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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mmacaulay | @mmacaulay | Jul 6, 2023

In reply to @jibway "Were they nodules? Did they biopsy them, how big were they?" + (show)

Pathology report: PSMA activity 4 mm periaortic thoracic lymph node.
Subsequent endoscopy with MRI guided sampling.
Biopsy positive for metastatic adenocarcinoma of prostate.

hammer101 | @hammer101 | Jul 7, 2023

Kune, treatment decisions are personal and one size does not fit all. For me, I am not someone to leave a known cancer to continue growing in my body. However, I was 56 when diagnosed last year, healthy, and have an expectation for many more healthy years of life. I chose a radical prostatectomy (robotic). The surgery went very well and I am very happy with my decision. The key for successful treatment is to do your research and go with a center of excellence, such as Mayo-Rochester.

Best of luck with your final decision.

Jim

myersja | @myersja | Jul 7, 2023

In reply to @vkmittal "Hello I had prostactomy 6 weeks ago robotic and I am still having burning pain in..." + (show)

Hello, I am 8 weeks post RP surgery and am having the same burning issue with my penis. I did have a UTI but that has been resolved and have had multiple negative tests since. I also have pain that radiates into my penis when I sit on hard surfaces as well.
My Dr wanted me to get a CT scan to rule out any infections, ascites, fluid buildup, or lymphadenopathy. Results were all negative.
I also have a very active bladder and urine frequently. I believe I have a stricture in my urethra as my flow is weak and breaks into two streams. I go to have a Cystoscopy in 4 weeks for an official diagnosis. I am currently chalking the burning sensation to a potential stricture. I don't know what else it could be... Maybe I need more time to heal. I am 52 years old.

vkmittal | @vkmittal | Jul 7, 2023

In reply to @myersja "Hello, I am 8 weeks post RP surgery and am having the same burning issue with..." + (show)

OMG I am having same issue. I need to talk to you. I m worried . I do not want Cystoscopy because of pain in penis. It will cause more pain to me. My MRI is negative. I pass my urine ok if i drink lots of water. Take AZO it helps to me . But it comes back. Keep me up date on this please. I m concerned about cystitis or nerve pain. Avoid acidic food or drinks. Drink more alkaline like baking soda powder and heat compresses. Thanks

groundhogy | @groundhogy | Jul 7, 2023

This is cancer.

You said gleason 6 and then wrote (3+4).

You should read up on micro-mets. Be sure to read the part where they used to think they were shed only in late stage tumors, but now realize they are thrown off much earlier.
And also the part where they can lodge in somewhere and remain dormant for years.

hbp | @hbp | Jul 7, 2023

If you are Truly Gleason 6 and under 75 then I would think that active watching would be in order. Otherwise, if your biopsy showed that the cancer was contained in the prostrate , then if I were you I would personally get a second opinion from a well respected cancer center and keep an open mind to surgery. Good luck This is life threatening Cancer.

roberdc | @roberdc | Jul 8, 2023

Get the book. Has your doc ordered a bone scan and cat scan of abdomen?

The approach sounds good unless it has metastasized.

Praying for you to get a good prognosis.

hammer101 | @hammer101 | Jul 8, 2023

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

My recommendation would be to go aggressive with this cancer. As long as the cancer has not metastasized and out of the pelvic region, it is my understanding that you are a candidate for surgery - Surgery coupled with follow-up treatment (radiation, ADT, ...). I was a Gleason Score 7 (4+3) and fortunately the PC did not get to the lymph nodes, thus did not need the radiation/ADT following surgery.

Good luck and I pray all goes well for you and your wife!!!

groundhogy | @groundhogy | Jul 10, 2023

Here is a good website to compare your odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see your odds of 10-20 yr survival, etc. based on the treatment you pick.
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

bens1 | @bens1 | Jul 10, 2023

Kune: I had a psa of 10 and Gleason 3+4. I was 69 last year. My decipher test was also low end intermediate risk. Cancer was confined to the prostate. Of the 5 radiation oncologists I spoke with, one gave me monitoring as an option.

No doctor is going to guarantee a specific growth rate. I was afraid to leave myself with more complicated treatment and side effects if I waited. I chose radiation with the MRIdian machine from viewray. 5 treatments that finished in February. Viewray.com.