PSA question

You are a Gleason nine the seven and eight are irrelevant. That is why you are grade group 5.

It’s probably too soon to say your PSA is under control. Three months is a good time to wait to see if it goes below .1 which is considered undetectable.

Since your last PSA test was in June, you don’t know what your PSA was 28 days ago. It may have risen a lot above 5.2 since a Gleason nine is very aggressive.

Do you have plans for surgery or radiation? As a Gleason nine, it is important that you do get treatment within the next few months.

Have you had a PSMA PET scan to see if there is cancer outside the prostate. That is sort of essential to making a decision about what treatment to get. You need to get that test soon because if your PSA drops below around .7 the test becomes unreliable.

Not that it matters much, but was your Gleason 9 a 4+5 or a 5+4?

If you’ve been on Lupron for just month, it’s difficult to know what your PSA should have dropped to. Lupron can take many weeks to impact PSA levels.
> A better indicator is —> What is your testosterone level now?

Did your MRI or biopsy report mention any of these terms: cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma?

Have you had a biomarker (genomic) test or a genetic (germline) test yet?

When do they plan to schedule your treatments?

(After 6 weeks on Eligard, my PSA dropped from 7.976 to 0.224.)

Surgery was ruled out. I am doing 20 IMRT treatments and 1 to 2 years of ADT. PSMA PET scan October 9, 2025 showed no meatastatic disease. Looks like treatment will start in early January. Thank you for your response Jeff. @jeffmarc

Gleason score was 4+5=9. I did have a germline Color genetic test done and it showed no genetic cancer connections. The biopy stated cribiform featues were present. Thank you Brian for your response.@brianjarvis

@marc1955
My brother had five sessions of SBRT radiation at 77 and it seems to have been very successful. I know many other people that also had SBRT instead of IMRT for their primary treatment. SBRT radiation is very commonly used instead of 20 sessions of IMRT. SBRT is just as affective as IMRT and it Kills the cancer more effectively since it’s a higher radiation level. The doctors that do SBRT say it’s preferable to IMRT.

Have you spoken to a radiation oncologist about SBRT? I know that in Canada IMRT is sometimes the only option.

I had 8+ weeks of IMRT 12 years ago because I needed salvage radiation since my cancer came back after surgery. Because they do the whole prostate bed they need to do IMRT. The same is not true when they just treat the prostate.

@marc1955
I had 5 radiation treatments with the Mridian radiation machine. That and the Elekta Unity are the only two radiation machines on the market that have a built in MRI so what the doctor sees, in real time, they can treat. You may want to ask your RO about the machines. There is also less exposure to radiation (and side effects) as they use smaller margins around the prostate, when they use this type of machine (2 mm vs 3-5 mm for other forms of radiation/machines).

@marc1955
As per your information your pca is within the prostate, so wondering why was surgery ruled out.... Are you from Canada?

No, i had an umbilical heria repair with mesh placed which would rule out robotic surgery and possible adhesions would cause excessivebleeding. USA@shalom7777777

@marc1955
Awww.. I get it. Thanks for answering. Wishing you all the best in your journey!