Im 57 and was diagnosed with prostate cancer on 4/21/23. Following a 3t mri which revealed a pirads 5 leasion I had a targeted mri fusion guided biopsy. The pathology report revealed adenocarcinoma in 2 of 14 cores. Gleason 7 (3+4), grade group 2, 30% involved. Chronic inflammation was noted as well in areas around the cancer. My PSA started in 2109 at 1.8 and went to 2.1, 3.57, 5.91 and 6.7 a couple of months after the 5.91 and before the biopsy. My PSA density is 0.15. My urologist recommended surgery and a consult with a radiation oncologist obviously suggested radiation therapy but states active surveillance might be appropriate if the second opinion on my slides didn’t change. Any thoughts?
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With your score of 3+4 , which is what my biopsy showed you have a lot of options. One of the radiation oncologist I consulted told me the difficulty is choosing the one that is best for you. Surgery and the various types of radiation all have documented good results. They all have pros and cons. Do not hesitate to get several consults with urologists and radiation oncologists before you make your decision. I did some virtual visits with various specialists including Mayo and found this to be helpful. Then decide what fits your lifestyle and what you are comfortable with.
Just to add some resources that I found helpful. There is a nice video on youtube for prostate cancer 3+4 https://www.youtube.com/watch?v=sLYpQHiThyI Another nice source is the Prostate Cancer Research Insitute, which has various video presentations on the various treament for prostated cancer.
I also had 3-4 and 4-3 and chose 5 proton radiation treatments at Mayo Phoenix with no regrets so far. Too many horror stories of bladder incontinence after a RP. Did not want to take a chance on wearing diapers for the rest of my life. You are also much younger than my 74 years old. Even if the radiation fails and I only get 15 more years that puts me at 89.
A consult with a medical oncologist specializing in urology was helpful for my decision-making with a similar clinical picture. Neither a surgeon, nor a radiation oncologist, she did not have a bias either way, and thus seemed most inclined to help me choose based on not only my own values, but physical and emotional status as well.
Definitely start with self-education and consulting with doctors. Continue this until you get to the point that you know more about your condition and options, then the doctors you are talking with. Then, make a decision about the path you want to take (surgery, radiation, etc.) At this point you are educated, confident and have decided on a path, now start to interview doctors to find the professional you are comfortably with to perform the action. — You will find the right path for yourself and it is highly probable that a curative treatment is available.
We met with 2 surgeons and an RO. All 3 teams recommended radiation.
Gleason 4+4, stage 3b. 71 years old & healthy.
Radiation is now done. Will stay on zytiga and elligard 18 more months.
Doing well and its gets better every day!
Good luck to you.
I am 59, was diagnosed in Sept 2022 at 58. After my biopsy, the surgeon didn’t recommend surgery, my oncologist suggested brachytherapy but had some issues. I decided on 5 proton/hormonal therapy. I just finished on May 12 and so far other than some minor side effects I am recovering very well. The issues were with my bladder and flow max helped. I was stage 1, intermediate Gleason 4+3/7. Get a copy of surviving prostate cancer by Walsh and read it, it will help immensely. You have time so do your research. It’s seems insurmountable but you can do it.
After my Gleason 8 was diagnosed the radiation oncologist showed me a flow chart developed by a panel of doctors that said radiation/hormone treatment or surgery would be equally effective. My family doctor recommended surgery. My ENT had the surgery. I asked my urologist what she'd recommend to her father and she said he'd had the surgery. Then I saw the surgeon and he recommended against surgery because of my hypertension. So 20 sessions of radiation and 3 doses of Lupron later (#4 coming up in July) here I am. There has been a lot written about Lupron on this site and I suggest you study them before you decide. Many men have said their doctors grossly minimized the potential side effects of this treatment and mine was one of them. For me quality of life has deteriorated greatly but not everyone reacts and same. In his book Dr Peter Welch recommendations against hormone therapy. Do your homework and ask around. Good luck.
Just commenting: Agree with all.
However, my copy of Dr Walsh's book is the 2018 3rd edition.
And some treatment protocols involving ADT may have evolved.
I too am Gleason 4+4. 72+ years old. Had 20 fractions of Tomotherapy. 3 months before that started on ADT (Zoladex 10.8mg 3-monthly and Abiraterone 1mg daily) which I have to continue for 2 years as per my Radio Onco.