Gleason7(3+4) - treatment options recommendation

Posted by manojsmishra @manojsmishra, Aug 25, 2024

Got recently diagnosed with Gleason group 2, 7(3+4). Was in state of shock to know about the cancer.
I’m 56 year old and fortunately I’m with Mayo care since last decade.
Recommendation for me is to have prostatectomy as radiation therapy has long term implications. Took outside opinion also and same recommendation. But not sure how to deal post procedure with urge to urinate situation currently there.
Biggest thing is I’m hoping there is no recurrence occurring after this. Any suggestion/recommendation?

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

Profile picture for johnnyz @johnnyz

@jc76 Hello and Happy Monday - I have not had conversation about a decipher test or genome test. I have asked but they brush it off. Now that I have detailed consultations with an RO (appointment is being scheduled today), and Robotics Surgeon Sept. 24, I will push these topics for additional testing. Even the need for a PSMA PET scan as I have a bit of worry around if the fact that they found evidence of cribriform and it's know for micro matastasis ...

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@johnnyz
Yes both tests (I had both) will provide you and your doctors information in deciding your treatment plans.

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Profile picture for pesquallie @pesquallie

@rlpostrp

More than 50% of men do not recover from ADT and if you are over 80 you likely will never recover and you will have side effects for ever. Recent data indicates that testosterone does not feed cancer and low testosterone may actually increase cancer. I am 84 and my urologist who said no Testosterone Replacement Treatment 6 months ago now has me on TRT and my Lupron side effects have disappeared within a week and I just started having some libido and erections.

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@pesquallie
You are quoting loose and fast with numbers you cannot justify with statistics.

From the PCa commentary

Examples of the relationship of the duration of ADT exposure to subsequent recovery to their
original T levels after stopping ADT are as follows:
- After 3 - 9 months of ADT nearly all men fully recover by about 10 months;
- After 18 - 24 months of ADT only 60% fully recover by about 3 years; and
- After 36 months of ADT exposure only 50% fully recover by ~ 5 years.
It is clear that after receiving ADT for longer than 6-9 months many men never fully return to their
T baseline. This raises the very important question of whether it is safe to offer replacement
testosterone in symptomatic men who have been rendered persistently hypogonadal (<230
ng/dL).

As it shows here whether or not you recover, depends on how long you’ve been on it. Only in the longest cases Do 50% not recover their testosterone. With 3 to 9 months of hormone therapy virtually all of the men return to their previous testosterone levels.

When somebody is first diagnosed with prostate cancer, hormone therapy drops their PSA immediately, and it stops the cells from growing and spread spreading. That is a fact and has been repeated over and over.

Only when somebody becomes castrate resistant does dropping of the hormone therapy help because resistance cells can’t handle testosterone at that point, though not all cells are resistant so some of them would still be suppressed.

You make it sound so simple and it’s actually very complex.

I would like to see your statistics to back up what you were saying.

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