Biopsy results

vjlvpjalways Member Posts: 4 Member

My husband is 68 PSA 4 last January retest 90days 4.2 retest 90days 5.2 biopsy

digital exams clear until last results firm

i know the results are not good.. the urologist is scheduled to call us tomorrow

I read that with the higher Gleason/grades the prostate quits putting out the PSA higher numbers..

I am thinking scans would be next.. he has no pain, no symptoms, high energy..

our problem will be location. We are hours from closest major medical that is going to bring challenge..looking for advice on being prepared any educational site’s recommendations..I have been reading through here the past few days and it’s helped me understand a little bit..all advice, encouragement and direction for education much appreciated


  • VascodaGama
    VascodaGama Member Posts: 3,598 Member

    Welcome to the board.

    The diagnosis is not good for the voluminous case and high Gleason score of 9 but it is treatable. The next step will be to check if the cancer has metastasized at far places (bone, lymph nodes, etc) via scans but contained Gs9 cases are rare. The pathologist's report indicates existing perineural invasion on cores "E" and "I" which seriously justifies a perception for extraprostatic extensions.

    Surely your husband needs to submit to several image studies for completing the diagnosis process but in your shoes I would request having an MRI (instead of CT) and discuss on multimodal treatment approach. Some survivors in this forum with aggressive cases choose a combination of surgery plus radiotherapy adding hormonal treatment which is nowadays recommended in high risk diagnosis. A positive bone scan would decrease the options.

    Hopefully you will get answers from the doctor you meeting today.

    Best wishes,


  • vjlvpjalways
    vjlvpjalways Member Posts: 4 Member

    Thank you for your response, what tx options are possibly lost/withdrawn with the bone infiltration?

    can the urologist order the mri/scans?

    Or referral first?

  • Clevelandguy
    Clevelandguy Member Posts: 866 Member


    With the Gleason score of 9(4+5) you should start assembling your “team” which should include a Oncologist and a Urologist from a well known hospital network. Some major hospital networks have specialized cancer centers which are a definite plus. Even if you have to travel I feel it would be worth the seasoned medical staff that will help your husband treat this. I would want an MRI, PET, and bone scan to determine if the cancer has left the Prostate. With the perinural invasion the cancer has reached the outer limits of the Prostate. Like I always say great doctors+great facilities = great results.

    I have included a link to get you going for treatment options.

    Dave 3+4

  • VascodaGama
    VascodaGama Member Posts: 3,598 Member

    Hi again,

    Dave provided above a link with references for treatment options worth reading.

    When the diagnosis identify bone involvement, then surgery is no more practical because it wouldn't provide cure but added risks. Radiation would only be recommended if the case involves a fewer number of lesions and these are located at proper areas to radiate. Typically patients with bone metastases are moved to palliative therapies such as chemotherapy, hormonal treatment or immunotherapy.

    Cases with fewer bone lesions can be treated with spot radiation alone or in combination with a palliative treatment.

    Localized PCa cases are typically recommended for surgery in contained cases, and radiation in non-contained, or for a combination of both therapies when dealing with aggressive types of PCa.

    A List of Questions to the Doctor may be helpful to get those doubts clarified. Here are some references you can copy to prepare your own list;



  • vjlvpjalways
    vjlvpjalways Member Posts: 4 Member

    Have there been any post or opinions on castration vs adt therapy

    i figured out how to search


  • VascodaGama
    VascodaGama Member Posts: 3,598 Member
    edited December 2021 #7


    we have discussed here before on the benefits of chemical and non chemical castration options. Orchiectomy equals to permanent castration where ADT on drugs allows return to previous status once it is stoped.

    Nowadays, doctors recommend ADT with drugs independently of patient age. Orchiectomy is usually chosen because it is cheaper than the treatment with drugs or because the patient has other illnesses whose treatment prohibits or interacts with ADT drugs. Both lead to hypogonadism and cause the side effects due to the lack of testosterone in circulation.

    Drugs taken in long periods of treatment add the effects from an imbalanced hormonal regimen (disrupted endocrine system) that could lead to diabetes, cardiovascular issues or deterioration of kidney function.

    Can you tell us the reason for this question?


  • vjlvpjalways
    vjlvpjalways Member Posts: 4 Member

    Looking at which has less severe side effects, 1 am understanding the benefits of stopping the testosterone.. I also need to understand better the point of disease the RP ISNT an option..

    I hope that our urologist will order the scans/MRI BEFORE waiting for referrals