Gleason7(3+4) - treatment options recommendation

@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.

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.

@pioneer

Latest research indicates that cancer does not feed off of testosterone and low testosterone may actually enable cancer.

@pioneer

Latest research indicates that cancer does not feed off of testosterone and low testosterone may actually enable cancer.

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.

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.

@pioneer You know, that’s pretty impressive. I’ve always thought TulsaPro was an excellent alternative for either small tumors or total gland ablation for low grade cancer.
But to use it for cribriform pattern - an aggressive feature - is a real surprise for me.
Even radiation sometimes can’t kill it, so using TulsaPro is pretty ambitious.
Best with continued improvement!
Phil