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Treatment advice for prostate cancer

Posted by kune @kune, Jun 27, 2023

Hi folks. I am 68 years old and was recently diagnosed with grade 3 prostate cancer. PSA is 6, Gleason score 6(3+4), and just got genomic(gps?) test result of 29. I am at the low end of the intermediate risk range of 25-60. My plan is to go on active surveillance and see where PSA is in six months. My doctor is ok with this. Does this strategy seem reasonably safe at this point? My other choice would be radiation. Thanks for your input.

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ddun1953 | @ddun1953 | Jul 5, 2023
In reply to @melcanada "Have rad do rapid arch on margins and lymph notes Last 5 sessions Get on Zolodex..." + (show)
@melcanada

Have rad do rapid arch on margins and lymph notes Last 5 sessions Get on Zolodex 2018 radiation came back in L1 lumbar in 2020 had it radiated and back on Zolodex 2023 put on Xtandi or Enzalutamide 78 years young feel great PSA 2.3 down from 9.8 Was over 1,000 in 18

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What does rapid arch on the margins mean bud?

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cesar52 | @cesar52 | Jul 6, 2023

You have a low risk by Gleason score and genomics. That goes in your favor. I always was hesitant about active surveillance because of my fear the cancer can spread for doing nothing. However, it is a good approach in your case due to side effects of treatment and the fact you do not have an aggressive tumor. Best to you,

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vkmittal | @vkmittal | Jul 6, 2023

Hello I had prostactomy 6 weeks ago robotic and I am still having burning pain in my penis since surgery with urgency and frequency of going urine. All cultures are negative x 3.
I wonder if i have cystitis and urethritis non specific. OTC AZO helps to calm down my pain and frequency. MRI negative for abscess or any fluid.please advise. My bladder becomes very active to go frequent urine. Thanks i am 67 yr old.

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michaelcharles | @michaelcharles | Jul 6, 2023
In reply to @remington "My primary recommended surgery. My urologist recommended surgery to her father. My ENT had surgery. Dr..." + (show)
@remington

My primary recommended surgery. My urologist recommended surgery to her father. My ENT had surgery. Dr Peter Welch advised against hormone therapy in his book. Unfortunately because of my hypertension I was not a candidate for surgery and treated my Stage 1, Gleason 8 with three rounds of Lupron+ 20 sessions of radiation. Good news is PSA is undetectable. Bad news is for me the side effects of Lupron have been miserable. Of course you have to trust your doctor's advice. Do your research and decide but everything that's been said about Lupron has been negative except it does works, and that's the main thing. Lots of luck

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Sorry to hear that your ADT side effects have been significant.
There are other other 1st line ADT agents that some men have foundmoretolerable, if a change is an option (Eligard, Gosselin, Relugalix, Orgovyx, Firmagon).
Patrick Walsh's book is very valuable. I have the 2018 4th ed which is "somewhat negative" toward ADT.
However, it seems that protocols have evolved toward the use of ADT.
Just noting.

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melcanada | @melcanada | Jul 6, 2023
In reply to @ddun1953 "What does rapid arch on the margins mean bud?" + (show)
@ddun1953

What does rapid arch on the margins mean bud?

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Last 5 sessions of 39 or 40 are Rapid Arch where machine radiates all the margins It goes around fast

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1 reply
ddun1953 | @ddun1953 | Jul 6, 2023
In reply to @melcanada "Last 5 sessions of 39 or 40 are Rapid Arch where machine radiates all the margins..." + (show)
@melcanada

Last 5 sessions of 39 or 40 are Rapid Arch where machine radiates all the margins It goes around fast

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I hope it is gone for you bud. So, I will ask this after the surgery, Lord willing so thanks for telling me this data. Dave

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melcanada | @melcanada | Jul 6, 2023
In reply to @ddun1953 "I hope it is gone for you bud. So, I will ask this after the surgery,..." + (show)
@ddun1953

I hope it is gone for you bud. So, I will ask this after the surgery, Lord willing so thanks for telling me this data. Dave

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It came back 3 years later in L1 lumbar Had it radiated 1 inch out Put back on Zolodex Then PSA up to 9 in jan 23 as its in L2 now so added Xtandi and Xgeva Psa back to 2.3 Feel great at 78

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jibway | @jibway | Jul 6, 2023
In reply to @mmacaulay "Be sure to get a PSMA PET scan. Mine detected tiny hits in my chest, later..." + (show)
@mmacaulay

Be sure to get a PSMA PET scan. Mine detected tiny hits in my chest, later confirmed by separate biopsy. Wouldn’t have been detected via other scan methods. Led to chemo and radiation with Lupron and Nubeqa.

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Were they nodules? Did they biopsy them, how big were they?

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1 reply
kune | @kune | Jul 6, 2023
In reply to @cesar52 "You have a low risk by Gleason score and genomics. That goes in your favor. I..." + (show)
@cesar52

You have a low risk by Gleason score and genomics. That goes in your favor. I always was hesitant about active surveillance because of my fear the cancer can spread for doing nothing. However, it is a good approach in your case due to side effects of treatment and the fact you do not have an aggressive tumor. Best to you,

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Thank you. Hope you’re doing well

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dpcarriere | @dpcarriere | Jul 6, 2023
In reply to @badeyeaz "I’ll try to make this short, but I’m new to this group and PC in general...." + (show)
@badeyeaz

I’ll try to make this short, but I’m new to this group and PC in general. Since a PSA score that rose from 0.89 to 12.1, I’ve had an MRI, Biopsy, and finally a PET scan at Mayo, PHX. The biopsy revealed Gleason scores of 3x8 (4+4); 3x7 (4+3); 1x6 (3+3); and 2 benign. It got my attention that Gleason 8-10 are an indication for aggressive samples. A subsequent PET scan revealed involvement of a seminal vesicle and a lymph node.
Tx plan is ADT (Degarelix) for 3-6 months then radiation (5 doses in 2 weeks).
My wife is quite concerned at this point. She has been through breast cancer (ILS) and her late husband died of head and neck cancer. I would like to hear some positive encouragement I can pass along to her from people who have had a similar diagnosis. Who am I kidding. I’d like to know for my own self as well.

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Mine was a Gleason 10 diagnosed June 2022. I opted for Lupron and Proton Beam. I'm now off Lupron. So far so good (as I pass the 5th floor). Lupron was not pleasant at all and slow to wear off. Will have a check up this coming August. Will keep you all informed.

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