Newly diagnosed. What doctor should we see next

hungarian
hungarian Member Posts: 20 Member
edited August 2022 in Prostate Cancer #1

Hello everyone. My husband was just diagnosed with prostate cancer. He is 76 years old and overall very healthy. He had an abnormal DRE during his yearly check up and a PSA score of 2.8 which doubled from the year before.He had a biopsy five days ago and the results came in with a Gleason score of 8. Our urologist recommends a bone scan. My question is whether we should go to a cancer center before the bone scan and have the scan there or have the scan through our urologist, sit down with him for evaluation and then move forward?

Comments

  • Clevelandguy
    Clevelandguy Member Posts: 1,181 Member
    edited July 2022 #2

    Hi,

    First of all with a Gleason score of eight you should know if it was 4+4 or 5+3 or 3+5. The first number is the grading of the majority of the cells and the second number is the minority cell grading with a higher number being more aggressive. Wether you do it at a cancer center or stay with your Urologist make sure they have access to the best facilities and consulting doctors. A PET scan and a bone scan are good diagnostic tools. Also check with a Oncologist to look into radiation treatment types if you go that route and have the Oncologist review your case.

    It would be good to know if your cancer is contained within the Prostate or has spread to surrounding areas, the scans above should help pinpoint that. All of these things should help you start to form a treatment path along with consulting with your Doctor team. I have included a link to get you some basic info on treatment types.

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


    Dave 3+4

  • hungarian
    hungarian Member Posts: 20 Member
    #3
    https://csn.cancer.org/discussion/comment/1698437#Comment_1698437

    Thank you for the info and the link. I do not know if score is 4+4 or 5+3. For some reason I was locked into automatically thinking 4+4. (Just sooo much new information to digest.) Bone scan tomorrow so we will see.

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    #4

    I may be a bit late with this comment, but it should be OK to get the bone scan (wherever) and then sit down with your urologist to discuss. I hope (s)he will have the time and patience to offer advice. It can be quite overwhelming at first. Believe me, I have been there.

    We will be glad to answer any questions that you may have after the consultation with your urologist.

  • hungarian
    hungarian Member Posts: 20 Member
    #5

    Thank you so much! Currently waiting on the bone scan report. Should come later today.

  • hungarian
    hungarian Member Posts: 20 Member
    #6

    Hi All

    The bone scan was clear. Biopsy showed 4+4-Gleason 8 PSA 2.75

    5 out of 14 cores cancerous. Met with urologist who recommended Cyberknife and hormone therapy. We have an appointment with top notch radiation oncologist tomorrow. Any suggestions for relevant questions to ask. ( I am a bit worried about hormone therapy and side effects).

  • Clevelandguy
    Clevelandguy Member Posts: 1,181 Member
    edited August 2022 #7

    Hi,

    Cyberknife is a very good treatment for Prostate cancer. Another good one is Proton radiation which has a fixed focal length so the beam does not go completely through the body but stops at the tumor site.

    As others have stated hormone therapy will not cure your cancer but weaken it so the other treatments can be more successful. The bad thing about hormone therapy is the nasty side affects like mood swings, hot flashes, ect. If I ever need future treatment I hope there are some new hormone drugs that have less side effects. With that said you need to meet with your team of doctors and decide what treatment protocol is the best for you to get rid of your cancer. I have included a couple of links for you to study on radiation therapies.

    https://www.mayoclinic.org/tests-procedures/proton-therapy/about/pac-20384758

    https://www.cancer.org/cancer/prostate-cancer/treating/radiation-therapy.html


    Dave 3+4

  • hungarian
    hungarian Member Posts: 20 Member
    #8

    Hi All

    Just met with radiation oncologist. He wants to start with one hormone shot. (Not sure what type, tbd by our urologist.)Then in 2 months 25 rounds of IMRT (due to Gleason 8 score and tumor size) and then 3 Cyber Knife treatments. Any thoughts or experiences with various types of HT?

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    edited August 2022 #9

    Hi,

    The treatment seems good to me. It all starts with the hormonal shot (ADT) 2 months in advance of the radiation.

    The traditional shot is Lupron (or Eligard) which typically follows one or two weeks of antiandrogenes (to avoid flare).

    A substitute is Firmagon that doesn't need antiandrogenes. Firmagon is also friendlier with lesser side effects than Lupron.

    Two months later the IMRT starts which will covers the prostate and surrounding areas (including lymph nodes). The Cyberknife will serve as a boost to attack the gland.

    The length of the period on ADT varies according to the risky case one has but Gleason 8 cases may require at least one year on drugs.

    To such extent, 3-month Lupron shots can be conveniently better than Firmagon because this shot is only monthly available.

    I would recommend you to inquire further on the above, discuss with your doctor and decide on what you feel better.

    I also would recommend that you have a testosterone test done before taking the shot. The value will be important to follow your treatment case.

    Best wishes and luck in this journey.

    VGama

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #10


  • hungarian
    hungarian Member Posts: 20 Member
    #11
    https://csn.cancer.org/discussion/comment/1698749#Comment_1698749

    Thank you so much! This was very informative and helpful.

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    #12
    https://csn.cancer.org/discussion/comment/1698733#Comment_1698733

    Interesting; that protocol is very similar to the one I had (several Gleason 9 lesions, presumably all contained). I had Cyberknife (SBRT) first, then IMRT (all at Georgetown University Hospital). Also 18 months of 'hormone treatment' (Androgen Deprivation Therapy).

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    #13

    With respect to 'hormone therapy', there are (daily) pills nowadays that one can take (expensive): Orgovyx).

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