Gleason score of 7
In 3 of 12 biopsies Dr wants to remove prostate ? Should I ? Or better options ?
Comments
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Hi,
If I was in your position I would want to know a few facts before I made a decision. What was my Gleason score(3+4 or 4+3, it makes a difference). Were any scans done(MRI) to locate the cancer? Where inside the Prostate was the cancer found(deep inside or at the edge of the Prostate)? Was any Cribriform noted? Were any lymph nodes involved or other organs?
Dave 3+4
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What is your age? That is an important factor. Any BPH symptoms? How did the biopsy analysis characterize the aggressiveness and location of the lesions? Noting that they really don't know what's in there until they get in to take it out.
Have you read up on the side effects of radiation vs surgery? Hormone therapy? There's a lot to go into the decision besides the score.
I (67) chose surgery because I wanted the cancer out, not just hurt. I don regret my decision.
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Radiation is an option from the information you provided. At the very least consult with a radiation oncologist at a reputable center. Your urologist may not be up-to-date and may be biased.
Some academic centers will allow you to consult with both kinds of specialists.2 -
November 2024 biopsy found two spots in the prostate, 4 + 3 and 3+ 4 = Gleason 7
PET scan followed, with three spots identified in the prostate and activity indicated in two nearby iliac lymph nodes. I almost chose prostatectomy and lymphectomy, but with prior right inguinal hernia surgery, there was the possibility that the surgeon could not remove one of the lymph nodes due to the presence of scar tissue or mesh material. I am currently completing my second of twenty-four months taking oral ADT, Orgovyx, and will begin 44 weekday radiation treatments on February 20. The hormone therapy is draining but no traumatic side effects. Prayer for clear direction in choosing treatment!
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I recommend watching Dr. Mark Scholz videos on You Tube. Very informative in my opinion, you will at least have a better understanding of prostate cancer and different treatments.
Connecting with an oncologist who has specific experience treating prostate cancer is something I did not do but would if I knew then what I know now. I feel an oncologist should have big picture view.
You can also find a plethora of surgeons or radiologists giving explanations of their specialties, just Google prostate cancer. Obviously you need to interview with both as well.
To be honest, I have prostate cancer in my immediate family, (dad and brother) and they both had prostatectomies with no recurrence of cancer. That was a huge factor in our (my wife and I) decision to have RP.
And…….start browsing this site. You will find topics from more than 15 years ago that are still relevant today. First hand accounts from cancer survivors really helped calm and educate me.
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Lots of ambiguity in making a decision. Many factors to consider. I like you, I had gleason score of 7 (4+3 =7) which after two MRI's, one bone scan, two biopsies, and one PSMA PET scan all indicated the cancer had not spread from the prostate gland. I opted for a Focal treatment which ablated the tumor within the gland. Post procedure MRI and biopsy all indicated success but PSA doubled in a three month period which led to another PSMA PET scan indicating that I now had metastatic spread to lymph nodes. In my case, it's likely the cancer is a more aggressive sort. Anyhow, get all the info you can before deciding on any treatments. If you have low volume Gleason 7 (3+4) you may be eligible for Active Surveillance. I may have made the wrong decision, but perhaps it may not have made any difference what I chose. Recurrences can happen with any of the procedures. You can only make your best call and go forward from there. I'm sorry you're here, but hang in there and keep in mind there is a lot of successes treating Pca and you likely have plenty of time to figure out your plan of attack.
Good luck with your journey
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jimekrut, Our situations are similar. I too am on Orgovyx and am supposed to start Zytiga (Abiraterone acetate) as well. Taking both is supposed to be more effective. I've only been on Orgovyx for a couple weeks and haven't had bad effects yet other than a dry mouth and a little fatigue. How are you fairing? From what others are saying it sounds like things will become more intolerable with time.
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more fatigue, less libido…I'm trying to stay busy with home/auto projects and exercising weekday mornings. I'm struggling a bit to balance medications well enough to avoid dizziness. Alfuzosin for frequency of urination also affects blood pressure and likelihood of dizziness when changing position. Drug interaction can be a pain!
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Hi,
Sounds like the best treatment path based on your previous surgery plus lymph node involvement.
Dave 3+4
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it varies for everyone. When I first was diagnosed in 2023 I was Gleason 6. I chose Active Surveillance and honestly didn’t really worry much about things as Genomic testing showed I was only 5% high risk.
Fast forward a year later and Gleason had increased to 7 with one sample being an 8. I did a PET scan and a full bone scan which indicated no metastasis.
I had the option of the 24 months of ADT and the 44 radiation treatments or the RARP.With me it just came down to wanting the cancer out of my body and dealing with the side effects of the surgery immediately rather than deal with the two years of ADT therapy and its associated side effects.
So, in October of 2024 I underwent RARP. Now three months and two weeks post op I am having significant improvements with incontinence Erectile issues are still very much a problem - but I’m relieved it’s gone , and that I had negative margins and that my Gleason were all 7’s or lower on final pathology. There’s a small chance of recurrence but I’m 60 years old and so far PSA is undetectable.
For me I’m confident my decision was the right one. But, with all of todays options it’s not a one size fits all approach anymore and you’ll make the best decision for your situation!
Whatever you decide that are a lot of good people here with tons of good advice and similar experiences!0 -
Hard decisions, seek lots of opinions. While you are making your decisions and waiting on test focus on your physical fitness. Going into any surgery or treatment being physically fit will help with recovery. Prior to a laparoscopic appendectomy and just completing RARP I went into both operations being at the height of my physical fitness. I feel that significantly enhanced my recovery from both surgeries. As a bonus having a fitness routine can help deal with the mental issues surrounding your decision and recovery.
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I am 59 had a Gleason Score of 7=4+3. I went to several doctors and finally decided to go with RARP. One radiation oncologist suggested surgery the other recommended radiation. I opted for surgery after looking at all of the pros and cons. I have a family history of colon cancer and a personal history of polyps. That was part of the reason I selected the surgery option.
Based on the research I did they have the same results I wanted the cancer out if possible. I am 3.5 months out of surgery except for some ED I am doing pretty well. I am back to running 6 miles a day.1
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