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Ductal cancer Gleason score of 8 Radiation/hormone therapy or surger
I’m looking for advice from anyone who has or has or has had DUCTAL prostate cancer because it is a rare and aggressive type. I’m an active 71 year-old who was just diagnosed with ductal prostate cancer, a rare and aggressive cancer that spreads easily. PSMA scan showed no spread outside of the prostate. The surgeon recommends surgery because he says that leaves the option of radiation after surgery if needed, but that it is difficult/impossible to do surgery after radiation. He said there’s about a 50% chance of the cancer returning after surgery.
The radiation oncologist recommended radiation/hormone therapy for 18 months. He also said there’s 50% chance of reoccurrence/spreading, but that surgery has a 70 to 80% chance of reoccurrence. He also said the surgery wouldn’t be needed after radiation because they rarely see cancer return in the prostate because it usually spreads elsewhere in the body. But if it were in the prostate, he could do more radiation or cryotherapy. Anyone who has had ductal cancer would you please give your input? I need to make a decision soon.
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I would suggest that being reasonably confident with whatever treatment path you choose will be important to your emotional well being as you go forward. Since you're not entirely sure which path is best for you (and I certainly don't know as well) if it's an option available to you I'd suggest getting a 2nd or even 3rd opinion (preferably from a recognized cancer center of excellence). It might give you an additional degree of confidence in whatever path you choose so you can be at peace with it and not have any regrets later. Best wishes to you and yours.
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1 ReactionYes ductal is very aggressive, You don’t mention your Gleason score and that can be a factor in aggressiveness as well. After listening to people with new cases of prostate cancer weekly for four years I have never heard someone say they have ductal cancer, definitely rare. Lots of intraductal, not one case of ductal.
Having surgery removes the ductal cancer, but the chances are you will have reoccurrence if you don’t do more treatment, like hormone therapy. That will give you the best chance of avoiding reoccurrence.
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1 ReactionMy own two cents on this, as a layman who has had Gleason 4+3 return after 5 yrs, is to have the surgery, go on ADT immediately and start radiation as soon as the RO feels your surgical recovery is complete.
Yes, it is probably the most aggressive treatment in terms of duration, but an aggressive cancer WILL come back and if it was ME in your shoes I would want to hit it as hard as possible at the outset…why waste precious time? Best of luck with whatever you decide
If the PSMA shows no spread beyond the prostate, which is the situation here, why would you recommend going to radiation as soon as surgical recovery is complete? Where are they going to radiate? My surgeon was very clear on this- they would not under any circumstances recommend I begin radiation and put me on ADT until they can actually see evidence of biochemical recurrence. Otherwise they are literally shooting in the dark. If there is a 20-30% chance you will not have a BCR, they will not put you through these kinds of very highly aggressive treatments with all of their potentially major side effects until the evidence shows that you indeed have a BCR, or in other words, until the chances you won't have a BCR go to zero.
Hey Tango, Yes, I was told the same thing and my PSA went to .18 5 yrs after surgery and here I am in salvage radiation.
At .18 my PSMA scan was negative also. Yet I am led to believe that most - if not all of them - show NOTHING under .5 - .7…..Salvage radiation is ALSO shooting blind. You are radiated from just above the prostate bed and then downward into the pelvic lymph nodes. You are blanketed by the beam top to bottom and from the posterior as well - 360 degrees.
The only time the PSMA is truly useful is in metastases large enough to show by tracer uptake. These areas are usually pinpoint targeted by SBRT and dealt with quite successfully.
Also remember that no surgeon sends his patient for radiation unless the pathology comes back with PCa cells in the lymph nodes - or there is a broken capsule, etc. The surgeon always wants the patient to believe that their efforts were totally successful. My surgeon told me at my consult that due to my Gleason 4+3 and how widespread it was in the gland (don’t know any of the other morphological patterns present) that even with his best efforts “this could still come back”.
If he had given me actual numbers like 50%? I would have done what I said in my post. Also, this is MY opinion of what “I” would do facing similar circumstances - NOT an endorsement of treatment for anyone else. I thought I made that clear in my post. Apologies for any confusion.