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Gleason7(3+4) - treatment options recommendation
Prostate Cancer | Last Active: 2 days ago | Replies (354)Comment receiving replies
@jonathanack hi Jonathon, thanks for your story. Do you know what PiRad rating each of your tumours were? I have a 1.0 which is pirads3, and a 1.9 pirads 5. The larger one is pushing on my AFS and my cause future issues around the bladder neck during treatment to reconnect is surgery. If I do radiation, then they would have to do significant beam radiation to get that large tumour which may cause post surgery scare tissue issues.
My RO says the SBRT 5 sessions is all that is needed without ADT. Sort of “yay” for me if I do radiation. Still not sure as he is not doing a spacer but is mapping the area with gold seeds to improve accuracy and minimize margins. That all said, my potential robotics surgeon is very experienced and should be master skilled at nerve sparing. Will have to wait to hear his concerns if any about the larger one is tumour being so close to the bladder neck… I see the RARP surgeon next week. BTW - my PSA has been hovering around 10-13
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@johnnyz
My pi-rads score was 4 for both the cribriform tumors. One of them was an existing tumor from my initial diagnosis at age 62 that had been a gleason 6 and moved to a 7 with cribriform. The other cribriform tumor, also a pi-rads 4 score, was new and on the very edge of my prostate. My PSA never went above 4.2 throughout my Active Surveillance timeline and my SBRT timeline. My surgeon that referred me to Dr. David Byun (radiologist - MSK/Cornell Weil) immediately. Dr. Joseph Wagner (Wagner was an early daVinci adopter with over 4k surgeries). I fully expected Wagner to recommend a prostatectomy. However, he was very clear in saying that with my circumstances that radiation would be equipoise, and surgery would likely require longer recover and potentially lifelong changes.
SBRT was not much of anything (fiducial markers were used) - some discomfort that was tolerable, some fatigue. Orgovyx was not all that bad either with the same issues and some hot flashes (very low libido).
For me it came down to the risk of incontinence for long (or lifelong) periods and intimacy (I am 64 with no issues) and that surgery was not a better option (confirmed 3 times over by Smilo, MSK, Tufts surgeons and radiologists). That said, I know of many people that want it out and that is a very good option as well, but wasn't my choice. I am all be back to normal now and realize things may change and have talked about that very candidly with Dr. Byun and have plans tentatively in place should they be needed.
Please let me know if you have other questions. Happy to help. We are very lucky to have this type of cancer at our age and not what I see children and other younger people deal with. Good luck to you and you will make the right choice for you.