71 year old gleason score 3+4=7 need direction please

I am sorry that for your husbands diagnosis.

Generally surgery is age dependent. A surgeon can do an excellent operation; a patient at age 50 will do great, however an older patient will suffer side effects. Also surgery is a major operation with inherient risks.

There are various options for treatment that are less invasive than surgery, These include various forms of radiation. You need to do research and interview speciallists as well as do research by reading , visiting local support groups.

Additional diagnostic tests are indicated, specifically an MRI using a tesla 3.0 magnet to see if there is an indication of extracapsular extention, which will be a critical in the treatment decision.

Johns Hopkins is a center of excellence, I think ranked number one for urology by US News and World Report. You are at an excellent place.

Kongo said:

Options

Dear Twin,

Sorry to read of your husband's recent diagnosis.  As you know now, a Gleaon 3+7, T2a means that your husband's cancer can be felt by the doctor during physical examination and that it is at the lower end of the intermediate risk category.  (A 3+4 is better than a 4+3, for example).  I believe that the (a) part of the T2a indicates that cancer was found only in one of the two prostate lobes.  While this diagnosis is something you surely want to address, it is not something you need to rush into, at least in my lay opinion.

Most doctors avoid surgery for men over 70 because of the increased risk that the major surgery poses for a man that age compared against the fact that there is no statistical benefit of longevity to surgery over modern radiation treatments so why take the risk?  Some men in their 70s may be such robust specimens of health that surgeons feel more comfortble in operating on them or perhaps they just turn a blind eye to the guidelines of the ACS and the American Urological Societies.  Besides, each prostate cancer diagnosis is different and it is rather pointless to compare treatments of one to another unless you have all the gritty details in front of you.  Not all prostate cancers are alike.  I'm sure that if you widen your seach of potential surgeons you will eventually find one willing to operate.  Check Craig's List.

There is a persistent urban myth that if you have had radiation treatment then you can't have surgery later.  This may have been true a few decades ago but with modern treatment methods the radiation delivery is so accurate and confined to such a small space that this is not as much as a concern as it used to be.  In fact, there are doctors who specialize in this procedure although, to my knowledge, it is rarely ever done.  In that past three years since my own diagnosis and treatment I have read a dozen or so detailed books about prostate cancer and literally thousands of posts by men on a number of prostate cancer forums.  I cannot recall a single instance where someone essentially said, "Dang, I had radiation and my cancer came back and now they won't do surgery on me!"  It just doesn't happen.  The prostate may end up being removed later for other reasons but it's not because the cancer came back in the prostate.  If someone could point me to such a case I would be grateful and there may well be one out there somewhere but I suspect the odds that your husband will be hit by lightening on the golf course sustains a higher probability than this happening.  I believe that this prostate cancer myth is something that is further propagated by knowing urological surgeons who are using a hard sell approach on trusting patients.  While the resultant scaring caused by radiation may make surgery more difficult than otherwise, it is not impossible and someone who tells you that is either deliberately lying to you or is repeating information that is simply not true.

From what I have read and what my radiologist has explained to me is that most modern radiological treatments for prostate cancer radiate the entire prostate.  Post mortem pathologies of the prostate (done on men who have died from something other than prostate cancer...like a heart attack) almost always show that there is no cancer in the prostate gland.  

If the cancer "returns" it is because it metastasized prior to radiation (prostate cancer lovers to metastasize to other parts of the body) and it is growing elsewhere in the body.  Keep in mind that cancer in the prostate cancer isn't fatal.  It is when that cancer spreads to other organs such as bones, liver, lung, and so forth that it eventually kills you.  This isn't a quick process, by the way.  The histology of most prostate cancers (adenocarcinoma) is about 56 years from the first cell to death.  The cancer in your husband has been there a long, long time.  Most prostate cancer treatments are aimed at interrupting this long cycle long enough for something else to kill us.  Then doctors can claim they "cured" us and tout our cases in their long term survival statistics.  The most common cause of death by men with prostate cancer is heart disease.  Think about it.  

Before the miracles of modern medicine most men died in their 60s.  Men surely had prostate cancer but they were usually meeting their maker as a result of heart attacks, plague, malaria, small pox, or some of the other diseases common in the early last century.  Now that the 70s are the new 40s men are living longer than before and now prostate cancer is seen more and more.  It is still not much of a killer.  While one in six men in the USA will be diagnosed with prostate cancer in their lifetime, only about 1 in 32 actually die from it and these poor souls were frequently diagnosed very late in the game.  Men diagnosed "early" with low or intermediate risk prostate cancer (like your husband) almost always die of something else.

If Johns Hopkins is in your area then you and your husband are fortunate to live in a neighborhood with many, many fine institutions to treat prostate (or any other) cancer.  Off the top of my head I would suggest Georgetown as a potential place to seek a second opinion.  While Johns Hopkins is certainly world renowned for its prostate treatment excellence (the first prostate cancer removal was done there more than 100 years ago -- patient died a few months later) there are others nearby and I do hope your husband seeks second opinions from a variety of sources.  One of the frustrating things about this disease is that lay men, generally ill-equipped by education or experience, are forced to make decisions about treatment choices where they are totally out of their depth.  These men are particularly vulnerable to suggestions from doctors who seek to sell certain types of treatments on unsuspecting, elderly patients.  Prostate cancer is a huge, multi-billion dollar business.  (our generation was brought up to trust our doctor..."doctor's orders!").  The best way I know to sort this out in a reasonable fashion is to visit several specialists of diferent disciplines and read everything you can find about prostate cancer.

Frankly, my personal opinion is that you should thank your lucky stars this doctor has given you pause about surgery.  I hope you visit some other specialists to learn in detail the full range of options your husband has available to him.  Also ask about alternatives to treating your husband's BPH (that's the enlarged prostate that is likely causing urinary difficulties) and a decrease in potency.  There are plenty of options in this area that does not invovle removing his prostate!

Good luck to you both.

K

 

 

Does 3 years really make that much difference? What shape is your husband in? If you are close to DC, you might consider having a consult with the foxhall urology group, suggest you ask to see doc Constantinople, and see what he says. I'm curious, who did your husband talk to at Johns Hopkins? If, other than the cancer, your husband is in good shape one might think he would be a good candidate, but then I'm not a doctor.

best of luck