New member with Gleason 4+4

AccuNeal

Greetings to everyone.  Please allow me to introduce myself as a new member here.  I am 70 years old in good health with controlled type II diabetes.  I am an active cyclist and ride 20 to 30 miles daily.  Last year's physical revealed no lumps on prostate but PSA rose to 6.5.  Uro scheduled 6 month PSA in February 2017.  Results were 7.1 and a 12 core biopsy was scheduled which came back clear.

Another 6-month PSA recently taken came back at 7.1 again, but this time the Uro could feel lump on right side of prostate.  MRI scheduled and revealed small mass in upper right lobe.  Targeted 3D biopsy: all 3 cores were Gleason 4+4.  Bone scan scheduled for last week.  The results were posted today on website: no bone involvement detected.  I'm feeling good about that.

Tomorrow is appointment with Uro. I expect he will discuss treatment options (if there are any options for a 70 year old man).  Last time he said that usual accepted treatment is radiation for someone my age.  I am reading this forum for age-related experiences in particular.  I would be grateful for any readers' experiences

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Neal

Clevelandguy

Welcome

Hi,

Welcome to the club, depending on the severity & if the Pca is all in the gland it's usually surgery or radiation.  Sounds like you might be in pretty good shape for 70 yrs. old so that can help with your decision.  4+4 is agressive and nothing to mess with so I would think it needs to be delt with sooner than later.  If it's all within the prostate then you have some time to research treatment options, if it's escaped then you will need to consult with your urologist & oncologist for the best treament plan.  Lot's of experienced people here to help you along your journey, good luck.

 

Dave 3+4

Max Former Hodgkins Stage 3

Varies

Neal,

There are commonalities regarding how age channels PCa treatments, but none are set in stone.  A 50 year old suitable for surgery would still be able to choose surgery at 70, if a surgeon would go along, and if his heart health was good.  But in general 70-ish is when men more commonly have radiation and hormonal therapies preferred.  Many guys here had surgery after 70, but it is not the norm for over-70 men for first line treatments.

In general, radiation is easier to undergo than surgery, and usually has fewer side-effects. Radiation is also the first-choice if there is clearly metastatic disease.   Yes, there are many options for men 70 or older.   Discussing those will require more details from your scans abnd other test results though.

Most men live a long time with this disease, and most of that time for most has good quality of life.

max

contento

Neal

Neal, i was a lot younger than you when I was diagnosed  with Pca and I chose surgery. I only found out that I had aggressive  Pca Gleason 8 (4+4) after surgery ( pathology report ).

Worse it reoccured about 17 months later. If I had known via biopsy prior to treatment that I had a Gleason 8 I would have chose radiation. Not only in hindsight  but because a Gleason 8 has a higher likelyhood that it left the prostate. For me , so far, the good news is that the spread was around the prostate bed and not in distant locations.

im now 2 years post radiation ( 4+ years post surgery ) and my psa is non detectable.

VascodaGama

Is your case contained or localized?

Neal,

You have been diagnosed with a positive DRE which finding leads to believe in existing spread. The real status should be firstly identified and considered in your final decision. In fact, Gleason score 8 cases are often found with extra prostatic extensions (high probability to metastasize) and the traditional image studies and bone scan may not be helpful when the tumour size is small (lesser than 1.2 cm) or the PSA is below 10 ng/ml, commonly providing false negatives. For such reasons, doctors usually recommend radiation therapy to Gs8 guys. Surely a surgeon would prefer to have the patient choosing surgery (his trade).

What is your clinical stage?

In regards to your appeal for experiences, you can find in the bellow site the stories of many PCa patients listed by age, Gleason score, region, etc;

http://yananow.org/query_stories.php

Best wishes and luck in your journey,

VGama

 

AccuNeal

Thank you

Thank you to Dave, Max, contento and Vasco for your thoughtful comments.  They are very much appreciated.

 

I am just back from bone scan follow-up visit with Uro.  He feels certain that there are no mets outside the prostate based upon the hi-res MRI, bone scan and biopsies.  He said I should be aware that there may be a period of AS before any treatment depending on the outcome of the consult that I have scheduled with the radiation oncologist next week.  He has issues with proton treatments from the experiences of prior patients and recommends against it.

 

Now... to do a bit of googling of the oncologist.

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Neal

RobLee

There may be a period of AS before any treatment (?!!?)

IMO there is no place for AS in the case of 4+4. Your pathology calls for action, the sooner the better.

AccuNeal

Couldn't agree more

Absolutely concur, RobLee!  Thank you.  I think waiting one week for the oncologist appoint is sufficient AS duration.  Furthermore, the past two years since my PSA climbed above 4.1 has been AS as far as I am concerned.  So enough of that for me.  If this oncologist hesitates, there are many more in southwest Florida from which to chose.

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Neal

RobLee

many more in southwest Florida

BTW I am in Dunedin, near Clearwater.  I too am G8(4+4), T3B w/SVI, had RP one year ago and now in 8 weeks daily radiation. 

I asked my RO if I should get a medical oncologist involved and he said no.  Also I have a blog here on CSN if you want a little light reading.

Old Salt

RobLee said:

There may be a period of AS before any treatment (?!!?)

IMO there is no place for AS in the case of 4+4. Your pathology calls for action, the sooner the better.

Somewhat similar case

Perhaps relevant, I was a bit older when my prostate cancer was found in 2013 (many Gleason 9 tumors, but no detectable spread outside the prostate). Hormone therapy was started prior to SBRT (3 sessions) followed by IMRT (24 sessions). 

PS: this protocol was experimental at the time (and probably still is) and executed in an academic medical setting. 

FloridaTom

AccuNeal said:

Couldn't agree more

Absolutely concur, RobLee!  Thank you.  I think waiting one week for the oncologist appoint is sufficient AS duration.  Furthermore, the past two years since my PSA climbed above 4.1 has been AS as far as I am concerned.  So enough of that for me.  If this oncologist hesitates, there are many more in southwest Florida from which to chose.

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Neal

Down on Marco.  Have surgery

Down on Marco.  Have surgery schedule for Friday.  Looks like SW Florida is well represented here!

-Tom

RobLee

FloridaTom said:

Down on Marco.  Have surgery

Down on Marco.  Have surgery schedule for Friday.  Looks like SW Florida is well represented here!

-Tom

Good luck Tom

Hoping all goes well for you on Friday.

Max Former Hodgkins Stage 3

RobLee said:

There may be a period of AS before any treatment (?!!?)

IMO there is no place for AS in the case of 4+4. Your pathology calls for action, the sooner the better.

Definitely

Rob is for certain correct: No way should you even think A/S.  There are cases where it is suitable and a good thing, but your's in not such a case.

max