Prostate Cancer Gleason 9, need your urgent advice

Kongo said:

Diagnosis
George,

Sorry to read of your diagnosis. As you seem to realize, you have been handed a serious diagnosis and your pathology report represents an advanced stage of prostate cancer with potential involvement of the seminal vesicle. Your Gleason score of 4+5 indicates that you have highly developed cancer cells that are poorly differentiated. Based on what you provided, I think there is a good possibility that prostate cancer has already spread beyond the prostate gland.

While every case is different and you must address this diagnosis sooner rather than later it is important to keep in mind that prostate cancer is different in every man. Most men live very long and productive lives after an advanced cancer diagnosis and the CT scan at least shows that organs where prostate cancer frequently travels to when it leaves the prostate are clear, at least at the level that the CT scan can discern. You should be aware that CT scans cannot detect microscopic prostate cancer but there are other tests that may be available to you in Canada that can provide more specifics to your medical team.

I suggest that you take the time between now and your appointment with the urologist to educate yourself on the various treatment options. If the cancer has indeed left the prostate, removing it through surgery will not stem the growth of cancer in other parts of your body and could cause additional side effects such as incontinence. While your pathology didn't indicate the volume of the prostate, it seemed enlarged and I wondered if you were experiencing other symptoms such as a weak urine stream, an urge to use the toilet more frequently, blood in the urine, or other symptoms. There are some surgical techniques that can reduce the size of the prostate and you should discuss these at your appointment. You should also be studying about hormone treatment and radiation as potential therapies; including HD brachytherapy or IMRT in conjunction with hormone therapy.

Canada has some prostate cancer treatment options that are not available in the USA such as HIFU. I don't know much about the Canadian health care options in cases like this but I am sure you can find additional information on the internet or some other Canadian patient in this forum might have gone down this path before.

At your next urologic appointment your doctor will explain the impact of your diagnosis and the available treatment options. While you probably need to move with all due deliberation, I would try to avoid being rushed into any decision you don't fully understand. Your medical team should explain the various options to you in detail along with potential side effects. In the end, it is you who will have to make the decision on how to proceed. You can't make an intelligent decision without more knowledge, so please take the time that you have now to do a crash course on prostate cancer.

When you go to the appointment, I suggest you take someone like your wife, other family member, or close friend, who can take notes while you try to concentrate on what the doctor is telling you. Ask the doctor if it is OK to record the conversation so you can review it later. I can almost guarantee that you will forget much of what he tells you at first as this is all new territory that you don't yet have the background to handle.

There are several postings in this forum from men who have had a diagnosis similar to yours and I encourage you to read back through several pages of posts to see how others have dealt with this situation. Most men who have had prostate cancer and who post here regularly welcome private emails (you can send them through this site) to ask them additional questions. There are a lot of people here who will be willing to help and encourage you in the journey you are just starting.

Best of luck to you as you deal with this difficult situation.

K

VascodaGama said:

Do not be anxious but act timely and coordinately
George

Welcome to the board.
It is clear to you about the advanced status of your case; however that is not a death sentence.
There are ways to deal with the problem and “blow out” the bandit.

Before advancing with your concerns, you should get other info regarding the number of positive cores in the biopsy and cancer volume, and tests results such as; DRE, PAP, etc., and a complete clinical stage, and still any symptom or other health concern, which will be required to properly access your real status.
While researching you should prepare a List of Questions with as many inquires as possible to present to the doctor in your next meeting. Here is a link that may help in that “job”;
http://csn.cancer.org/node/224280

In an advanced case with positive extra prostatic extensions (seminal involvement and positive lymph nodes) and negative bone metastases, surgery may be not top recommended. It would not provide you cure but debulking, together with a series of risks and side effects. In fact, both treatments of surgery or radiation are usually recommended in advanced cases with the intent of “Debulking”. Some controversy exists regarding this principle of administering a radical treatment with no curative intent.

The treatment of choice to the many survivors in similar cases, reported in forums for PCa, has been for a combination of radiation plus hormonal therapy, which, while advocating cure have long term survival rates over 20 years. Nevertheless, NCCN guidelines address the concern of the radiation modality to patients with high Gleason scores if benefits are not expected. Instead the guidelines recommend chemotherapy or hormonal therapy or a combination of both. Doctors also prefer to keep the radiation to a latter attack.
High Gleason grades lead often to systemic disease so that you should care for your case the soonest. I would recommend you to do researches in the net googleing this sentence;
“treatments for prostate cancer and side effects”

Here is a good “compendium” of advices from Chuck (a survivor and PCa advocate at Us TOO), that as many of us here has no medical enrolment. He provides a series of links and doctors comments which you can follow in your introduction to your problem.
The title is;
ADVANCED PROSTATE CANCER/HIGH GLEASON SCORE AT DIAGNOSIS?
http://www.ustoowichita.org/pdf/Advanced Prostate Cancer at Diagnosis.pdf

Do not be anxious. Educate yourself and take actions timely. Many here will help you along your journey.

The best to you.
VGama