PSA 32 Gleason 3+4=7 Localized

Follow up?

Hi Indy,

Follow-up treatments will depend on the disection results after they remove your Prostate.  If it comes back all contained and your Prostate bed looks clean you might be in good shape.  Sounds like with all cores being positive at around 90% that the cancer was getting close to leaving the barn.  Glad your getting it out now.........

I was 3+4 with plueral neural invasion, 5 years later I still have undetectable PSA, so there is hope.

Dave 3-4

Playing roulette

Indy,

In your shoes, apart from investigating on the treatment consequences, I would check deeply the results of the exams that made you to decide on RP. Sincerely, your comment makes me to think that you are more playing roulette than on the right track.

You say; " RP lined up for mid Dec. Thankful for the clean scans of course which found no obvious spreading", but neither Bone nor CT scans are that accurate to assure a clean localized environment. You also say that you expect to be "...  in line for follow-up treatments", meaning that you know or was informed that RP may not be the best option. In such regard my opinion is that you may opt for radiation from the very start, avoiding the unnecessary risks from two treatments (RP plus RT).

I was also 50 years old and asymptomatic when diagnosed with PCa. My life at the time was at its best, healthy and successful professionally. The bandit was not causing me any trouble but the high PSA (22.4 ng/ml) and the positive biopsy (all 6/6 cores) made me to recognize that I needed to treat. After investigations, my choice was RP not for the high PSA but for the negative scans (like yours) and the low aggressive Gleason score 5 (2+3). Surely I also played roulette (all positive cores have a 99% possibility of spread) and lost because RP did nothing to eliminate the problem but set me with the side effects typical in prostatectomies, wiping out my quality of life. My idea on health problems at my age was as simple as that of taking a pill to get cured. However, Prostatectomies and/or Radiotherapies are not that simple. It involves risks and causes permanent side effects that we should be aware of before committing. You family will be affected too so that they should take part in the final decision too.

In my lay view of your case, I attribute the high PSA to the high volume of existing low aggressive Gleason rate 3 cancerous cells. These types of cells produce more PSA serum than the more aggressive siblings. Gleason rates of 4 are risky and more prone to spread rapidly but rate 3 cells, though less aggresive and more indolent, may also spread to other localized tissues. You can get rid of the whole gland (the bigger tumour) dissecting it via surgery or you can target the whole gland with radiation that can be delivered wider covering surrounding tissues in the same process.

I disagree on the idea of having surgery for the simple purpose of checking the whole gland under the microscope. It will not provide any additional information that could influence on a decision in a future salvage treatment. Radiotherapy as a salvage treatment got the same successful results if done earlier or latter, independent of what the pathological report describes on the whole gland examination. One needs the right timing at the cells divisions to achive the perfect kill with radiation.
I would recommend you to get a PET scan and get second opinions from specialists in both RP and RT. A genetic test can also add more information on your clinical stage. Surely PET scans may also provide false negatives but these are the most advanced image exams today in diagnosing PCa. At least one has the feeling that one has done the best at its disposal before deciding.

Best wishes and luck in your journey.

VGama

Prostatectomy + RT + ADT

Hi Joe,

I had a pretty advanced case so I did the triple.
The advantage is that you remove the cancerous prostate before you start the RT so you do not have complications as the cells die and the gland turns fibrous.
However you are doing a prostatectomy plus RT and the RT tends to exacerbate problems like incontinence, I was lucky but more men have more problems with this than with a simple prostatectomy.
I suspect that your surgeon is planning on a non nerve sparing prostatectomy so you are not going to have a natural erection again.
Some men manage to do RT with ADT and manage to preserve some sexual potency although this may diminish with time.

Best wishes,

Georges

Specimen Pathologist's report and the Pathological stage

MAX,

Thanks for adding the comment clarifying the importance of the pathologist’s report after surgery. I have dropped the above comment on your post to exactly clarify that the choice of prostatectomies should not be dependent on such idea of having the whole gland out in hand to check if the surgeon’s clinical stage (before RP) was in fact correct. We have seen repeatedly guys posting here on the matter, who believe that choosing RP to get a good look on the gland   is better than other modalities of treatment. This is a total erroneous way of thinking when deciding on a therapy.

The Pathologist’s report after a radical prostatectomy is important to judge the risks for existing metastases and to determine prognosis but it does not provide significant details to single out a type of salvage treatment or the timing when it should be done. The main items in the report will be on Extracapsular Extension, Seminal Vesicle Invasion, Positive Margins, Gleason Score and Type of Adenocarcinoma confirmation, and findings of other particulars of existing tissues. They also write about findings regarding the analysis done on lymph nodes if any has been dissected too. These are all relevant items that should be evaluated before the initial treatment, not after it.

In my view, the decision for an adjuvant treatment post prime therapy should be done before anything is executed. Salvage treatments are decided upon confirmed recurrences. The pathological stage (after RP) will identify those that have the risk to recur later but it is via the PSA that doctors make the decision on the timing to deliver such a treatment. The combination treatment (RP + RT) of Georges is a good example of proper care. I believe that his team of doctors based their decision on the data collected during the diagnosis process. They did not identify metastases initially but his case was so risky that the combination treatment looked to be the best option from the very start. RP followed by adjuvant RT has the higher possibilities for a successful outcome in high Gleason rates of 4 and 5.

In IndyJoe’s case with a Gleason score of 7 (3+4) where the rate 3 covers 90% of the gland, the intermediate risk weighs more in the decision process than the high risk poorly differentiated rates. This is a case that deserves more time to certify a due clinical stage before deciding on that treatment that would give higher hope of success. The biopsy showed a totally infested gland which diagnosis provides high probabilities for existing extracapsular extensions. In such cases many doctors discard the capability of RP alone which may be Joe’s doctor opinion by suggesting that he might need additional treatment if he decides in a radical prostatectomy. That is what you say above “… In cases where there is, or very likely is, metastasis, radiation is considered by most authorities as the preferred choice”.
Combination therapies for low or intermediate risk cases involve usually the hormonal component (ADT) added to a prime radical (RP or RT).

Best,

VGama 

Gaining confidence

Indy,

The MRI is super. You’re doing well in gathering more information on your status and the treatments. It will give you more confidence in what you choose. It is common to spend over two, three months in researches to get to a decision.
Take your time and get second opinions at reliable hospitals. Prostate cancer does not spread overnight so that you can choose the best timing for the D-day. I also would look for facilities and doctors with loads of experience in treating PCa. There is a difference in outcomes proportional to their skills.

Wishing you luck.

VG

 

Parallels
Hi there,

I think there are strong parallels between my case and Joe's.He is a 7a and I was a 7b but there is a lot of grading in there and you have to allow for the fact that the biopsy is localised samples.
Like me he has a very large tumour but localised , it may be totally organ confined or it may be outside.
But 7a,b's are often quite localised, I have seen examples where the tumour is more advanced and has grown into the bladder wall, etc but there are no distant metastases.
The main side effect of going for straight radiation seems to be urinary restriction.
Here is an example similar to Joe's where the guy went for straight radiation plus ADT.
https://www.yananow.org/display_story.php?id=1636

Best wishes,

Georges

Max Former Hodgkins Stage 3 said:

Addendum

I would like to post a short corrective or clarification:  I have never recommended RP as the first-line modality of choice because of gland pathology afterward.  I noted that, if selected, it is highly valuable afterward in future decision-making.  Conversely, first-line RT predictably sends PSA into oscillations without any form of clear meaning, sometimes for as long as two years prior to establishment of a nadir.    A lab dissection of the gland is probably 100 times more accurate and detailed than any current form of pre-treatment biopsy available. 

Bless your choice, Indy, and RP and RT famously have approximately equal clinical outcomes in cases that do not present metastasis.   In cases where there is, or very likely is, metastasis, radiation is considered by most autorities as the preferred choice.

 

I agree

 Taking out the gland and sending it to the lab and getting a full report to me now that I did not do that I wish I had it removed it would definitely bring me peace of mind one way or the other. They say knowing is half the battle it right now since I did not remove it I don’t know Jack I’m just hoping that did not escape where is it I took it out I would know for sure one way or the other so I totally disagree about making a primary choice based on the fact of just being able to send it to the lab ..that is a huge deal 

VascodaGama said:

Specimen Pathologist's report and the Pathological stage

MAX,

Thanks for adding the comment clarifying the importance of the pathologist’s report after surgery. I have dropped the above comment on your post to exactly clarify that the choice of prostatectomies should not be dependent on such idea of having the whole gland out in hand to check if the surgeon’s clinical stage (before RP) was in fact correct. We have seen repeatedly guys posting here on the matter, who believe that choosing RP to get a good look on the gland   is better than other modalities of treatment. This is a total erroneous way of thinking when deciding on a therapy.

The Pathologist’s report after a radical prostatectomy is important to judge the risks for existing metastases and to determine prognosis but it does not provide significant details to single out a type of salvage treatment or the timing when it should be done. The main items in the report will be on Extracapsular Extension, Seminal Vesicle Invasion, Positive Margins, Gleason Score and Type of Adenocarcinoma confirmation, and findings of other particulars of existing tissues. They also write about findings regarding the analysis done on lymph nodes if any has been dissected too. These are all relevant items that should be evaluated before the initial treatment, not after it.

In my view, the decision for an adjuvant treatment post prime therapy should be done before anything is executed. Salvage treatments are decided upon confirmed recurrences. The pathological stage (after RP) will identify those that have the risk to recur later but it is via the PSA that doctors make the decision on the timing to deliver such a treatment. The combination treatment (RP + RT) of Georges is a good example of proper care. I believe that his team of doctors based their decision on the data collected during the diagnosis process. They did not identify metastases initially but his case was so risky that the combination treatment looked to be the best option from the very start. RP followed by adjuvant RT has the higher possibilities for a successful outcome in high Gleason rates of 4 and 5.

In IndyJoe’s case with a Gleason score of 7 (3+4) where the rate 3 covers 90% of the gland, the intermediate risk weighs more in the decision process than the high risk poorly differentiated rates. This is a case that deserves more time to certify a due clinical stage before deciding on that treatment that would give higher hope of success. The biopsy showed a totally infested gland which diagnosis provides high probabilities for existing extracapsular extensions. In such cases many doctors discard the capability of RP alone which may be Joe’s doctor opinion by suggesting that he might need additional treatment if he decides in a radical prostatectomy. That is what you say above “… In cases where there is, or very likely is, metastasis, radiation is considered by most authorities as the preferred choice”.
Combination therapies for low or intermediate risk cases involve usually the hormonal component (ADT) added to a prime radical (RP or RT).

Best,

VGama 

Kids

V,

In the US, kids have an acronym "BFF": Best Friends Forever.  It is my wish and opinion for the two of us....