Gleason7(3+4) - treatment options recommendation

@manojsmishra
I agree nothing is guaranteed, it’s all a crap shoot based on statistics. That is why Las Vegas is so big, its not because everyone wins. It is built on losers. They are winning because the odds are in their favor. That is why everyone makes their decision’s based on statistically the treatment that is giving them the best odds at beating the beast.

Are you a candidate for final therapy? Many advantages over RP and radiation

I'm in much the same boat. Gleason score of 7, (3+4) and PSAs in the 10-12 range for the past two years. The MRI shows a 1.4 cm nodule, and a second 1.2 cm nodule, confirmed by biopsy. Cribiform cells. The PET scan shows no spread. Some sort of genetic testing (I am not clear what) has been ordered from the biopsy material, no results yet. I am seeing doctors at Memorial Sloan Kettering in NYC. The surgeons want to do a radical postatectomy, but I am leaning toward treatment by the radiation oncologists who want to irradiate using stereotactic body radiotherapy (SBRT) and a rectal spacer gel. Side effects are said to include infertility, ED and a small chance of permanent effects on urination and rectal function. Watching and waiting seem to be out of the question. I would like to hear from anyone who had SBRT about their experiences.

@wheel1
Exactly. It is the individual working with there medical professionals to decide on their treatments based on them as individuals not statistics. We are not cattle we are individuals with our own specific medical and mental health history.

Watching a video or watching a podcast or seminar does not give you the individual medical guidance you need for what is best for you as an individual. A podcast, seminar is only working with statistics not you as an individual.

No one one MCC has your full medical or mental health history and has not seen you as a patient as a medical professional. Don't feel pressured to do something or not do something. That is your decision with the guidance from your medical professionals.

If you don't trust your medical professionals many on MCC will suggest second opinions and even if you trust your medical doctors a second opinion will always help you make decisions.

I was going to Mayo and got my diagnosis but working with my PCP (per his recommendation) got a second opinion not that I did not trust Mayo but another institution agreeing or not agreeing helped my mentally make the decision of what was best for me as an individual statistics as they do not address the individual full medical and mental health history.

I agree patients need to work with their medical professionals to determine if they are candidates for active surveillnce. It is also important to note that active surveillance is not a fringe idea found only on videos and podcasts. It is part of standards that guides urlogists nationwide. For someone newly diagnosed with low-volume Gleason 3+4 disease, the current NCCN and AUA guidelines support considering active surveillance—but only after confirming that the patient truly has favorable intermediate-risk disease. Many men (and even some physicians) still think "3+4 means you need treatment," whereas the guidelines have evolved considerably.

Current NCCN and AUA guidelines recognize that carefully selected men with low-volume Gleason 3+4 (Grade Group 2) prostate cancer may be appropriate candidates for active surveillance. Patients most likely to be suitable have - as others have indicated - favorable intermediate-risk disease, including a small amount of Gleason pattern 4, low tumor volume, low PSA density, favorable MRI findings, and favorable genomic testing. Active surveillance is not recommended for patients with adverse features such as extensive pattern 4, high tumor volume, unfavorable genomic classifiers, cribriform or intraductal carcinoma, or other signs of more aggressive disease. Treatment decisions should be individualized after discussion with an experienced urologist who is up to date with the current standards on active surveillance.

My experience was Gleason 9 and 90% involvement. As I understand it 7 and above is aggressive and probably needs surgery. It may depend on the % involvement though. Aggressive AND advanced definitely needs surgery and like me you may need radiation and hormone therapy after. Hope this helps. Good luck to you!

@jc76
Exactly. I took not one not two but three opinions before I decided to stick with Mayo for my treatment. Endless research myself for treatment options and assessment of short and long term issues to face. 2.5 years since taking treatment. As of now things are looking good except for some of the expected likelihood of issues the treatment may pose

@frog69
I am similar in many ways (3+4) 2 tumors (3+3) in 4 tumors. Age 64 - 62 when diagnosed and was on AI for about 2 years. I have cribriform in the 3+4 tumors and a decipher of .72. I opted for SBRT and 120 days orgovyx after consultation with Joseph Wagner (4k robotic surgeries) who advised that both radiation or surgery were equipoise. I confirmed the same with Smilo and MSK. I am 7 months out since the last SBRT and 3 months since the end of orgovyx. Everything is as normal as one could hope. Treatment provided the usual symptoms and they were manageable. Some lingering fatigue yet. Exercise has been a great help as have many of the contributors on this site. A number of these folks are very involved in the treatment community and news and I make a regular habit of reading Jeff Marci and Heavy Phil among others a few times each week. The mental part of this seems as big an issue with me as the symptoms and having perspectives from others (and exercise) has been very helpful - and informative. I wish you good luck and easy days as you move forward. Prostate cancer is a drag to hear you have and almost always quite manageable.

Hello,

I would suggest you research a procedure called TULSA PRO. It’s a one day out patient procedure that I found much more appealing than radiation or surgery. I was 69 when diagnosed with prostate cancer in October last year. My numbers were PSA 9.6, Gleason 7 (4+3), biopsy revealed 17 out of 20 samples had cancer, cribform was present and the cancer had started pushing against my bladder. The one thing that saved me ways the cancer was still within the prostate. With the TULSA PRO procedure the prostate capsule must still be intact.

My first urologist suggested I go the radiation route, but thought surgery would be an option as well. I started down the radiation route by taking Orgovyx to reduce my testosterone levels as cancer feeds off of testosterone. Two weeks before I was scheduled to have the gold markers placed in my prostate for radiation treatments I learned about TULSA PRO.

I was fortunate that a rather close hospital in St. Louis MO (St. Louis University/SSM) had a doctor (Dr. Sameer Siddiqui, Chief of Surgery, Associate Professor, and Chief of Urology) who performed this procedure. My procedure was done on 23 April, with total time in hospital of about 6 hours (most of which was spent pre and post procedure) and sent home with a catheter. The catheter stayed in for about 14 days.

Everyone is different, but since my procedure I am dealing with incontinence and ED. The incontinence is improving and I expect the ED will resolve itself eventually. I had my 3 month PSA test on 23 July and the result was less than 0.1. I posted my results in another portion of this forum and someone asked if I had to do it all over again would I make the same decision. My response was a resounding YES. The radiation route would have taken 9 weeks with 45 treatments and required me to take Orgovyx for two years with who knows what side effects from the radiation.

Hope this helps.

@jonathanack "... Everything is as normal as one could hope. Treatment provided the usual symptoms and they were manageable. ..." I am glad you're back to a sort of normal. It is encouraging to read. I am considering SBRT as opposed to surgery. The prospect of a major life change is hard for me to accept, being, it appears, a new life of infertility, incontinence and impotence in one degree or another regardless of the treatment modality.