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Gleason 7 (4+3) Considering surveillance VS radiation

dawgdaze
Posts: 2
Joined: Aug 2017

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

GeorgeG
Posts: 127
Joined: May 2017

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)

 

dawgdaze
Posts: 2
Joined: Aug 2017

No.

Hopefully get copies soon.

Lucky64
Posts: 29
Joined: Jun 2017

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
Posts: 29
Joined: Jun 2017

You can PM me, I have more info.

 

Nick

contento
Posts: 76
Joined: Jul 2017

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's picture
VascodaGama
Posts: 3032
Joined: Nov 2010

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
Posts: 462
Joined: Jun 2015

Hi,

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

 

Dave 3+4

SubDenis's picture
SubDenis
Posts: 130
Joined: Jul 2017

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 opt...
Posts: 2226
Joined: Apr 2009

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
Posts: 127
Joined: May 2017

Sub Dennis:

Well said.

George

 

contento
Posts: 76
Joined: Jul 2017

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.

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3309
Joined: May 2012

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

Clevelandguy
Posts: 462
Joined: Jun 2015

Hi,

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

Dave 3+4

hewhositsoncushions
Posts: 279
Joined: Mar 2017

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
Posts: 1
Joined: Aug 2017

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's picture
VascodaGama
Posts: 3032
Joined: Nov 2010

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
Posts: 462
Joined: Jun 2015

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

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