Gleason 10 and rapidly escalating PSA


Hi All,

I am writing on behalf of my father. On tuesday (22 October) this week he was diagnosed with stage 4 prostrate cancer that has metastisised to the hip bone and spine. The biopsy has returned a gleason of 10. His PSA was 5 in the beginning of august and is currently sitting at 14 after the tests this week. He has started with casodex this week. Depending on other tests on monday we will, i assume, pick up treatment levels and or methods.

I am very uncertain of what to expect and all that i have read other than stating to keep positive (which i agree 100% with) does not give real prognosis etc.. I ndestand the current situation does not look good but i feel that there is so much more that can be done, am i wrong?

What other treatment should we be looking at?

What do you expect with such agressive growth? will the casodex work as aggresively?

I would really appreciate any information





  • djs123
    djs123 Member Posts: 102
    Gleason 10

    I am not a doctor but can only tell you of my husbands experience.  He was diagnosed with prostate, gleason 9, January 0f 2012.  He had 40 rounds of radiation therapy and has been on lupron. Doctors want him to be on lupron for at least 2 years.  

    Since his cancer has spread to bone & lung, he also had 8 rounds of chemo with a good response.  He is not in pain.  Stopped chemo for several months and will be starting again.

    Hang in there.  My husband is an older man and surgery was not recommended with a gleason 9 since doctors said he'd need radiation regardless.

    Don't know your dad's age, so not sure if it's treated differently in a younger man.

    Good luck, prayers are with you.  Keep us posted.

  • Rakendra
    Rakendra Member Posts: 197 Member
    Gleason 10

    My heart goes out to you and your father.  I am in a very similar situation with PSA before of 200 and very extensive matastatses in Stage 4.  There is no way to give any kind of estimate of life extension.  If there is no involvement of organs or lymph system, he MAY have a good future.  And get the Gleason 10 checked by another Pathologist.  I am 82, and after a devastating weight loss, I have now gained 10 pounds back and feel that I am healing.  It is a moment by moment experience for me.  I have no pain and if your father has no pain as well, this is a favorable event.  I would contact your best Naturopath and get on natural supplements as soon as possible.  I take 3 big handfuls of supplements every day.  Get on the cancer diet and look to cure and treat with the aid of natural substances. I tend to rely on natural treatment rather than poison, burn and cut, but everything has its place.  Celebrate any time remaining, live in the moment, have no worry about the future because it is not in your hands.  In reality, The future does not exist for any of us, so celebrate the moment now with your father.  Godspeed and good luck.  love, Swami Rakendra

  • Trew
    Trew Member Posts: 932 Member

     C, I understand your concern for your father.

    Many of us have put family through just what you are going through now. 

    I also want to add there is no relationship it seems between PSA and a gleason score. 

    At time of my surgery my gleason was 5+4= 9 with bladderneck involvment and my gleason never got over 10 and I earned the stage iv classifiction. 

    I am doing ok right now, but back to your father, his lab numbers demonstrate the seriousness of a cancer that can be hidden behind lower PSA numbers.









  • VascodaGama
    VascodaGama Member Posts: 3,668 Member
    Advanced Status, Gs10


    Your father is confronting a very advanced status as per the info you share above. Existing treatments are therefore limited and palliative, and will look more to handle the effects caused by the cancer than looking for the cure of the disease. Usually doctors recommend to such patients combo protocols with hormonal therapy (HT) and/or chemo (CT) plus radiation (RT), but many physicians spare some fields/spots in bone to radiate when pain becomes unbearable at latter stages. This occurs when there is wider spread of metastases making it impossible to radiate the all areas fully. Another fact they take into consideration is the restrictions of radiating over areas that have been previously radiated. In any case, HT manages to control the disease during long periods of time (years).

    The age and physical fitness of your father, and any other illness he may be confronting or that he may be already initiating (heart health, diabetes, osteoporosis, etc.) will interfere with any decision made for a treatment. Medications interact with HT drugs prohibiting the administration of some protocols. Traditionally, PCa therapies are seen as a continuous practice so doctors will reserve some protocols to be administered along the years when the time is right.

    In the case of your father, starting with an antiandrogen while waiting for tests results seems proper and due. Bicalutamide (Casodex) will alleviate compressions in bone joints at the spine “infested” with PCa. This is recommended before starting LHRH agonists/antagonists like Lupron or Firmagon. This is the usual HT protocol which may be your father’s doctor’s recommendation. Radiating the prostate (if any) is done as a palliative measure but the doctor may want to include the spots at the hip bone which will require a wider and sophisticated isodose planning field. Surgery is also only done in case of obstruction at the urinary track. More treatments more side effects can be expected to occur and those will add to the ones from the hormonal/chemo drugs. The quality of life will surely deteriorate.

    A newer medicine named Xofigo (Alpharadin) is known to kill cancer in bone. It tackles the metastases using the path that controls osteoblast (deterioration of bone cells). It has been FDA approved to use in chemo refractory patients. This is a good drug for your father’s case but he needs to get a doctor that will administer Xofigo off-label. Another way to get it will be through clinical trials. You can discuss with his doctor about any opportunity of getting him involved.
    Read this;

    Some patients prefer to tackle the cancer from every front from the beginning. It is possible to do it but one needs to find a doctor that can look upon all areas of treatment (urology, radiation oncology and medical oncology) at the same time. Medical oncologists specialized in PCa treatments are the most recommended to advanced cases because they are closer to the patient and care for the side effects.

    I recommend you to get a copy of this book;
    “Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers; which informs on diagnosis and treatments for systemic cases.

    Here are other links to additional information like nutrition, and matters of PCa, etc;

    Try getting second opinions on the above and prepare a list of questions to expose to the doctors while you go around. Here are some ideas to prepare your own list;


    Best wishes in the journey of your father.

    Welcome to the board.

    VGama  Frown

  • ascott23
    ascott23 Member Posts: 16
    Hi Nicolas,
    I am so sorry

    Hi Nicolas,


    I am so sorry to hear about your father, I can relate very well my Father was diagnosed a year ago with stage 4 prostate cancer, Gleason score of 10 with bone mets to the spine and hip , also lymph node involvement. He was only 60 years old at the time of diagnosis. He was initially on casodex and zoladex. Since then he recently had a bone scan and mri in September, with no new mets. Although they did find a spot on his Thyroid, he also has constant swollen parotid glands. Recently last week he had a stiff neck on the left side of his body and was unable to turn his neck. He went to the Doctor and they told him it could be a muslce spasm or from the cancer. When he  had an xray in July from his shoulder hurting the lab called back and said it was the beginning stages of osteoperosis.

    His Psa initially was a 32  during diagnosis then it went to a 7, all the way down to a 0.04 it has since begin rising since April of this year, he was diagnosed in August of 2012. His Psa in April was a 0.22, then 0.13, and then in September it was a 0.27. He is due back this month for another PSA.

     He is being treated at NIH/Walter Reed in Bethesda, Md. Doctors of NIH want him to go on Provenge or perhaps a clinical trial.


    I know this is all overwhelming, please feel free to ask me any questions?