Recently Diagnosed, Intermediate Prostate Cancer

Scj. You are still young and should have many years of cancer thinking and planning and perhaps treatment ahead of you. Cancer tends go to sleep and then wake up again. If I were you I would have robotic surgery as that preserves the use of radiation in years ahead, conversely, doing radiation now eliminated the option of surgery later. I had the surgery, no pain, fully continent and a few days to recovery. I am in favor of an aggressive treatment at an excellent facility for this dreaded disease. I am against just hormone therapy as that fails in time and you should have a lot of time ahead of you. You need to be focused on a cure. The most important issue is a long and good life. Good luck!

My prostate was 110 cc. Was on AS for 2.75 years. At first I had 3+3 on single seen lesion in transition zone, but this year they did a better biopsy (transperineal) that one needle had 3+4 on a new lesion on one side. Another hit a small area in anterior transition zone (original lesion) with a 4+4 (only 0.2 cm in needle though), this is the same lesion that several years ago had 3+3 in posterior part, anterior part obviously had 4 in it but could not be sampled on original biopsy method (trans rectal). I had Tulsa pro 5 weeks ago with Dr Scionti in Sarasota, FL, they took out roughly 2/3 or so of my prostate. Had catheter for ten days was about the hardest aspect plus a bit hard to pee after, still on alpha blockers. That is all clearing up though, no ED, no incontinence. Hopefully all stays well cancer wise. The Tulsa pro can bring the prostate size back down to 35 or 40 cc or so from my last 110cc measurement, and for me since things were in transition zone + on one side - they didn't have to go near nerves, ducts, etc at the bottom.

What was your PSA and any related history? In other words, what drove you to do a biopsy?

Your above average prostate size naturally comes with above average PSA numbers but....

Excellent comments from bjroc and ozelli. From my experience in 2021 into 2022, I'd like to ask if you have any sign that cancer has escaped the prostate? A scan could help define that. Also, with the "7" in your biopsy score, does it clearly show a chance of an aggressive area of the PC? That could guide any sense of urgency to have the prostate removed.
Best of luck and a short recovery and long, high quality of life.
Blessings!

scj428, welcome to MCC. I wish I had known about MCC when I first started my journey,

My numbers were similiar to yours. I had only one area at 3+4=7 the rest were 3+3. I think at this point you should consider doing a Decipher test that is done on biopsies taken. It will give you a more specific diagnosis of your cancer being low risk, intermediate, or high. The biopsies diagnoses of levels can be subjective and this helps define them.

A PSMA test will determine if cancer has spread outside you prostrate. Extremely inportant in what your treatment will be. A bone scan is another test that can determine if spread to bones.

You are fairly young at 63 I am 76. I think the test you see recommended are something you should asked your providers about so you have more information on your cancer diagnosis and the treatment options for each level of risks.

Watchful waiting is still an option but I had same Gleason Score as you but did not want to leave a cancer diagnosis untreated. I would worry to much about it and I am a heart failure patient (diagnosed way back in 2000) and just did not want the stress. I agree with your doctor on that one but again the test recommended will give you a better specific diagnosis to help YOU decide on your treatment options.

What were you PSA levels prior to diagnosis? Are you going to a major medical provider with experience and kwowledge of latest diagnoses and treatments for prostrate cancer? Have you sought a second opinions?

Just remember we are all different and our cancer diagnoses will never be the same nor a standard treatment or what to do for each of us. If you decide on radiation strongly suggest you research the different in photon radiation versus proton radiation. And explore the newer 5 high dose versus the lower dose but much longer treatments. All depends on YOU though not us.
Good luck,

Good morning. I was diagnosed with PC in August. I had 2 cores of 14 with cancer, one was 3+4=7 and one less. My prostate varied in size from 68 to 88. After talking with 2 surgeons I decided on removal. One important factor over radiation was if I chose radiation and it wasn’t effective, removal could not take place(although one person was told it could be removed but very difficult). My surgery on November 7 went better than expected: no pain, no incontinence(doing Kegels is very important!). One concern: my pathology came back with my one core being 4+5; not 3+4. So understand after removal your pathology report will be more exact than the biopsy.(your core could come back less as well). My 30 day recovery ended yesterday and I am back to doing whatever I want, although I am starting slow(I am a retired exercise professional so weight training and cardio are important to me, even at 71). I will have my Followup PSA in January and am praying for an undetectable amount. I would suggest that you talk to at least two surgeons for an opinion. I looked for experience(mine has done over 1000); and a feeling of comfort with him as well. Best wishes whatever treatment you choose.🤞🙏

At a similar age, I had similar biopsy results. At this stage in your journey, as previously mentioned, a Decifer test of the biopsy samples will provide you additional information that will be helpful for you to decide upon a treatment. I recommend getting as much data as possible about your specific prostate cancer condition and ensure that you are treated by a PC center of excellence for the specific treatment that you choose. The Prostate Cancer Foundation (PCF) has literature that will help guide you on the data you need to make an optimal decision for your specific situation. Knowing the questions to ask and the data you need will make all the difference in the success of your decisions.

I agree you have time to gather more information about your particular situation and possible treatment. Three steps which may help: get a second opinion on the biopsy slides from a center of excellence; get genetic testing on both the biopsy material and your own DNA; get at least two second opinions from MDs not associated with your own.

Also, read Patrick Walsh's book on PC, who covers diagnosis and treatment risks, side effects, and question to consider.

Finally, gain clarity on your own values: quality vs quantity of life, willingness to tolerate the various types and lengths of side effects, support of friends and family, etc.

In my own case, I had a 12 core biopsy which showed 3 cancer sites, two @ 3+3, one at 4+4. Second opinion reduced that latter to 4+3. Genetic test and imaging were negative. I had nerve-sparing robotic surgery, with return to urinary continence after 3 months and usable sexual function after 8. I was 74, with no other medical problems (normal weight, no prescription meds, physically very fit and active). My wife stated, "Keeping you alive is most important to me. Everything else is secondary." So far, so good with undetectable PSAs.

scj428: I had 3+4 Gleason. 10.2 PSA and was 69 when treated in January/February. I was diagnosed in October of last year. I looked at removal, different forms of radiation and tulsa pro/ablation.... I spoke with 5 radiation oncologists from at least 3 centers of excellence.

I too had the Decipher test and it was one piece that was definitely used by the doctors and me to help with our treatment decision.

Removal was not right for me as I did not want to deal with a 20-30% of biological re-occurrence. I was also willing to rule out, or make removal more difficult later on. Tulsa Pro and ablation statistics were not robust enough for me to decide for that type of targeted treatment. I felt the same way about cyberknife, though it has been out longer, so I focused on radiation.

I looked at Proton and narrow margin photon machines. The process of radiation usually involves radiating the entire prostate and 3-5 mm outside of it to cover any possible microcell spread. Anything that narrows that margin to limit healthy tissue exposure, and therefore side effects is important. Most of the radiation treatments used margins of 3-5 mm. The margins on the photon machine I used was 2 mm. Thats a BIG deal (2mm vs 3-5mm) and I had 5 hypo fractional treatments. The MIRAGE randomized trial also showed how important real time, while on the table, MRI imaging is versus fused images. Again, PROTECT HEALTHY TISSUE by choosing reduced margin treatment if you choose radiation.

Proton was a choice that I strongly considered because of how the radiation exit could be stopped and its narrow beam but it did not have real time built in MRI. There are several MRI guided machines to use on the market now but NOT for Proton.

I also had spaceoar inserted to give separation between my rectum and my prostate, to minimize healthy tissue exposure. There are several spaceoar type gels on the market as well as a fairly new saline into a narrow disappearing ballon insertion.

You will see on this site that most were happy with their choice and treatment. I too would not do anything different except I would have a fusion MRI. I had restricted urine flow after 3 treatments but Flomax helped reduce that within a day. I had no bleeding and no pain and am still that way. PSA has been going down with each blood test every 3 months. No ed issues either.

Feel free to private message me or ask here if you have any questions.

The most important next step is a pelvic scan to determine if the cancer has spread beyond the prostate…this will drive your treatment options…your first treatment is very important be aggressive in your plan…I had cancer on the margins of the prostate and needed to go for radiation,and hormone therapy..2 years later and still psa is undetectable 👍