PSA jump 16 to 30 in 6 months. Radiation candidate?

One question is were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions)

Any of those can be more aggressive cancer, even though the Gleason eight is an aggressive.

If you have a Gleeson eight is unlikely that you will actually be cured. It’s more likely you will be put into remission and it can last for decades.. You should ask for a decipher score to see what your chance of reoccurrence is.

It may make sense to get a second opinion from the center of excellence. Your PSA is high and radiation makes sense but if you are younger, you could have surgery and be eligible for radiation later if it comes back.

It wouldn’t hurt to see a medical oncologist that specializes in prostate cancer. Some don’t want to work with people who don’t have metastasis, because radiation or surgery can possibly end the need for treatment.

Have you had a PSMA Pet scan? Most people that have your level of cancer get that scan so they can see if there’s cancer anywhere else in their body. You really should ask your doctor about this. It’s important..

I had surgery 16 years ago and 3 1/2 years later had radiation because it came back. 2 1/2 years later, it came back again and I Went on Lupron. It kept me undetectable for 2 1/2 years at which point I became castrate resistant so they put me on Biclutamide for 1.25 years followed by.Zytiga for 2.5 years. Those two drugs kept my PSA down below .5 for most of the time I only was undetectable one month. When I finally stopped Zytiga, I had to have a metastasis zapped on my spine with SBRT radiation. I then started on nubeqa And I’ve been on it for almost 3 years. I’ve been undetectable for two years, Which means the cancer has not been growing. The benefit of Nubeqa Is that it has very few side effects fewer than any of the other ARPI drugs. I do have a genetic problem BRCA2, which causes the cancer to keep coming back. I am 78 and a Gleason 4+3.

You cancer is aggressive, but it doesn’t grow real fast so you do have some time. If they put you on ADT, it could give you many months to make a decision since it could stop the cancer from growing and spreading. You really should consider getting a second opinion from a center of excellence.

Thanks for your informative reply Jeff. I don't recall seeing anything in my biopsy report about the first of your questions but will check. I had mentioned it before but at my age of 89 I need not worry about lasting decades so will be happy for another few years. Have had the PET scan and luckily there was no metastasis found and the cancer was limited to 3 of 12 biopsy samples from the prostate. I looked into your suggestion of considering Nubeqa and found it was counter indicated for me with my CAD disease and Gleason score of 8. Now I am seriously considering the radiation treatments and not the medical approach unless absolutely necessary.
Art

I would ask myself: "How long did my father live? How long did both of my grandfathers live? If you are 80, having found or been told that you have 2-3 year life expectance, that might easily fly out the window, if your father and grandfathers lived into their '90's. If you were younger, I'd say: Get the radical prostatectomy. But...you would likely have a tougher recovery, and the hassles are several: catheter, followed by months of urinary incontinence; if you are still sexually active, you may never regain the ability to "perform. If you were younger, I'd also say: "Get the radical prostatectomy because if you do radiation therapy first, and live long enough that the cancer comes back, you will not likely be a candidate for radical prostatectomy at that point." When I asked my urologist about my various options including radiation, instead of radical prostatectomy, he said that "radiation therapy basically turns your prostate into a walnut sized chunk of concrete, and it is nearly impossible to surgically remove it once you cooked it with radiation." So, my suggestion is to ask yourself about the male longevity in your family. I did the same, but still opted for the radical prostatectomy, despite my father living to 99 year 10 months "with untreated prostate cancer", and both grandfathers to 96, one of whom had prostate cancer treated for 20 years with only lupron. Good luck to you.

@augustahuss
Long term radiation is as effective as a Prostatectomy. In your case, SBRT radiation would be pretty straightforward and would leave you with the few long-term issues. My brother had it at 77 and he is now 80 and has no issues at all. That’s pretty common for most people that have SBRT. SBRT radiation involves five sessions, not 20 to 30. It is just as effective and actually more effective because the more intense radiation kills more of the cancer, sooner. You could listen to the latest PCRI conference to find out information about that. A radiation oncologist goes into quite a detail on how much better SBRT radiation is. This is something to discuss with your doctor why he recommends IMRT. I did have almost 40 IMRT sessions for salvage radiation, I had no side effects from it, Some people do have issues because they use more radiation with the 20 to 30 sessions than they do with the almost 40 that I had.

If you do have radiation, you should ask the doctor about having one of these put in to protect your rectum

SpaceOAR, Barrigel, or BioProtect

You mentioned that Nubeqa Could be a problem because of your CAD. I’m not really sure that’s a problem, I have a lot of heart issues and it doesn’t affect me at all. On the other hand, Zytiga gave me a lot of heart issues.

I think it would really give you a lot of information if you were able to attend One of the ancan.org Advanced prostate cancer meetings. They have one every week. There one on Tuesday At 3 PM Pacific time. Check out the website, Sign up and get the newsletter, which includes an incredible amount of information about the latest things going on in prostate cancer treatment. If you get there about five or 10 minutes early, they will talk to you first and give you advice about your case. They’ve been doing it for 15 years and there’s always at least three doctors in the meetings. They could help making your final decision on what to do.