Prostate Cancer- After RP, Gleason 9 from 6 and PSA relapse
I have searched and studied a few publications and some literature. This is my first time posting on this very useful forum, so hoping to help others and/or get some inputs.
I am now 49 years old and have been healthy and very athletic in sports. I had an RP in Sep. 2020 when PSA was 32, and the surgeon thought that I could be cancer-free after that. 5 weeks post-RP, PSA was 0.8 and 9 weeks post-RP it was 1.2. A pathology report in Nov. 2020 was pretty bad with 1/3 of prostate filled tumours with Gleason 4+5=9. Five (5) out of 14 lymph nodes harvested have 0.1mm to 2mm invasion. The rating was T3a N1. Docs schedule me for a PSMA PET/SCAN in the middle of Jan. 2021 and then will decide what to do. At the present time, No treatment is offered. I mean no ADT, no SRT, nothing. Not really sure why both the urologist and oncologist said this to me.
I am on a daily 400 mg of itraconazole and a daily 20 mg of melatonin medication which is recommended by my naturopath doc. I also get twice a week of IVC with 50 grams. Diet is switched from 50/50 veg./meat to 90/10. Regular exercises with daily infrared dry saunas. Twice daily meditation with yoga and tai-chi and of course, a positive attitude. Some history of my cancer history below:
In 2015, my first PSA was 4.0 and DRE was normal. Then PSA keeps elevating. No urinary and erection related issues.
In June 2018, PSA was 12, DRE normal, 1st biopsy with 10 samples with Negative result. No urinary and erection related issues.
In Jan 2019, PSA was 18, DRE normal, 1st MRI with Negative result. Due to those negative results, the urologist thought I had BPH. No urinary and erection related issues.
In March 2020, PSA was 24, DRE normal, 2nd MRI with Negative result. This result was false negative as the surgeon can find two bilateral grade 5 tumours upon re-examining the 2nd MRI images in July 2020. First time noticing a smaller urine stream and delay in ejaculation with fluid coming out not once but about small portions in a duration of 2-3 minutes.
In June 2020, PSA was 30 and the 2nd biopsy was made with 8 samples with Only One Positive prostate cancer tumour sample with Gleason 3+3=6 at the Apex area. An open-cut RP was scheduled in July but I opted for Davinchi RP in Sep. 2020 due to those findings.
In Sep 2020, robotic RP was made, docs had to remove nerve bundles due to some findings during the surgery. and my recovery has been great with about 90% continence and 50% hardness of pre-RP with 50mg of Viagra and some arousals. No health issues so far.
In Jan. 2021, I will have a PSMA PET/SCAN. In Vancouver, there is currently an open trial on Lu-177 PSMA therapy, but docs told me that it may not benefit my case. Although wondering why not, I found that most patients taking this treatment has T4 prostate cancer with severe metastatic spreading.
Q1: Why Gleason went from 6 to 9 in three months? I guess the 2nd biopsy didn't tell the whole story, especially since the tumour was on the apex area.
Q2: If I got an open-cut surgery in July instead of Sep. (two-month delay), would this T3a N1 become T2? I don't think so as this spreading must be happening when PSA went up from 24 to 29 in March 2020.
Q3: If the surgeon knew I had T3a N1, would he perform RP? Definitely not as there is no benefit. I blame all those false-negative results that now lead to more problems.
Q4: With both nerve bundle recession, why do docs still recommends me to try erectile with ED tablet? I found a publication indicating about low 30% erectile recovery in my case, but this is not my current priority, especially with itraconazole no ED tablets.
Q5: Will this anti-fungal and melatonin medication, IVC, and self-regulated lifestyle allow my body to somehow limit the progression of cancer? I don't know but fingers crossed on my next PSA and the PSAM PET/SCAN.
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