Gleason7(3+4) - treatment options recommendation

Hi @jc76
I have been given option for focal as well as radiation therapy at Mayo Phoenix. I do have appointment in them.
In my case I do have a 1.2cm lesion which is g7(3+4) and mri is stating that it is in epe1 . But that did not seem to concern my oncologist urologist who will eventually perform my surgery if I choose to do so. I’ll discuss with R/O about it . With radiation
Were you told about its short/long term effects?

@manojsmishra
You are at a great place.

Are you asking about radiation effects? Yes both Mayo and UFHPTI were very thorough with side affects both short and long term. One thing that all said was everyone is different and some will have symptoms and side affects that are minor, moderate or severe. Mine were minor and everything that showed up was told to me as a side effect.

All of those side effects gradually went away and not stopped my exercising (exept bike riding because of SpaceOar) or life style.

I am not a urologist or R/O but have you been offered additional diagnostic test: Decipher, PSMA, bone scan. Those test can really helped your urologist and R/O determine the treament options for you.

The side affects of surgery are much more than radiation normally but not for all. What I have read on MCC is the hormone treatments are the worst side affects for those who get it. I am glad both the R/O I had seen said hormone treatment would not be necesary and radiation alone should cure the cancer.

@clandeboye1
I had 30 rounds of proton pencil beam radiation treatments at UFHPTI.
After my Decipher test came back low risk, my PSMA was negative, and my bone scan was negative both Mayo Clinic Jacksonville and UFHPTI recommended radiation only and no hormone treatments.

Mayo originally suggested to add hormone therapy. However again after Decipher, PSMA, bone scan it was changed to radiation only. I got my second opinion on all tests and recommendations at UFHPTI.

Hormone treatment does not kill cancer it drastically slows the growth and thus a better outcome if you have agressive prostrate cancer or has spread outside the prostrate gland. This goes both for surgery and radiation treatments. This statement comes from my R/Os not my opinion.

I went with the recommendation of both R/O. Mayo and UFHPTI who recommended same. Mayo Jacksonville does not have proton radiation so went with UFHPTI which does and has been a major institution doing proton radiation since 2006. It is quite a modern facility with 5 proton radiation gantries (which means 5 different treatment rooms). They offer a wide variety of protron radiation treatments and for many types of cancers.

FYI: Jacksonville Mayo is building a new cancer center that will have proton radiation.

@manojsmishra
You are at a great place.

Are you asking about radiation effects? Yes both Mayo and UFHPTI were very thorough with side affects both short and long term. One thing that all said was everyone is different and some will have symptoms and side affects that are minor, moderate or severe. Mine were minor and everything that showed up was told to me as a side effect.

All of those side effects gradually went away and not stopped my exercising (exept bike riding because of SpaceOar) or life style.

I am not a urologist or R/O but have you been offered additional diagnostic test: Decipher, PSMA, bone scan. Those test can really helped your urologist and R/O determine the treament options for you.

The side affects of surgery are much more than radiation normally but not for all. What I have read on MCC is the hormone treatments are the worst side affects for those who get it. I am glad both the R/O I had seen said hormone treatment would not be necesary and radiation alone should cure the cancer.

Welcome to our unlucky club of guys with PC. I'm not a medical professional, and nor do I have any special expertise, and I certainly don't know which treatment option will be best for you. That said, I'm 70 and in otherwise good health when I was diagnosed 3/30/24 with 3+4=7. My best piece of advice is to go to a recognized "cancer center of excellence", which with Mayo clinic you're already doing that. Also, I'd strongly recommend the latest edition of Dr. Patrick Walsh's Guide to Surviving Prostate Cancer Paperback – (last I looked October 3, 2023 was the latest edition). It's on Amazon and it's the best $20 I ever spent. It really helped educate me on some key points in my decision making. At this point, probably the biggest thing is educating yourself. Whatever treatment option you choose, things may not work out as you hoped. So being at peace with your decision will really be integral to your peace of mind going forward. That said, another key piece of information will be how aggressive your cancer is and how widespread in the prostate. The results of a decipher test for aggressiveness coupled with the fusion MRI biopsy results giving an indication of how dispersed your PC is should help guide you to what's most likely to be the most effective treatment. In my case, for a variety of reasons my wife and I felt NS RALP surgery was the best option for me and that's what I did in late June 2024 at Mayo Phoenix. So far the results have exceeded my expectations as the recovery has been remarkably low pain and quicker than I imagined. Also, the pathology of the prostate found both Cribiform and IDC (not good) so I was glad I went with surgery. As you research which treatment is best for you, be sure to ask your potential providers specifically about incontinence, ED, cancer reoccurrence, long term survival, and other major aspects/side effects of the major treatment options you'll be considering. When I did that I was surprised that for my specific case with
NS RALP the numbers for not having incontinence and ED were more favorable that I thought they would be. Long term survival and quality of life were also factors high on my list. Best wishes on educating yourself and figuring out which treatment option will be best for you.

Sir , you have a great writing style . Your information and advise was very sage. I think also treatment options to consider is age . At 56 I was diagnosed . Steep family history of this Cancer. I pulled the sheets over my father head 24 years ago from PC, and I can still see him . He was a good man, a good dad . I know have the same disease as my dad . Back then , my dad went with external radiation therapy . At 60 he got radiation and died at 67 . Very young in retrospect. I was more proactive with my health because of his experience. After the Operation for me in March 2021, my PSA did not zero out but hung around 0.1 or so . at 0.14 ( about a year ago ) I got External Beam Radiation (EBRT) for 22 session. Nothing happened really until about 7 months , then my PSA went from 0.14 to 0.072 , last PSA was at 0.056 ( one year level) . The trend is my friend here . My next PSA is in 2.5 weeks . I have PST I think from looking after my Dad . I was his care giver when he was sick . I am loosing sleep over the next PSA in 2.5 weeks . I know its silly and im trending great ....but how will I feel if the PSA data point is higher than 0.056 ? I know ).056 is a very low number but I have seen guys in my support group go to zero from here and also a one guy I know rebounded to 1.2 PSA ! Ouch ! I dont know what I would do ... Anyway , God Bless Sir . James on Vancouver Island .

Are you waiting for it to get worse? If its in you,
get it out.

Oh sorry the kind words were meant for someone else