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Gleason 8 diagnosis at 51: Likely opting for surgery

Posted by topf @topf, 3 days ago

I just got diagnosed with a Gleason 8 cancer and I am only 51. I think I will opt for surgery, but not 100% sure.

I would like to share my results and see if anyone is/was in a similar situation and could share their experience:

A total of 7 or 8 (with second opinion) positive cores out of 14.
3 are low volume gleason 6, 1 high volume discontinuous gleason 6.
One high volume discontinuous 3+4 with only 5% pattern 4
One high volume 4+3 with 70% pattern 4
Two low volume (10%) Gleason 8
Negative mpMRI
Negative psma
Decipher 0.2, low risk

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

brianjarvis | @brianjarvis | 7 hours ago
In reply to @topf "I accidentally hit the reply button. What is germline? My decipher was 0.2. The PSMA report..." + (show)
@topf

I accidentally hit the reply button.

What is germline? My decipher was 0.2.

The PSMA report said negative in prostate, but my oncologist said that it lit up just not enough to determine cancer. Not sure what to make of that, but it is a little concerning.

For treatment, my main concern with RT plus brachy boost plus ADT is the risk of viable cancer cells being left in the prostate. I am aware thst durgery carries a high risk of SRT.

Jump to this post

Decipher is a biomarker (genomic) test that looks for mutated genes, proteins, and tumor markers that tell more about the prostate cancer. These tests include Decipher, Prolaris, OncotypeDX, and many more. Knowing this may help with treatment decisions.

Genetic (germline) test tells you which genes related to prostate cancer you have inherited from your parents. (Like BRCA1/2, ATM, CHEK2, HOXB13, MSH2, etc.) Knowing this may help with treatment decisions.

If the 8(4+4) cancers in your prostate don’t exhibit enough PSMA to light up a PSMA PET scan, then if there are other prostate cancers elsewhere, those also might not exhibit enough PSMA to light up a PSMA PET scan either. You would want to know this. This is certainly worth discussing with your medical team. (An 8(4+4) should’ve lit up the PSMA PET image like a Christmas tree.)

ADT+RT is so advanced these days that results are statistically equivalent to prostatectomy. The purpose of ADT is to lower testosterone to starve/weaken prostate cancer cells, making them even more susceptible to death due to radiation damage. With your 8(4+4), they would likely recommend 18-24 months of ADT. (I had 28 sessions of proton radiation + 6 months of ADT for my 7(4+3).)

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