Gleason 7 (4+3) Considering surveillance VS radiation

dawgdaze
dawgdaze Member Posts: 2

Husband has Gleason 7 4+3, No evidence of tumor on CT although enlarged/hardened on DRE and minimal symptoms.

72 yo Vietnam Vet. Highest PSA 5.84 (slow increase over past 3 years from 2.3) Had hormonne therapy and now PSA .66.

Any informed feedback for Not doing radiation? OR, results of radiation. How do you hold that 20 ounces of water for the treatment???

Thanks in advance for input....worried wife

Comments

  • GeorgeG
    GeorgeG Member Posts: 152
    Do you have the details of

    Do you have the details of the biopsy report - number of cores, percent content, etc? That information will help the guys here to give you some thoughts.

    George (4+3, RP, SRT, ADT)

     

  • Lucky64
    Lucky64 Member Posts: 29
    edited August 2017 #3
    Hmmmm....

    I was a 4+3, had surgery one month ago and when they biopsied it, I was a G8. A 4+3 is not safe enough to be considered for AS, it's an intermediate, Group 3, something has to be done. If your husband has a long life expectancy, if he is otherwise healthy, I doubt if they will suggest AS. It can spread.

     

    Nick

  • Lucky64
    Lucky64 Member Posts: 29
    edited August 2017 #4
    Hmmmm2

    You can PM me, I have more info.

     

    Nick

  • contento
    contento Member Posts: 75
    Gleason 7

    dawgdaze, my two cents is that a Gleason 7 is too aggressive  to consider watchful waiting especially since your husband is still relatively  young. I'm am confused by your statement that your husband has had HT.  What led to that and only that ? I had a similar experience as Lucky64 in that my biopsy also revealed  a Gleason 7 with everything else being clear.

    I opted for RP and my post pathology report was a lot worse including an upgrade from a Gleason 7 to a Gleason 8. In hindsight I would have opted for IMRT since I required salvage radiation about a 1 1/2 yrs later.

    and Yes drinking and holding your water prior and during the daily treatments is a hassle, no question, but necessary. Each patient had to hold a different amount of water depending on bladder expansion.

  • VascodaGama
    VascodaGama Member Posts: 3,512 Member
    What is his clinical stage?

    I wonder what your husband is looking for. Cure or just prolong life?

    The hormonal therapy is palliative but it can hold the advance of the cancer if this maintains its present profile of hormone dependent. Radiotherapy or surgery would assure cure if the case is contained or if the bandit's location is properly identified to provide targets. All treatments got risks and side effects that put the quality of life into jeopardy. I think it better for you to get second opinions from different specialists (urologist, radiologist) and decide after knowing details on treatments.

    Gleason rates 4 and 5 are aggressive types prune to metastasize which case added to the positive DRE, leads to think in existing extra prostatic extensions. Did his physician done any image exam? What about the bones is there any info on spread?

    Best of luck in his journey.

    VG

  • Clevelandguy
    Clevelandguy Member Posts: 767 Member
    Above good advice

    Hi,

    Good advice from the people above, 4+3 I don't feel is a candidate for AS.

     

    Dave 3+4

  • SubDenis
    SubDenis Member Posts: 130
    The decision to do AS is a

    The decision to do AS is a personal one IMHO.  There are two schools of thought emerging in the literature.  A conservative one and a more inclusive one.  Klotz and company think some 3+4 are candidates for AS, Epstein, and co probably not.  My take, new to this world, is if the big guys are unsure I have to check with my feelings, my comfort with my Uro and his/her opinions.  I am right int he middle of that decision right now.  Found out yesterday that second opinion pathology showed a very small amount of 3+4 in one core, <5%.  We are ordering a decipher test to inform the next decision but leaning towards AS.  Clearly, this is emotional and some folks are very passionate about their position.opinion.  I choose to listen, reflect and then make my personal decision (with my wife) on what we feel is best for us.  Many of us, if not all, have a bunch of fear concerning "CANCER" not little c cancer and the fear may drive too many hasty decisions.  I am trying to let this wash over me (only a few weeks into this chapter of my life) and allow my wife and I to make an informed rational decsion.  I wish you well. Denis

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    Active Surveillance

    All, in replying to dawgdaze, please be advised that the poster is referring to type of treatment; either hormone only or a combination of hormone and radiation. It is not "active surveillance" for treatment for initially diagnosed patients, as we generally refer to "active surveillance"

    Vasco input addressed this , however dawgdaze as vasco requested will need to provide more specifics, so that we can give best input.

  • GeorgeG
    GeorgeG Member Posts: 152
    edited August 2017 #10
    Sub Dennis:

    Sub Dennis:

    Well said.

    George

     

  • contento
    contento Member Posts: 75
    edited August 2017 #11
    AS

    Agree that AS , as any treatment or not is Always a personal decision. It was for me as well when I ( we- wife n I ) chose to treat my Pca when I was diagnosed with a

    Gleason 7 ( 3+4 ) with everything else rather normal ie DRE . Im glad we made that decision as my post op patholgy showed a very different ( worse) picture  of what was happening. It turned out to be low volume involvement but very aggressive. Treatment turned out to be the right choice for me.

     

  • dawgdaze
    dawgdaze Member Posts: 2
    GeorgeG said:

    Do you have the details of

    Do you have the details of the biopsy report - number of cores, percent content, etc? That information will help the guys here to give you some thoughts.

    George (4+3, RP, SRT, ADT)

     

    No.

    No.

    Hopefully get copies soon.

  • Clevelandguy
    Clevelandguy Member Posts: 767 Member
    4+3

    Hi,

    With contento's comments is a good reason why 4+3 would not be my choice for AS.

    Dave 3+4

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

    AS

    Agree that AS , as any treatment or not is Always a personal decision. It was for me as well when I ( we- wife n I ) chose to treat my Pca when I was diagnosed with a

    Gleason 7 ( 3+4 ) with everything else rather normal ie DRE . Im glad we made that decision as my post op patholgy showed a very different ( worse) picture  of what was happening. It turned out to be low volume involvement but very aggressive. Treatment turned out to be the right choice for me.

     

    As contendo wrote, pathologist's reports following prostectomy, when they differ from biopsies done earlier (usually they match, but not always), virtually always show a worse Gleason and/or staging...never less serious.  My own case was changed from Stage 1 to Stage II post-op, a teaching moment for me.

    He is already clearly a Gleason 7, with an 8 possible. As I think everyone has agreed, A/S would be a bad decision, based upon the available, empirical data you have.

    max

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 409 Member
    Hi DawgDaze

    Hi DawgDaze

    Sorry to hear your (husband's) bad news.

    Pretty much the same situation in many ways but younger and post op.

    I look at it this way, just having had a G7 (4 + 3) taken out whilst still encapsulated.

    If you remove it, you minimise the chance of Mets. If you wait, you run thrisk of Mets and a far higher chance of an earlier death.

    I have no regrets at all (well, I have many but none about RP :):):)) - Continence and ED issues can be overcome. The consequences of PCa spreading probably can't in the long term.

    72 is young these days, and as a 'Nam Vet I have no doubt your husband is a fighter. Taking action will probably sit better with him than inaction.

    What branch was he if I may ask?

    C

  • Wildsunflower15
    Wildsunflower15 Member Posts: 1
    Prostate cancer

    is anyone there?

    im scared, worried, and lost.  My husband was diagnosed in 2015, prostate cancer.  The cancer cells went outside the prostate and has metastasized.  Surgery was done to remove the prostate. When he started his first chemo the PSA was 150 and declined to 30, but the cancer got immune to it.  Now He's on another type of chemo, his 3rd session and his PSA has jumped to 258.  He has lost muscle mass, difficult time walking, in pain, concentration is short, very little appetite.  

    it would help me greatly if someone would tell me what to expect.  This is my first time speaking about this to anyone.

    Thank you

     

  • VascodaGama
    VascodaGama Member Posts: 3,512 Member
    Wildsunflower: Please add details on his status and case

    Wildsunflower

    I am sorry for the situation. It is difficult to provide you an answer without more details on him, his case and health status. Some guys here have been treated with chemotherapy and they may help you with ideas. Probably you should start your own thread with a definite title and questions regarding the help you are looking for.

    Best wishes for improvements.

    VG 

  • Clevelandguy
    Clevelandguy Member Posts: 767 Member
    Immunotherapy

    Hi,

    Sorry to hear about your Husband, keep on asking questions, doing reasearch, ect.  You might want to look at this article, good info on using the bodies immune system to fight cancer.  The article is from the National Cancer Institute.

    https://www.cancer.gov/research/areas/treatment/immunotherapy-using-immune-system

    Down into the article they talk about Sipuleucel-T to fight Pca that has spread outside of the Prostate.

     

    Dave 3+4