered multilevel degenerative
changes in the spine. Right shoulder arthroplasty with associated beam
hardening artifact.

Impression
Summary of Target Lesions:
-Focal uptake in the left hemiprostate, SUV max 9.3 (fused axial image
154), with suspected invasion of the inferior aspect of the left
seminal vesicle (fused axial image 150).

Comments:
1. PSMA uptake in the prostate consistent with known malignancy, with
suspected left seminal vesicle invasion.
2. No evidence of avid metastatic disease.
3. Trace bilateral pleural effusions. Trace pericardial effusion.
4. Right inguinal hernia containing a short segment of small bowel,
without bowel obstruction.

@ghansonsmoker Unfortunately, no one can answer that question - not even the best surgeon or radiologist.
However, seminal vesicle invasion along with your high Gleason score points to a more aggressive cancer.
If you are really sincere in your timeline - and don’t expect or want to live to 100 - radiation (there are many types and combos) with a 6 month course of ADT would probably take you to your goal of 4-5 years and probably well beyond.
Surgery really isn’t something I would personally consider at age 81, but that’s just me. Best,
Phil

6-9 mos ADT with a round of radiation would prob get you 8-10 yrs...or more. but you need a good oncologist to discuss all options with you..listen to what is important to you and help you toward that end..

but I would continue to buy green bananas and enjoy each day- you may have a 6-9 month treatment window where you exp some side effects ( ADT/radiation) but you can prob easily handle that.

It has already spread locally so to get 5 years you probably need to treat. Stats for metastatic prostate cancer are grim with historically less than 35% 5-year survival. This has improved somewhat with combined ADT and ARSI therapy. Even though you cannot feel the cancer now if it moves to your bones it becomes painful. It is unlikely you will have even 4 good years untreated. As mentioned, radiation is probably the best treatment to get a few more good years.

The problem is that you have a very advanced case of prostate cancer. It may take a year or two before it metastasizes to the bones, at that point, you will begin to have pain. Prostate cancer pain is unrelenting, You can’t get into a position that will make you feel better. You probably would need opioids to relieve the pain And the side effects of them are not something you want.

My father died of prostate cancer. He had an incredible pain tolerance. When I was a teenager, 60+ years ago,He had his teeth ground down and crowned without Novacaine, Then came home for dinner at night.

When he was dying of prostate cancer, his pain was so intense. He had to be on so much morphine that he couldn’t communicate..

In your case, a treatment of radiation and then going on a drug to suppress the cancer growth, Would probably give you more than five years. Five years without pain. You could try going on a drug like Nubeqa Without any other drugs. That can suppress the cancer without needing your testosterone lowered, And having no side effects for most people.. ADT for a certain amount of time would make a lot of sense however, After radiation, it can cause the cancer to be unable to continue growing and can kill most of it that radiation doesn’t kill.. I’ve been on ADT for eight years and I’m 78. Not really a major problem. For some people it can be real problematic, however. If you went on a drug like Orgovyx For ADT it would allow you to take a pill every day and if you wanted to stop you could and your testosterone would usually come back pretty quickly.

You should discuss these options with your doctor. Find out what they have to say. See a radiation oncologist, a urologist that does surgery and hopefully a GU oncologist that can help direct your treatment.

The T3b means Seminal vesicle involvement. The cancer has gotten out of the prostate into the Seminal vesicles. That can result in spread later, But radiation can frequently handle that.

You don’t mention if any of these things were found in the biopsy intraductal, ductal, large cribriform, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can also make the cancer much more aggressive.

I'm one of those that strongly recommends surgery even at 81 (also me), if you are in good health & not overweight. Less likelihood of peripheral damage with an experienced surgeon. I had surgery five years ago & it was a breeze, & I was never incontinent.

Don't remember my gleason but I had open prostatectomy in 2023, and things are going great.