Gleason 8 - Surgery scheduled in early Sept - timing ok?

Posted by undetectable @undetectable, Aug 1, 2023

My husband (71, active) was diagnosed June 16, Gleason 8, PSA 8, 9/18 positive cores, four 4+4. PSMA PET is clear. He is scheduled to have surgery on Sept 7 but is on a waitlist to have it done sooner. He's psychologically comfortable with this wait time - should we push for an earlier date because of the aggressive nature of the cancer?

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I don't know if I'd say "push." As long as you're on the wait list if a spot opens up, I'm not sure there's much more you can do.
That surgery requires a team, it can be somewhat lengthy (mine was 6 ish hours) it's not like they can just throw another one on the schedule. I was originally scheduled to wait 4 mos for mine. I was on the "list" as well and it was moved up to 2 mos out.
I'd say a little more than one month isn't bad in the scheme of things.

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A 6-8 week wait after a prostate biopsy is necessary to allow inflammation to go down so the surgeon can better visualize the delicate dissection needed during the operation. My urologist told me the additional few weeks I waited should not have an impact on chances for long-term survival.

I wonder, though, if testosterone inhibiting therapy makes any difference (good or bad) during the wait time from biopsy to surgery, however long that is.

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I would use the month of August to do walking, kegels, situps, healthy diet, and enjoyment. Get comfortable with the timeline of healing. Stay positive.

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Bummer! https://www.sciencedirect.com/science/article/abs/pii/S1078143919304454
The presence of 4 of those 4+4 cores decreases the chances that less cancer will be found than those cores indicate. It's interesting that you mention a PSMA PET scan but no MRI. I assume, though, with 18 cores, that it was an MRI-guided biopsy. Multiparameter MRI's with good interpretation can give a clearer picture in some ways than biopsies, they're just later to the game of diagnosis and treatment. (12 of the biopsy samples were systematic, one per region, and the remaining six were targeted. The 4 most significant were likely two each in nodules identified on the MRI and guided by ultrasound.
In the larger scheme of things, from diagnosis to surgery in 12 weeks is not slow :-). A lot has happened quickly. If your situation is like mine, you have a lot of catching up to do--understanding the nature of the disease, the impact and recovery from surgery and how to manage it, getting your affairs in order given these new realities and possibilities, spending time with those close to you adjusting and helping them adjust, and enjoying this last summer with a prostate in the best ways possible.

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I’m 74. Had needle biopsy in late April. Two 4+4 and two 5+4 cores. Eight clear. Mayo consult in late May. PET, MRI, and nuclear bone scan in June. All clear. Robotic prostatectomy July 10 at Jax Mayo. Also removed 13 lymph nodes. All nodes clear as well as clear margins all around. Catheter removed after eight days. Working on continence but realize it takes time. If I have to choose between wearing a Depends temporarily and cancer, bring on the Depends! First postop PSA scheduled for October. Praying all goes well for you!

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I STRONGLY urge him, if not already, to begin Pelvic Floor PT at a clinic where people have been trained in Prostate Cancer PT. The urologist or surgeon can write this prescription.

I had several weeks of this at Baylor, Scott & White in Austin TX, BEFORE & after my RALP last August. As a result I was FULLY CONTINENT immediately after the catheter was removed.

EDIT: I was 72 when I had the PT and surgery.

One can find the resistance bands, like those used at PT clinics, on Amazon be searching “Whatafit Resistance Bands.” Great sets for $30 and less.

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I had a metastasis to a hilar lymph node in my chest. After 3month of Lupron, they rechecked it with a scan just days before the surgery to remove it. Good thing, it had shrunken so much that they decided not to remove it since it would have been hard to find the right one.
(My prostate was not a candidate for surgery).

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@spino

Bummer! https://www.sciencedirect.com/science/article/abs/pii/S1078143919304454
The presence of 4 of those 4+4 cores decreases the chances that less cancer will be found than those cores indicate. It's interesting that you mention a PSMA PET scan but no MRI. I assume, though, with 18 cores, that it was an MRI-guided biopsy. Multiparameter MRI's with good interpretation can give a clearer picture in some ways than biopsies, they're just later to the game of diagnosis and treatment. (12 of the biopsy samples were systematic, one per region, and the remaining six were targeted. The 4 most significant were likely two each in nodules identified on the MRI and guided by ultrasound.
In the larger scheme of things, from diagnosis to surgery in 12 weeks is not slow :-). A lot has happened quickly. If your situation is like mine, you have a lot of catching up to do--understanding the nature of the disease, the impact and recovery from surgery and how to manage it, getting your affairs in order given these new realities and possibilities, spending time with those close to you adjusting and helping them adjust, and enjoying this last summer with a prostate in the best ways possible.

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Thanks for your concern. He did have an MRI in May after an elevated PSA and then an MRI-guided biopsy in June. Sounds like a similar biopsy to yours - 12 systematic cores, 4 targeted. The 4+4 cores had lower percentages of involvement and the core with the largest percentage was 3+3, so there is some hope there. Two surgeons and two urologic oncologists he interviewed didn't seem too concerned about spread, so fingers crossed.

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Looks like you have had some good advice so far. From what you said and what I know, you will be just fine. Preparing yourself physically is a great idea and don't stop after the surgery. And having a good wife is also good and by the sounds of it, you have that. Ten years ago my diagnosis was the same as yours and like you, had a good wife. Had the surgery and now I have to go to do a bike ride. My birthday is tomorrow, 83.

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I was staged at Gleason 8 in August last year. Due to various reasons, I didn't undergo RARP until the end of January this year. All was contained with no lymph node involvement

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