Pathology report in - should we commend with HT?

Pathfinder Member Posts: 55
edited August 2016 in Prostate Cancer #1


*THREAD TITLE ADJUSTED 16/8 - Surgery was performed on this day, and related questions are further down the thread.


Hi all,

New to the board and desperate for your knowledge. 

My Father in law has been diagnosed with PC, result of the biopsy is Gleason 8 and his PSA is 24. Based on his medical records the PSA appears to be doubling yearly (don't ask why this wasn't addressed earlier, it's not a nice story!).

His bone scans and MRI came back negative for mestastatis, and he has no symptoms.

From all of my research it seems to me like surgery ASAP is the best option. We're all extremely worried about the cancer being aggressive based on the numbers and don't want to give it time to breach the prostate.

However the doctor has reccommend three months of hormone treatment first, including a monthly injection and pills to diminish testosterone. I understand that the reccommendation is based on making the surgery safer, however as the PSA is doubling yearly at a rate of almost 1 a month, that seems like a long time to wait.

And here's the serious part: He's in China. Chinese hospitals are fairly dark. If they can make an extra 10,000 in treatments prior to the surgery, they probably will regardless of his biopsy results. This is the main reason why we're seeking a second (or third) opinion (this week), but I'm fairly wary of the reliability of the system here from experiences passed down by other people.

I hope you can help. If I sound frantic, I am! I feel as though this is a race against time and I'm not comfortable with his biopsy numbers at all. If someone can give me any advice regarding how 3 months of hormone therapy would benefit the surgery, how it works exactly (does it actually stop cancer cell growth, or reduce its size making it easier to catch-all with prostate extraction?) I would appreciate any information you have.

Thank you so much for taking the time to read this.




  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    edited June 2016 #4



    Others here are much better informed in aggressive and advanced treatments, but I have read that a Gleason of 8 is ordinarily ASSUMED to have escaped the gland. It constitutes very aggressive disease. 

    Many doctors, when treating aggressive cancer that has escaped, would recommend that prostectomy not be done at all, now or later. The argument ""for" surgery is toward debulking, the argument "against" is that RPt will not remove all of the disease, and the side-effects are more dibilitating for the patient than they are worth.

    He probably needs to be more precisely staged, which would require advanced imaging that perhaps is or is not readily available in China.    Regardless, beginning with HT does not seem unreasonable to me, but as I said, I am not well versed in aggressive or late-stage treatments given first-line.

    Do get the additonal opinions.



    Prostate Cancer is a very slow growing disease, so it best for your father in-law to make an educated decision and not panic as you are. It is counter productive.

    Max gave excellent advice.

    What is the patients age? Surgery can have major side effects, the older one is the more likely the side effects 

    How many cores were taken. Of these how many were positive. What was the Gleason of these positive cores. What percent of each Core was positive. 


    Many men with a Gleason eight, first have hormone treatment. The results of radiation treatment is Better when radiation follows hormone. In addition radiation treatment includes a greater range outside the Prostate so there is a better chance of cure.


    Keep on asking questions, we can help.

  • Will Doran
    Will Doran Member Posts: 207
    edited June 2016 #5


    So very sorry to hear of your father-in-laws situation.  What you are saying is the reverse of what was recommended for me.  I was diagnosed with a PSA of 69, Gleason 7, I had no symptoms, at the age of 67. I had no metastatis, but post surgery pathology showed one very small spot in one lymph node ( that spot didn't show up on my MRI's because it was so small).   I had Robotic Assisted  Surgery in Dec 2013.  Followed by two years of Hormone Therapy (Lupron) and I had 8 weeks of radiation, after I was on the Lupron for 4 months.  It was done that way so the Lupron would weaken any remaining cancer cells that might have remained in the cavity so the radiation could kill those remaining cells. I was a very high end Stage 3, aggresive, and they treated me as I was an advanced Stage 4.   My PSA dropped to <0.010 in 2 months, post surgery, and has remained there ever since (as of check up last month).  I am off the Lupron and have been for 5 months.  My testosterone has come back up a little bit ( from 17, at it's lowest, to 134, which is still very low--normal is 250 to 1,100).  I have another check up with blood work in September.  I was given the option of doing all radiation treatment with radioactive seeds, But I wanted the cancer removed ASAP.  So, I understand your concern.  All of our cases are different, so what has worked for me (so far) might not be what is needed in your Father-in-law's case.  However I would strongly recommend that you get other opinions.  Study up on all of the side effects of these drugs/chemo, the side effects of the surgery, and all other treatments that will be needed.  Make sure you have all the information you can get so you and your Father-in-law can make an educated decision.

    Good Luck

    Know that your family is in my thoughts and prayers.

    Peace and God Bless


  • Pathfinder
    Pathfinder Member Posts: 55
    Hi guys,

    Hi guys,

    I appreciate your responses!

    "Prostate Cancer is a very slow growing disease, so it best for your father in-law to make an educated decision and not panic as you are. It is counter productive."

    My worry about time is related to what I know about PSA velocity, in that the doubling speed seems very fast (yearly). Coupled with the biopsy result, I feel under pressure to figure out the right course of action sooner rather than later. :(

    "Others here are much better informed in aggressive and advanced treatments, but I have read that a Gleason of 8 is ordinarily ASSUMED to have escaped the gland. It constitutes very aggressive disease."

    That's very worrying. The doctors said they thought that it was still contained at the moment, however I don't know how they came to that assessment exactly. It's hard to get details here and I can't talk to them directly owing to the language barrier. You say 8 is assumed to have moved outside the gland - is that a guarantee?

    "What is the patients age?" "How many cores were taken. Of these how many were positive."

    He is 63, I believe they took 14 cores but I don't have the papers right now, I will get the information for you ASAP. I just know that the Gleason scores for the different positive cores varied, some were 8, others lower than 8. I believe the average is 8.

    "Many men with a Gleason eight, first have hormone treatment. The results of radiation treatment is Better when radiation follows hormone. In addition radiation treatment includes a greater range outside the Prostate so there is a better chance of cure."

    What kind of radiation treatment are we talking about? Is it something that is localised to the prostate area, or full chemotherapy? 

    Thank you again for all of your help!




  • Old Salt
    Old Salt Member Posts: 934 Member
    Surgery is NOT the best option

    The above is just my opinion of course. But medically I am not too far removed from your father-in-law because my cancer was organ confined but with a higher (Gleason 9) score.

    The argument for a course of radiation is detailed in the response of 'hopeful and optimistic'. And as he wrote, hormone treatment should be on top of that. The latter will likely lead to the killing of cancer cells that might have escaped the prostate and will also kill cancer within the prostate. Starting out with hormone therapy in advance of radiation is standard procedure AFAIK. The reason being that the hormone therapy will make the radiation more effective (I see that 'hopeful' made a similar statement). 

    I realize that I am writing from a US perspective, and your father-in-law will have to deal with Chinese doctors and practices about which I know nothing.

    Please note that chemotherapy is an entirely different treatment, not appropriate at this time.

    As others have stated, take your time and study all the options.

    PS: Gleason 8 cancer cells may or may not have escaped the prostate; the imaging studies showed that no major metastasis has taken place, which is encouraging.

  • VascodaGama
    VascodaGama Member Posts: 3,513 Member
    Large sized Prostates are subjected to different requirements


    From the comments and info you share it seems that you are suspicious of his doctor’s suggestion. I agree that the combination therapy made of HT plus Surgery is weird but it could be suggested due to a reason you have not at hand. For instance, if your family in China has requested for early means of intervention to hold the advancement of the cancer while deciding on a treatment (They may have adopted this to gain time for receiving your comment from the USA); or if his gland is too big in size that would not be feaseble for radiation or earlier surgery intervention; etc.

    My opinion is that his case is not at the verge of becoming a night mare overnight. The high PSA of 24 signify the presence of a voluminous cancer (producing the serum) which could be composed of several independent tiny colonies of tumors of different Gleason patterns that could be contained in the gland or already have spread. It is a fact that aggressive Gleason patterns of 4 and 5 are commonly found in cases of extra prostatic extensions, but according to the biopsy info you provided, lower Gleason exists which could be the ones producing the high levels of PSA. Gleason 8 cancers are more for the type of cells that produce lesser amounts of PSA.

    I wonder about the Clinical stage his doctor has provided. This typically provides a clue on the data they have in hands. Was there any image study (MRI, CT, bone scan, x-ray, etc). Do you have any report?

    Physicians are aware of the limitations in these exams that quite often provide false negatives but when classifying a case they would not disregard the data collected. They tend to follow the guidelines provided by their association (Urology, radiology, oncology, etc), and only a few number follow their instincts based on past experiences. Naturally, a urologist most probably would recommend surgery as much as a radiologist would recommend radiotherapy.

    I would think that his doctor is following his trade principles. The suggestion for the HT (hormonal treatment) may have nothing to do with the surgery. In any case, when the prostate size is too big some surgeons (in particular those performing robot assisted surgery=Davinci) recommend diminishing the size of the gland firstly (with hormonal drugs), before operating on it. Robotic surgeries use small holes so that big glands could not be take out into one piece, it should be cut inside the abdomen which procedure raises the probability of leaving behind a tiny piece of “contaminated” tissue (microscopic) that could later cause recurrence.
    Such could be his argument of “… making the surgery safer”, as you describe in your post above.

    I agree that waiting would be better, even in spite of the risky doubling, if surgery is found to be the best choice, but is it surgery the only and better way to treat this patient? There are other options to be checked about.

    One note regarding the hormonal treatment is that this is palliative and does not cure. It manages to pin down the cancer so that the PSA gets lower; however, a lower PSA due to hormonal manipulations masks the results/outcomes of a radical treatment. Accordingly, the success of the surgery done while on the effects of the hormonal therapy cannot be verified at once. One should wait till the effect vanishes, taking about 6 months after the end of the effectiveness of the HT drug.

    You doing it well in getting second opinions but you should have in hand a copy of all tests and exams so that proper advice is obtained.

    Best wishes,



  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    edited June 2016 #9
    The PSA is an indicator only

    The PSA is an indicator only  , there are various factors before a blood draw that affect PSA such as exercise bike riding or even a hard stool. The the pathology results from a biopsy is the critical information of which you have requested. It is also important to look at the written results from the MRI. There are different MRI machines some better than others if the MRI machine used a 1.5 or 3.0 Tesla magnet

    As far as finding out about radiation it is best  to interview a radiation oncologist who would be knowledgeable and would administer the various radiation technology such as imrt and the variations of this technology as well as sbrt

  • Will Doran
    Will Doran Member Posts: 207
    Hard seat and PSA


    As Hopeful & Optomistic stated, things like bike seats will raise PSA.  I was a road cyclist and was on a bike seat up to three hours per day, riding with the Penn State cycling club, at times..  I had a PSA that showed 1/2 point above what was acceptable.  I had  DRE and was told that my prostate was "the smallest prostate" the doctor had ever examined.  He wanted to do a biopsy, but my GP said it was all from the bike seat and therefore didn't recommend doing the biopsy, since my prostate was so small. So there were no real signs of a problem.  I had no symptoms.   However 5 years later I had a PSA of 69.  If only I had done the biopsy 5 years earlier.  But that's the way it goes.  My cancer was found, by sort of accident, when I had an internal bleed and it showed up in blood work and MRI's.  At that point my prostate showed up bright red in the MRI (with contrast imaging) pictures.  So, we proceeded.  So as stated it's very important to look at all kinds of tests and the results. 

    Now, with the prostate gone, I'm on a spinner bike for 80 - 100 minutes per day and all is well (so far).

    Good luck

    Peace and God Bless


  • Pathfinder
    Pathfinder Member Posts: 55
    edited June 2016 #11
    Guys, you're all really

    Guys, you're all really wonderful, I didn't realise I would receive such fantastic help here. You're helping to calm my nerves somewhat.

    I'll try to make the biopsy information as clear as possible: the entire report is in Chinese. I can speak some, but can read none. However I can identify the PSA and the Gleason scoring, which has various numbers. I believe the number of cores taken were 12. However I'm holding out for someone here to get me the full breakdown so I can share it with you in detail. 

    For now, I'll tell you what I do know.

    The doctor has prescribed the following:

    - 1 Bicalutamide tablet daily

    - 1 injection a month of Zoladex (produced in the UK)

    The doctor has reccommended:

    - Neoadjuvant chemotherapy prior to surgery

    Regarding the additional scans:

    - As far as I know there is no sign of metastatis from the bone scans/MRI

    Doctors comment:

    - They don't "think" the cancer has left the prostate. 

    - They wany to do HT for 3 months before surgery

    Now some of this is dubious for me. We've not been able to have a doctor sit down and actually explain the test results and plan of action in detail. I haven't seen evidence (or what they believe is evidence) that the cancer hasn't moved outside of the prostate for example. I feel as though it's difficult here to get detailed answers, and it's disturbing when you're trying to figure out a plan of action.

    "Accordingly, the success of the surgery done while on the effects of the hormonal therapy cannot be verified at once."

    That's actually one of the questions I had, whether there was any effect of the HT on surgery, thank you for that. 

    I'm already aware of the way PSA levels can be affected by things like bike riding, we're just concerned at the yearly doubling rate. 

    We have some concerns also about the Bicalutamide, as apparently it can adversely affect the liver. Does anyone know about abiraterone? Apparently it's a breakthrough in Prostate cancer treatments, and has become available in China in 2016. We're not sure how to locate it just yet.

    We have an appointment for a second opinion tomorrow with a fairly reputable hospitable, I'll get back to you with any information I have!

    Thanks to you all for your support!


  • Pathfinder
    Pathfinder Member Posts: 55
    edited June 2016 #12
    Ok, the translation has been

    Ok, the translation has been very difficult, and we did our best! I hope some of this makes sense to you guys and you can help to explain some of it. We checked the MRI info and it does say negative for metastases, that's all we know regarding that currently. Here is the translation of the biopsy findings:

    (Left apex medial, left apex lateral, right apex medial, right apex lateral, right mid lateral) Benign prostatic hyperplasia, in glands and smooth muscle hyperplasia. 

    (Left mid medial, right bottom medial, right bottom lateral, 14 left nodule) Benign prostatic hyperplasia, in glands and smooth muscle hyperplasia. 

    (Left mid lateral) Prostate cancer. Gleason score 5+3=8 (10)  (ISUP Grade 4) Tumor cells: P504S+, CK34bE12-, P63-, Ki-67 Positive 8%. 

    (Right mid medial) Benign prostatic hyperplasia, in glands and smooth muscle hyperplasia. Epithelial cells: P504S-, Ki-67 positive 3-5%; Basal cell: P63+, CK34bE12+. 

    (Left bottom medial) Prostate cancer. Gleason score 3+3=6 (10)  (ISUP Grade 1) Tumor cells: P504S+, CK34be12-, P63-, Ki-67 Positive 8%. 

    (Left bottom lateral) Prostate cancer. Gleason score  4+3=7 (10)  (ISUP Grade 3) Tumor cells: P504S+, CK34bE12-, P63-, Ki-67 Positive 8%. 

    (13 left nodule) prostate cancer. Gleason score 3+5=8 (10)  (ISUP Grade 4) Tumor cell: P504S+, CK34bE12-, P63-, Ki-67 positive 8%, PSA+. 

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,736 Member

    These biopsy specifics will assit the guys, Pathfinder.

    You asked if a Gleason of 8 guarantees that PCa has escaped the gland. Absolutely not ! It is probable but not assured, but if forced to assume one or the other, assuming that it has is safer than assuming that it has not. To repeat: what he most needs is more precise imaging, if available. But no diagnostic tool or imagining ever guarantees anything in cancer treatments. There are no warranties, and you never get your money back.

    Vasco made the important observation that HT is not curative. Be aware that what is curative of PCa (when they are successful) is surgical removal or radiation (or a combination of both). 

    Somewhat at random I would add that against PCa chemo also is palliative only, unlike most other cancers, against which chemo isnoften potentially curative, especially against early-stage disease.

    It seems the many contributions submitted here are helping your decision making process move forward in a timely manner.

  • VascodaGama
    VascodaGama Member Posts: 3,513 Member
    edited June 2016 #14
    Is he set for any Chinese Clinical Trial?

    It is disturbing indeed when doctors do not explain details or pass over the data at their hands. I do understand that they are not teachers and we (the pupils) should get educated on the illness before visiting them. Preparing a “list of questions to the doctor” in advance of each consultation is reasonable.

    In the descriptions above, one missing piece of data is the size of the prostate (it should be written in the MRI report or Biopsy), in any case, your indication of existing hyperplasia (“..Benign prostatic hyperplasia, in glands and smooth muscle hyperplasia..”), leads to think that your Father-in-law could have a larger than normal gland. Larger sizes glands and Hyperplasia also justify existing high PSA of which a greater portion may be produced by benign cells.

    The term “smooth muscle hyperplasia” may signify PIN (prostatic intraepithelial neoplasia). They do not make any reference to the matter so that we wouldn’t judge it as high grade PIN, which would turn the case more aggressive, with the right side of the gland involved. The other information regards the cancer in the left side with Gleason pattern 5 found in two cores 8% each. They do not comment on a tertiary grade so that the score 8 (3+5) stands. From the data shared, his clinical stage is T2b but the PIN on the right side could upgrade it to T2c. The grade 5 provides the possibility for a T3a.

    I wonder about another comment pointed by you that the doctor has recommended “Neoadjuvant chemotherapy prior to surgery “. Does he recommend chemotherapy or hormonal therapy?
    Chemo and hormonal are two different treatments. Isn’t it a mere translation mistake?

    Bicalutamide (Casodex) and Zoladex (LHRH agonist similar to Lupron) are traditional hormonal drugs. Abiraterone (Zytiga) is also a drug of the hormonal arsenal, usually taken as a second-line drug when the patient becomes refractory to the initial HT drugs. I wonder if his doctor has recommended chemotherapy instead of the hormonal, but either way, both would be meaningless for an adjuvant surgery approach.
    One note goes to the possibility that his doctor is running a clinical trial similar to the one run at USA, below. Participants in trials have usually free treatment. You should investigate if he has been offered the inclusion;

    Max above says it all. Give preferences to a radical therapy (surgery or radiation) and add a palliative that may improve the primer. In such aspect, radiation (RT) seems proper when the case includes information regarding high risk for metastases.

    Here are some reading materials that may help you:

    A compendium on Prostate cancer and care;

    Booklet about biopsy;

    Please note that I have no medical enrolment. I have a keen interest and enthusiasm in anything related to prostate cancer, which took me into researching and studying the matter since 2000 when I become a survivor and continuing patient.


    Best wishes,



  • Pathfinder
    Pathfinder Member Posts: 55
    Thank you for your responses.

    Thank you for your responses.

    Indeed it's difficult to find a doctor patient enough to give us clear details so we know what we're facing.

    Regarding prostate enlargement, we were told it is enlarged, but not significantly so.

    VGama, would you mind explaining a few things to me? I'm not 100% on the medical lexicon.

    From the readings, does it say cancer is present on both sides of the prostate? Or hyperplasia is on one side and cancer on the other? 

    Does this case appear to be high risk for metastases in your opinion? Would you mind explaining what PIN constitutes exactly, and what T2b, T2c or T3a would mean in terms of risk and appropriate action?

    I understand RT seems appropriate at this stage, but is this all pointing to surgery as the wisest option?

    Today we got a second opinion with an equally impatient doctor, and the only valuable insight we received is that if the HT successfully reduces the PSA after a month, it is possible to have surgery at that point, rather than waiting 3 months.

    Thank you again for your help.

  • VascodaGama
    VascodaGama Member Posts: 3,513 Member
    I wonder why they recommend 3-month HT before surgery


    From the info you have shared, I cannot understand the reason for doctors at that hospital recommending hormonal therapy before surgery. They seem to be out of focus, treating the PSA not the cancer.
    The biopsy report indicates cancer in left lobe and benign tissue in the right. Hyperplasia may exist allover. The number of positive cores is not well specified but one could think that only a fewer percentage involves Gleason pattern 5. You can request a second opinion on the biopsy slides from another pathologist laboratory. You could request your family to DHL them to you and then send it to JH laboratory for an opinion on the findings.

    Regarding the treatment, surgery is recommended to contained cases (the whole cancer inside the gland). This is what surgery does, dissect the whole gland. Radiation can also treat at the same level as the surgery to a contained case but it can also cover a wider field including the gland, its bed and the localized lymph nodes. Radiation, therefore, is better when one has doubts about the location of the cancer. 

    The hormonal treatment can be done any time. It is paliative so that it only controls the advancement of the cancer. Three months HT is too short for any significant benefit. Usually HT treatments are done for 18 months or just 6 months when its purposes are to "improve" the results of the prime radiation treatment.

    You can find details of my comments googling the senrtences.

    Best wishes,


  • Pathfinder
    Pathfinder Member Posts: 55
    edited July 2016 #17
    Well, one of my first

    Well, one of my first questions was why 3 months HT before surgery, and the fact you're querying it is encouraging. We were told something to the effect of "HT will reduce the size of the tumours/cancer making the chance of surgery more successful". Whereas the 2nd opinion doctor yesterday said a month may be enough. He said if the PSA falls after a month of HT then you don't need to wait for surgery.

    Is the suggestion that HT will 'reduce the cancer's size' to make surgery more effective incorrect then? Because this is what we were lead to believe. 

    If that isn't the case, I think we should start looking for a reputable surgeon to act ASAP, however I am aware there are a few types of prostate cancer surgery available: the traditional one, which requires opening up the patient (I'm told this allows the doctor to see more, but the surgery is more traumatic), another kind that is less invasive but the doctor has less visibility, and robot surgery, of which I'm still reading about the details. Are any of these more effective in terms of results than another?

    Thanks again!


  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    edited July 2016 #18
    The side effects from surgery

    The side effects from surgery are severe more so than other active treatment types. Additionally surgery is a localized treatment. So if the cancer has  escaped the prostate, of which there is there is a good chance of in your father's case the cancet will still exist and and salvage radiation treatment will be required. The side effects of each of these treatments are cumulative.

    Hormone treatment before radiation increases the success rate of the radiation. 



     still exist.

    That is why radiation would be preferred treatment and your father's case. Not only will the prostate be treated but the surrounding areas around the prostate will be treated. It is more likely that they will be better treatment success with less side effects

    Having hormone therapy before radiation increases the effectiveness of the radiation


  • Pathfinder
    Pathfinder Member Posts: 55
    The initial MRI scan was done

    The initial MRI scan was done on a T1.5, however we have located a T3.0 as suggested here. To be clear, we are asking for another scan for bone metastases and to examine the prostate to see if cancer has escaped the gland - is this correct?

    We know that surgery has major side affects, but the dilemma remains: if the cancer hasn't escaped the gland then surgery is the best option and we need to act fast. We were told by the first hospital who performed the biopsy + tests that it hasn't escaped the gland. But here most people suggest that it probably has. 

    I know there's no way to be 100% sure, even with hospital examinations, but if we do a second scan with the T3.0 and they still believe the cancer is contained, would that be a good reason to go for surgery.

    Or should we just skip all this and go for radiation therapy post a few months of HT.

    Sorry, this really is a dilemma :(

  • Pathfinder
    Pathfinder Member Posts: 55
    That's extremely helpful,

    That's extremely helpful, thank you for putting that in perspective! I have indeed been focussed on surgery because I understood from various things I had read that if the cancer was contained within the prostate then surgery was advised. I will consult with the family regarding your post, much appreciated.

  • CowboyBob
    CowboyBob Member Posts: 31
    edited July 2016 #21
    You seem to be focused on surgery....

    I think you are not "hearing" what the members of this forum are telling you.  I don't believe anyone here has suggested they believe surgey is the best treatment for your father. On the contrary, posters have tried to warn you that the complications of surgery are significant and worse than radiation therapy. Although I think your father's workup is incomplete, it is my understanding that his survival rate with radition will be similar to his survival rate with surgery and the side effects significantly less. Outside of a study, I don't know why a doctor would administer chemotherapy for your father. 


    I am afraid this is a bit like Mark twain's quote: "To a man with a hammer, everything looks like a nail that needs pounding"  Your father seems to be consulting with surgeons. It's not surprising they are recommending surgery.

    If this was my father and with the information I understand of his case, I would be pushing hard to stay away from surgery at all costs.  I would strongly recommend he seek a second opinion from a qualified Radiation Oncologist (in Hong Kong or Singapore if necessary). Please don't push for surgery without understanding the facts

    edited to correct some typos

  • VascodaGama
    VascodaGama Member Posts: 3,513 Member
    We all confront the same dilemma at front

    We all confront the same dilemma at front. Which therapy is the best to treat?

    In the end, the one we chosen is the best. Though, you need courage to find that ultimate comfort for deciding.

    Cowboybob is correct. Nobody here has “invited” you to choose surgery. It seems that the family in China has set their minds in surgery and given you the task in proving that such is in fact the best. You are looking for a decision and now worried that your comment against the initial thoughts are unaccepted, or even worse, not proper. You feel responsible.

    As commented above, his status would not alter if the treatment (surgery or radiation) is done in three months. The cancer would not “runaway”, it will be there to get the blow when that is done (now or in three months). In such regards, the Tesla 3 MRI result could be your trigger threshold to start the treatment. This is acting fast. You do not need to rush anything.

    3T MRI is more reliable as image study. You can request for them in China to include measurement of the gland. You also can request them to provide the results on a CD/DVD which copy you can use in the USA (at a PCa specialist radiologist) to obtain a second opinion. This is your great chance to feel accomplished and to get a REAL decision.

    Back to the year 2000, in my times, surgery used to be considered the golden standard of treatment for prostate cancer. At present times such is not correct. The newer RT equipment and modalities can provide results at the same level, to reach the ultimate goal of cure. The choice is now done regarding the details of patient status. The risks and the side effects from treatment are different and that also contribute in the final decision. Incontinence and Erection dysfunction (ED) are prevalent in surgery interventions. Radiation is more linked to colitis, proctitis, libido and damage to semen. Both may prohibit fathering a child.
    These should be at the choice of the patient not at the decision of family members.

    Just for your information:
    Surgery is done open (the traditional) taking approximately 5 hours and requiring blood transfusion; The robotic is faster taking approximately two hours; A similar modality not using a robot is the Laparoscopic done by experienced surgeons but both are more linked to incontinence cases. Radiation is administered from outside non invasive using special equipment that can differ in dose modalities (large dose at many fractions: IMRT or fewer number of fractions hyper fractionated: Cyber Knife); Invasive modalities include Brachytherapy (localized seeds implanted) and High Dose Brachytherapy (with radiation rods).
    In contained cases, CK has the best performance status. For localized cases IMRT delivers better outcomes. RT can also be done in combination; eg: CK+IMRT or Brachy + IMRT, etc

    The prostate gland is considered too large for surgery or radiation when that extrudes into the bladder. This is accompanied of problems in urination (difficulty, pain, frequency, etc), so that surgeons prefer to do TURP instead of removing the whole gland. The normal size is approximately 30cc but many do surgery when this is 50cc. Some guys have glands at the 80 cc level and still manage to be treated. Hormonal therapy to reduce the size of a gland is done over six months, and even that will not assure a significant reduction in size. HT leads to a reduction of the PSA starting approximately 1.5 months from the first injection of a LHRH agonist. Castration is seen at the two weeks point but the body takes another two weeks (or more) to clean circulating serum. The comment of his Interim doctor makes no sense.



  • Pathfinder
    Pathfinder Member Posts: 55
    edited July 2016 #23
    Wow, this is really helpful.
    Wow, this is really helpful.

    To put things in perspective from this side, it hasn't been anyone's decision to chase surgery per se, we're just only now becoming educated in what we're facing. The issue is that the doctor post biopsy instructed us that there would be 3 months HT prior to surgery. When questioned has the cancer left the gland, the answer was "we don't believe so", and all this based on a Tesla 1.5 MRI and the biopsy results posted above. That and an incredible vagueness when it came to the details of the condition where staging was concerned.

    I suppose what we thought was, if the cancer is indeed contained within the gland, surgical removal of said gland is the most practical step. And because we're worried about the PSA doubling rate and aggressiveness of the cancer, we are trying to quickly figure out if this surgery can be done sooner rather than later.

    However talking to you guys has been both educational, and in a nice way, provided an additional dilemma! Because nobody here told us Gleason 8 is "assumed" to have left the gland, and indeed they told us they believe in this case that that hasn't happened.

    However we are all aware of the risks involved in surgery. We know nobody can make this decision for my father in-law. If radiation therapy is the better option for him, we will explain that in full.

    Here's the thing that I didn't understand previously:

    "The newer RT equipment and modalities can provide results at the same level, to reach the ultimate goal of cure."

    We were under the impression that there couldn't actually be a cure with radiation therapy! We were thinking that by choosing RT over surgery it would simply be a case of fighting until the very end through a variety of treatments.

    We kind of saw it this way: based on the information given here (Gleason 8 = likelyhood of leaving the gland) that surgery would have a 20% success rate of removing all the cancer, and an 80% chance of failure due to cancer having escaped. The 20% would be a cure, and that's the gamble.

    We thought RT and HT would be less damaging in terms of side effects, but would only control rather than destroy the cancer. Kind of like extending life expectancy, but conceding to defeat eventually.

    If RT can actually cure PC, then we need to reassess everything.

    I'm really sorry if this sounds uneducated! We are learning as fast as we can, and there's a lot of ground to cover. The biggest issue has been not being able to understand the seriousness of my Father in-law's PC. We don't know the definite stage, we don't definitely know if it's contained in the gland, and up to now, we're not sure when and how to act regarding treatment options. It's often frustrating and generally concerning.

    We will begin looking into the details of RT over surgery now, but if anyone has any more input, every little helps, because I'm getting more from you than I think I ever will from the domestic doctors here.

    Thanks again for your support!