Three different opinions need a recommendation for Telehealth consultation.

Kevin81
Kevin81 Member Posts: 7 Member
edited January 25 in Prostate Cancer #1

66 year old healthy male PSA 4.9, MRI Pirad 1, ExoDx 58, Biopsy 3/12 positive cores, 2 were 3+3, the other was 4+3 with 75% being a grade 4 and 25% a grade 3. Decipher score .44. Pet scan was normal except the two areas of concern mentioned above. Impression of PET "The prostate measures 4.4 x 3.3 x 3.5 cm. Focal increased activity is noted at the apex anteriorly on the left. This is possibly located within the anterior fibromuscular stroma or transitional zone. There is a 2nd focus at the apex slightly to the right of the midline and more centrally, most likely within the transition zone. Activity in the urethra is not totally excluded.."

Diagnosed three weeks ago, my urologist wanted me to see three different specialists and since then, I met with a Medical Oncologist who suggested active surveillance as he stated the odds of spread are low. Met with a Robotic Surgeon supposed to be the best in the area who said surgery is the best option, and me with a Cyberknife oncologist who "thought" that I may be a candidate if the decipher score was low.

Needless to say I am very confused. I am very active, exercise, health is excellent. I was thinking about a consult at Sloan in NY which is about 2 hours away but would rather do a telehealth visit. Has anyone received such conflicting opinions and then had yet another opinion? Will Medicare cover another consultation?

Comments

  • Old Salt
    Old Salt Member Posts: 1,259 Member
    edited January 5 #2

    You have not received conflicting opinions. Very much in general, there are three (generally accepted) options to treat prostate cancer absent metastasis: Active Surveillance, radiation or removal. In addition there are some more experimental procedures. Hence, to decide on a therapy will be not be easy or straightforward. However, you have time to consider all options and dig deeper into the pros and cons of each one.

    A consult at Sloan Kettering would be excellent, IMHO. Not sure about a telehealth consultation for prostate issues, never had one myself.

    Take your time and do what you think is best considering your own individuality.

  • centralPA
    centralPA Member Posts: 209 Member

    I'm surprised AS is offered up. The 4+3 value should be Grade Group 3, no? That lands him in Unfavorable Intermediate Risk category. A 10+ year life expectancy too. I guess I just learned something.

  • Kevin81
    Kevin81 Member Posts: 7 Member

    Yes, that is what I thought, unfavorable Intermediate. That is why I was so surprised at the mention of AS with a 4=3. What do you mean by a 10-year life expectancy?

  • Kevin81
    Kevin81 Member Posts: 7 Member

    The 4+3 was a grade 3 and I was shocked to have the medical oncologist suggest AS.

  • centralPA
    centralPA Member Posts: 209 Member

    The recommended treatment is a function of both condition and life expectancy. I assumed based on your post that you have plenty of good years left. If you’re staring into the abyss…no reason to undergo aggressive treatment.

  • Rob.Ski
    Rob.Ski Member Posts: 136 Member

    Might get a second opinion from a doc specializing in AS. What were the volumes in positive cores? What would be a trigger for discontinuing AS going in with a 4+3?

  • Old Salt
    Old Salt Member Posts: 1,259 Member

    Central PA is correct; a Gleason 4+3 score puts an individual in the 'INTERMEDIATE' category (grade group 3).

    I edited my somewhat misleading post accordingly.

    If AS is off the table, the decision process becomes easier. Actually, that isn't true because there are many radiation options and several prostatectomy procedures. But as I mentioned earlier, there is time to study and make a decision that seems right for you.

    Because your risk category is dependent on that one Gleason 4 spot, it might be good to have that reviewed by the Johns Hopkins specialists:

    Get a Second Opinion | Johns Hopkins Brady Urological Institute (hopkinsmedicine.org)

  • Clevelandguy
    Clevelandguy Member Posts: 949 Member

    Hi,

    Based on what you have said it sounds like you could either so surgery or radiation. Robotic surgery, Cybernife radiation, Proton radiation, radioactive seed implants are some of the more obvious choices. If it was me I don’t think I would even consider AS with the Gleason4 score. The Sloan consult does not sound like a bad idea, especially for the Oncologist. Time to do your homework with your selected medical team and decide your path.

    I have added a link for you to study:

    https://www.cancer.org/cancer/types/prostate-cancer/treating.html

    Dave 3+4

  • oldspice
    oldspice Member Posts: 50 Member

    Just too add to this conversation FYI…I was diagnosed with PCa in October. 3 cores were positive 3+3, 3+4, and 4+3 (65%) of tissue. I do have 1 lymph node that also showed up on PSMA scan. Now I am 73 years of age. My Urologist stated that because of the 4+3 Gleason it makes me a grade 3 intermediate unfavorable. If it was another 3+4 vs 4+3 he would have considered AS but since it was 4+3 it took me out of that equation. Actually if the beast would have stayed put with no lymph node it would have made things much easier. When all was said and done they believe I have up to 65% CURABLE and they are both believe 99% chance I won’t die from this cancer. 5 months of ADT and 45 radiation treatments on the schedule. I hope they’re correct

  • Kevin81
    Kevin81 Member Posts: 7 Member

    G. PROSTATE, RIGHT MEDIAL BASE, NEEDLE BIOPSY:

    PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1).

    CARCINOMA INVOLVES 35% OF ONE CORE.

    LINEAR EXTENT OF CARCINOMA: 5 MM


    H. PROSTATE, RIGHT MEDIAL MID, NEEDLE BIOPSY:

    PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1).

    CARCINOMA INVOLVES 5% OF ONE CORE.

    LINEAR EXTENT OF CARCINOMA: 1 MM


    I. PROSTATE, RIGHT MEDIAL APEX, NEEDLE BIOPSY:

    PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7 (GRADE GROUP 3).

    CARCINOMA INVOLVES 25% OF ONE CORE.

    LINEAR EXTENT OF CARCINOMA: 3 MM

    PERCENTAGE OF GLEASON PATTERN 4: 75%

  • VascodaGama
    VascodaGama Member Posts: 3,638 Member

    Hi, Kevin,

    In your other thread you mentioned that you "... ...Decided on RALP to be performed by a competent Urologist". I think that you have chosen well even with a Gleason score of 4+3 in one core. The gland is somehow large at 50cc which could restrict acceptance by some radiotherapists that would look into downsizing the gland before advancing with the radiation.

    In any case, I hope that you are aware of the risks and side effects commonly attached to RPs. These can deteriorate your present quality of life to certain extent. Incontinence and ED (erection disfunction) are the most typical ones. You will also lose the ability in having a child by natural meanings. Surely, not everybody has experienced the full range of the side effects (I did RP in 2000 and was never incontinent but suffered with ED).

    In any case, if you have gone the RT route, you would also confront a series of side effects. Treatments can free us from the bandit but not without leaving a scar. We need to learn and accept our newer we.

    Discuss with your wife and advance with the therapy that most comforts you.

    Best wishes and luck in your success.

    VGama