Gleason 8 and PSMA/PET scan not good

At 71y, how many years have you been getting PSA tests?

Did previous tests - MRI, PSA Density, % Free PSA, biomarker (genomic) test, etc. - give any indication that something more serious was lurking unseen that the Total PSA wasn’t indicating?

Regarding those SUVmax scores (21.4, 8.8, and 8.4), how do those match up to the SUVmax scores of your blood, liver, and parotid (or lacrimal) glands?

well I have very similar. Gleason 8 with 2 pelvic lymph nodes. SUV max 8.8 and 13.8 respectively. Prostate 4 cores of 12 positive- 2 cores 4+4 and 2 cores 4+3. (Diagnosed June 2025- went into shock -- PET Scan results)

But went on ADT in July '25- on and off for 6 weeks ( orgovyx and erleada) then just orgovyx. PSA dropped from 61 to .05. Then in October after 3 weeks of IMRT ( did 45 sessions) PSA went to <.02 ( put on Nubeqa * in early Oct.) Since October 2025, PSA has been <.02- 15 months. So feel somewhat hopeful now.

So prob just as much hope for you!

* Jeff Marchi ( contributor on this site-) recommended nubeqa and I got my doctor to switch out the Erleada for Nubeqa or else my situation would not look so rosey today ! Thanks you Jeff !! Lots of good info on this site if you look ! particularly for new patients !

You have to realize that prostate cancer is a chronic disease for most of us not a deadly disease.

You have been given some test results that aren’t really great, But they are very treatable. You can have radiation to the prostate and the lymph nodes, and the problem will go away. The only issue is if some of the lymph nodes are near other organs that could get damaged by radiation. They may not want to do radiation on them.

I’ve been living with prostate cancer for almost 17 years now. I’ve had surgery and radiation and lots of drugs with four reoccurrences. I’m 78 now and the prostate cancer Does not really affect my life and my ability to do things . I do walk on a track twice a day for a mile and go to the gym three days a week, But I would need to do that to stay in shape since I’ll be 79 in a couple of weeks. People are surprised that I’m so old, Yet in good shape.

You want to make sure you are being treated at a center of excellence. You have an aggressive case and you need to have it treated properly. If you do that, you can have a long progression free survival.

Ductal is an aggressive issue. Were any of these things found in the biopsy intraductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

Hang in there ! You will enjoy your "senior years".

Good news that this was uncovered before "surgery decision" - otherwise you could have end up having prostatectomy and then radiation any way (which is what happened to me).

@jeffmarc according to AI it’s concerning that PSMA PET scan shows an active right perirectal node (0.4 cm, SUV 8.4). This sits outside the traditional extended pelvic lymph node dissection template.
Could make surgery more difficult and could impact radiation as well but I believe the barrier gel would prevent rectal damage.
I’ll meet with original urologist Monday and then the radiation oncologist he recommends on Friday. I’m also meeting with Emory Winship team again after they have decipher. I’m also reaching out to Mayo Jacksonville.
The plan is to weigh my options and then go for aggressive treatment.

@malligood FYI only- ADT, radiation, exercise, white button mushrooms, green tea daily puts me at <.02 PSA for over two years now. Prostate cancer was located in seminal vesicle, lymph nodes. Not no more, it’s gone. Stopped ADT in Jan. 2025. RT therapy completed 3 years 7 months ago- I got to RING the bell. Mr. Marchi is a year older than I. I ll be 78 next month. We’re both hanging in there. Hope this helps, all my BS.

Whether your diagnosed at 57 as I was or 71 as you say, it still scares the crap out of you and questions of one's demise are on all our minds initially.

As you travel your particular treatment journey, likely you will find that with today's and future treatments yet unknown, you will live another 10-15 years or more unless a co-morbidity gets you. That or some idiot runs a red light...

I was diagnosed 23 January 2014, a day that still "lives in infamy in my mind. Those haunting words of my urologist, "that's a pretty aggressive prostate cancer...!"

Yet, 12+ years later, high risk, GS8, HG 4, rapid PSADT, PSAV,,here I am. Time on treatment, three years; time off 9+.

Currently on a 30-month treatment break, next labs in six months.

I've done a lot of living in those 12+ years, you can too.

Yes, the treatments have come with their side effects. Yet, even that didn't interfere with living.

Why, who knows, but, the mind is a powerful tool in this, attitude also. Like the story of the little engine, "I think I can...!"

So, as you seem to have already, buckle up, educate yourself, learn the language, stay abreast of ongoing research, have discussions with your medical team on treatments.

Shared decision making is essential, you are the 51% shareholder in your treatment decision. But, that requires you to be informed.

There is no black and white in treatment decisions, no absolutes. There are good choices, using the science such as NCCN, AUA guidelines, your own clinical data, preferences...

Wife and I just got back from a two week trip, Badlands, Custer State Park, Devil's Tower, Yellowstone, Grand Tetons!

Live...

Kevin

@xahnegrey40

I’m curious what was the complication with Erleada? I just started Orgovyx and Erleada combination 10 days ago. What was the benefit of Nubeqa?

@pmortaloni
Erleada Has a number of side effects, Fatigue, high blood pressure joint pain and brain fog are a some of them.

I’ve worked with dozens of people who have switched to Nubeqa. People like the drug after switching, because almost everybody feels no side effects at all from it.

Just yesterday, somebody posted that they were really happy that people in here talked to him about switching to Nubeqa. He switched and it is so much better. I’ve heard this from dozens of people. I attend 11 online prostate cancer meetings every month and recommend people switch at almost every meeting. If you were to attend one of the ancan.org Advanced prostate cancer meetings you would hear them recommending people switch at every meeting.

@kujhawk1978
Once the diagnosis comes, the range of emotions as you detailed are that. You are so right about Prostate cancer longevity, it is becoming to looked at as a chronic disease many will not die from, but from some other co-morbidity that comes up. This time allows for future treatments to come into play maybe years later.

I was first diagnosed with non Hodgkin’s lymphoma 23 years ago with life expectancy of 7-11 years back then. Today it is treated as more of a chronic disease, with many advancements in the last 23 years that have made it that way as the direction of prostate cancer as Jeff can acknowledge after his 16 years before much of today technology and advancements in Radiation and Surgery. I will always remember flying out on Halloween from California to Minneapolis on my way to Mayo in Rochester for a second opinion. My wife and I had dinner at a wonderful italian restaurant at the Mall of America that evening watching all the children in Halloween costumes trick or treating in the mall. Then returning home and undergoing chemotherapy therapy and new immunotherapy while my wife was pregnant. Tgen later a relapse and more treatments. Here I am, unfortunately with the prostate cancer journey and treatment beginning two years ago. I think my prior cancer helped me tremendously with my prostate cancer diagnosis and my approach to it. I have been so blessed never believing I might see our daughter graduate elementary school, then high school and finally college. It is important to look at most patients with treatments and relapses can and will live a long time.