wife- looking for support and information

Good for you to be studying the complex issues related to the optimal care for your husband with Gleason 8 cancer.

I was especially happy to read that you both will have a discussion with an urologic oncologist at a well-known medical center. Don't limit your discussion to surgical removal of the prostate. There are other options! Specifically radiation therapies.

With respect to surgery; there is a 'newer' technique that is called Retzius-sparing prostatectomy. The Duke specialist who you will be meeting should be able to give you more info.

You can also ask whether a PSMA directed scan is appropriate at this time. It is the most sensitive scan to detect metastases.

Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise on Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide - PubMed (nih.gov)

I do hope that the spot discovered on his hip will turn out to be non-cancerous.

Hi,

Sounds like you are working through the process. A PSMA PET scan should help pinpoint any cancer outside of his Prostate. A bone scan would also be a good diagnostic tool. Gleason score of eight(4+4 or 3+5,5+3) is on the aggressive side, 5+3 would be the worse, 4+4 would be slightly better? The first # is the most number of cells observed in his biopsy. Once you determine if his cancer is totally within the Prostate or not you can decide on which treatment options to follow. If he has suspicious areas outside of his Prostate some form of radiation therapy might be a better choice. If his cancer is totally within his Prostate then surgery could work. Get the best team of doctors and facilities to get the best results and make sure you also consult with an Oncologist to get both sides of the story. The treatment protocols you choose are up to you and your husband based on your doctor’s input. I had robotic surgery in 2014 and have no regrets. I have included a link to get you some basic info on treatment types, good luck.

Dave 3+4

Hey teammiller425...I began my journey over 15 year ago at 53 years old with this beast...Good news, you have figured out the best foot forward is with a University teaching hospital, not your local urologist. I also have had high grade prostate cancer and have had surgery, radiation twice, Lupron twice (6 and 5 month periods), surgery to repair radiation damage and just finished another body scan looking for the beast (didn’t find anything yet but PSA on the rise again)…Long story short, I have lived life every day for 15 years…I’ve been blessed to do things I thought I would never do, career change, major move, etc….Enjoy the ride

All anyone can do is share their personal journey....Diet has been important for me. I've been blessed with good health throughout my journey. I would recommend moving towards a Mediterranean Diet and lots of exercise. Yes, lots of care options and if I were doing this today, I'd be considering a flavor of radiation for a first line of defense BUT, you medical team at Duke will serve you well...good luck!

My clinical Grading was Gleason 4+3=7, TB2, palpable nodule on right base/mid…

I am mistaken, my post-surgery pathology report in summary is: Gleason 3+4=7, TB3, negative margins, right Seminal Vesicles was invaded :-(, lymph nodes were all clear…

Dr. Catalona said if it was his pathology report he would get salvage radiation 90-120 (this would have been May-June 2010) days out from surgery because of the Seminal Vesicles was invaded as well ( I did not receive salvage radiation until 2005=-5 1/2 years later)

There were no cancer cells in my nerves or blood veins within my prostate with the Perineural Invasion?

My medical team was baffled, as I had no PSA for about 2 years. I was a vegan for 6 years…I incorporated meat back into my diet. I would not recommend being a vegan, lol….Mediterranean Diet, exercise and force a smile on your face!

Remember, it is what it is, but it will become, what you make of it-All my best

"... ...our hands tied"

Hi, Miller

From the information you share above, I wonder if surgery (RP) is the main option to treat your husband’s case. The Duke doctor’s opinion may be a better choice even without the PSMA PET confirmation of the spot identified by the radiologist.

The risk for extraprostatic extensions in Gleason rate 4 cases are high which by itself creates the doubt in choosing surgery alone. There will be always the thought that salvage radiation will be needed in the future. In fact some doctors suggest a combination treatment of RP + RT from the start.

Both, the PSA and the MRI report draw a nasty “picture” of the case. High Gleason rates and sums typically produce low levels of PSA, and the MRI findings on the “12 mm capsular abutment” of the lesion leads to think in possible existing spread.

Of course, you can choose radiation therapy (RT) as the prime treatment that would care for the gland, it’s surrounding areas and the spot on the R hip.

I would like to know what lead your husband in getting a biopsy. Can you paste here the pathologist report on the biopsy findings.

Well, you have all the rights to be frustrated with the insurance negation. They may listen better to your appeals if the request comes from famous hospitals or institutions. You can still try after consulting the City of Hope Hospital.

I have no insurance so I depend on the “wishes” of the doctors assisting me at the National Healthcare NHS. They like to attend patients that are “educated” on the PCa illness but they do not like to be contested on their decisions. We have to use diplomacy when we want them to accept our wishes. It has been like that along my history.

I recommend you to get second opinions before deciding on the treatment. The status of your husband’s PCa case will not alter in three, four months, and the way to treat wouldn’t be different or have worse outcomes if you postpone it to that timing.

Best wishes and luck in your journey.

VGama