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Advanced Prostate Cancer
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Watchful Waiting with PSA 16 and Gleason Score of 7?

A friend of mine just had an MRI-guided biopsy on his prostate and was told he has a cancerous node on the gland. He was urged by his internist to get the procedure because his PSA had climbed to 16. His gleason score is 7 (3/4). He will be meeting with his urologist soon to discuss treatment. My friend believes "watchful waiting" is an option. He knows that I had a biochemical failure in late 2016 and had been treated at diagnosis in 2005. I don't believe waiting is a good option. Opinions, please.

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If the MRI showed that the PCa is still contained within the prostate then I would seriously consider proton therapy.

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Thanks tallguy2. I agree with you and will pass it along to my friend.

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Is he very elderly with comorbidities" If so, watchful waiting may be ideal. But I don't think you are really talking about watchful waiting. Watchful waiting means there is no intention to curatively treat, only palliative treatment is given because life expectancy is so brief.

Active surveillance means very close monitoring with at least a confirmatory biopsy. it is only appropriate for low risk men and a select group of favorable intermediate risk men with more than 10 years of life expectancy. Your friend falls into the "unfavorable intermediate risk" category because of his GS 7 and his PSA. He should not undertake active surveillance, His most curative treatment options are brachy boost therapy, SBRT, HDR brachytherapy monotherapy, or surgery. He should talk to specialists in each of those.

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Tall_Allen, Thanks for confirming what I thought about my friend's diagnosis and his desire to resist treatment. I have no doubt that the urologist will concur with your analysis. It will be a choice my friend has to make. I hope he chooses wisely.

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hey ron give him a ton of advice and tell him to see a Pca oncologist.

Good Luck and Good Health.

j-o-h-n Friday 07/27/2018 5:12 PM EDT

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Will do. I think he is in denial--as we all have been--about the future and what it will bring.

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You might have him check into HIFU as an option. That's the treatment I chose.

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Thanks, WSO, I plan to pass along all suggestions. I assume HIFU worked for you. Did you have similar stats?

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Gleason 8 with an oddly low PSA of just 2.7. Scans were clear. Prior TURP surgery was said to rule me out for prostatectomy. I was steered toward external beam radiation but some of the stories of damage from radiation didn't make that an appealing option to me. No nasty side effects from HIFU. Coming up on two years soon. My urologist didn't favor brachytherapy or HIFU -- maybe because those were not in his bag of tricks.

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Where did you have your HIFU and did insurance cover it?

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San Francisco. Insurance did not cover it in 2016 but I hear that Cigna and possibly Medicare now covers it.

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Medicare does cover it, probably 80%, but only if you don't have a secondary policy. In my case my secondary is actually the primary and they turned me down. I was talking to Santa Monica hyperthermia center who would co-treat with UCLA (Dr. Steinberg).

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