Prostate cancer detected at age 76 Gleason 3+ 4 what are the options

I was 78 (80 now) when diagnosed with Gleason 4+3. Did the ADT for 6 months and then 22 radiation treatments plus additional ADT. Other than the miserable hot flashes, I couldn't tell that anything had been done regarding my daily routine. Hope your dad is as lucky.

@astonishingurs
Did you dad get a PSMA, Decipher tests. The 3+4=7 is intermediate risk. It seems that your treatment is very aggressive but the 36 PSA is very high. Was he diagnozed with cancer outside the prostrate? It is hard for us to give suggestions without knowing the number and tests he got.

I would always get second opinions on diagnosis and treatements along with asking for Decipher test (genetic test done on the already taken biopsies to determine a more accurate risk level) and PSMA which shows if cancer has spread outside of prostrate. I also had a bone scan all were negative and Decipher changed my diagnoses from intermediate to low risk.

You mentioned biking. Most of the time a Space/Oar will be done. You cannot bike with the Space/Oar devices in. Also when doing any of the test including PSA it is advisible not to bike at least 72 hours or like mine asked a week prior to test.

Walking is something that is encourage to maintain fitness as well as mental health as will redude stress of treatments. I walked the entire time of my treatments (6 weeks) only having some fatiqure in latter weeks but did not stop my walking.

Talk to his urologist, radiologist/oncologist on these questions as they should be able to advise you. I would suggest also getting a second opinion on diagnosis and treatments.

@astonishingurs: I agree with jc76's comments. I had a 3+4 Gleason and a PSA of 10.2. I had a narrow margin radiation machine. No ADT at age 69.

Your Dad might want to consider a second or third opinion and as jc76 suggested, get the Decipher test done. Doctors will adjust their treatment based on this test from the biopsy material.

These are educated guesses by doctors and at 76 years old, comparing opinions can help decide the quality of life side effect issues.

Thanks for your detailed and encouraging response. PSMA scan was done . I have attached pic of results in reply as well. No abnormalities were found outside as read from this report. Thanks and appreciate your opinion.

From what I have been educated by this forumn...a 3 plus 4 is much better than a 4 plus 3. My husband is going to have targeted Proton Beam Therapy at Mayo. Before that he will have a surgery by the urology department who also did his biopsy to have a spacer surgery. This is gel that hardens that protects the rectumn from gtting radiation. We were also told that we should have a Decipher test which is material already taken from the original biopsy. This will determine the genetic part of this deal which would involve you for the future. We were also advised to ask the radiologist about a PSMA PET scan to see how aggressive the cancer is. I hope this helps!

I read that scan report differently. It mentions mildly avid nodes in the pelvic region. That means there was a small degree of tracer uptake outside of the prostate. This is probably why they are wanting to get started with radiotherapy and why they stared him on ADT.

Because of his age (and thus actuarial life expectancy) and the low risk nature of his disease I'd think this is a tough decision. On the flip side, the "low risk" disease has apparently spread to his seminal vesicles and other areas of the pelvis. One thing they mentioned in the report is that he has a median lobe of his prostate protruding into his bladder. Has he had difficulties urinating? If so, this might be a reason to consider surgery and RT (to treat the nodes and broader pelvic region).

What part of his body are their suggesting for radiation? ADT will surely cause the cancer cells to slow down dramatically due to starvation and Chemo will do the deed of killing any cells that are dividing (good ones and bad ones). There is some dialogue of targeted chemotherapy, but not sure what is being suggested.

PSA of 36.0 isn't a great place to start, but it will absolutely give you a good indication if treatments are working. I wonder if the health team is looking at doing all of this in a macro point of view, but actually doing it sequentially? There is much emphasis on couplet and triplet therapy with support from clinical trials, so that is a major component of the motivation.

Keep us posted and I second the suggestion for a second opinion, not so much because I question the original game plan, more so that it can give you more piece of mind.

Thanks everyone for encouraging responses and suggestions. I will keep this thread posted on further treatment details.
Is there any specific diet he has to follow before/during/after the treatment like eggs or protein requirements etc.

astonishingurs
Your oncologist/radiologist or urologist should be giving diet recommendations and restrictions. UFPTI gave a handout on the diet to use and was high protein and to avoid foods that cause gas like beans and other things that cause it (like soy).

This is to keep gas out of the rectum area that can push (the gas) up against rectum which can move the prostrate from oringinal mapping.

Does it happen, YES! I was careful but one day took a protein powder. The next day at radiation treatment I could feel some gas and sure enough techs came back and said could see gas in rectum and was affecting the prostrate as it had moved.

I was not eating anything outside the diet recommenations so I checked the protein powder. It was made with soy protein. My techs next time I came yes most definitely that was the cause.