Prostate cancer gleason 9; 88 years o... - Advanced Prostate...

Advanced Prostate Cancer
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Prostate cancer gleason 9; 88 years of age

My husband is young and healthy for being 89. He was just diagnosed ith prostate cancer. Gleason 9, no sign of metastasis. The docs are suggesting hormone therapy and radiation. If he does nothng how long can people live without any treatment?

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There is a nomogram that exactly addresses your question:

webcore.mskcc.org/survey/su...

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Thank you

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May I ask what his results were?

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I know he doesn't have a long lifespan at his age. My question is what would give him best quality of life - treatment or no treatment. In my estimation, if we are able to reach 90, we're living on borrowed time.

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What did the nomogram tell you?

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I’m confused with that anomaly

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?

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"nomogram." - did you fill it out? What did you find confusing?

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far majority would die of other causes - 97 out of 100 if not treated

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That’s pretty convincing, unless you’re in the 3%. The nomogram is accurate about 70-80% of the time, and MSK has a sizable database

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That’s a great question I would like to know that too. My dad is 82 and looks and acts 70 I wonder that all the time. I wonder too what if we stopped treatment cause there isn’t a cure! I don’t see how there will ever be a cure when companies make so much money for maintenance drugs and somehow yet no one can come up with a cure ??? Baffles me they can send a man to the moon but cant cure cancer or other diseases all they know how to do is TREAT them.

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Hmmm?

You wonder why cures aren't being found? Not to say this is the case but this article makes one wonder. The fact that those infected who are cured will no longer increase the patient "base" by infecting others is disheartening for those of us who hope for a cure.

Copy the entire script between the lines to access the article.

______________________________________________________________________________________

Goldman Sachs asks in biotech research report: 'Is curing ...

ca.finance.yahoo.com/news/g...

_______________________________________________________________________________________

Currumpaw

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Not sure Any prostate cancer treatment should be undertaken by an 89 year old man but ask me again when I'm 88. Definitely seek a Second Opinion possibly at Johns Hopkins.

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Umpire 20 is on it....Any major teaching hospital is where you should go..JH , Mayo,Sloan,MD Anderson, Duke and there are many on the west coast...

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I asked that exact question of my radiation oncologist, he said about 8 years, the last couple of years not being very nice. I was 75 at the time (2 years ago).

Bob, G9, proton, adt 18 month

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A nomogram tells you exactly nothing about your husband's fate; at best it tells you what the unidentified author of this webpage knows about men who were diagnosed, treated, and died long ago.

At his age, his life expectancy is less than 10 years. A Gleason 9 cancer is serious, but the side effects of any prostate cancer treatment are also very serious.

The best answer is the one that your father makes for himself. Is he willing to endure a significantly degraded quality of life in the hope of a few extra months or years? At 89 there odds of him dying from some cause other than prostate cancer is quite high, certainly more than 50%, perhaps as high as 90%.

Only he can answer that question. This isn't an emergency, prostate cancer is almost never an emergency. Take some time. Get over the shock so that everyone can think clearly. Help him to learn as much as he can about his options and the likely to certain side effects of any treatments. Doctors are one source of information but too many are horrible liars about side effects.

Good luck to you, and to your husband.

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Well said.

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Imho if he wants to stay young and healthy do nothing! He’s a lucky guy and you’re a lucky gal!

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At age 89 your husband is likely to die of something else even with a Gleason score of 9. Radiation should be used if his cancer is aggressive. Otherwise ADT drugs would be less demanding.

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I think Fcoffey's advice is right ---

I will share what my doctor's have told me... after RP in April 2016 -- with a Post RP pathology report of Gleason 8 -- N-1 PSA 0.033 (I originally had biopsy because of rising PSA 8.1 no other symptoms) --

I asked the doctor who did my RP --- he has done over 10,000 RP -- and is world renowned --- he said, if I did nothing -- the average time to mets. is 8 years before they would show up on standard CT/PET-- MRI scans or were likely to cause symptoms -- after which 3 to 5 years. This was with no treatment at all.

It is unlikely anyone would be willing to do RP. I was told it was highly risky to do RP on anyone over 75 regardless of otherwise good health. I was 69.

As for radiation:

Radiation oncologists at 2 different facilities said likelihood of adverse side effects increase with age and late term GU or GI side effects are low but if they occur are not insignificant.

And as for ADT:

At the NCI / Baylor /M D Anderson seminar last year-- the PCa MO said in front of over 100 in attendance that ADT does not extend overall survival. It raises the frequency of CV events, may lower bone density and cause weight gain and possibly gynecomastia. It lasts on average 2 years after which the cancer becomes CRPC and accelerates the growth of PCa.

If someone decides to go the ADT route -- ADT + Zytiga have shown to more than double the survival time compared to ADT alone.

I'm just reporting what I have been told by some of the best doctors in the field.

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The ADT comment is certainly discouraging. I will be coming up on 2 years next month. Of course the xtandi may lengthen the inevitable. At the beginning I actually thought I would be a basket case by now, but still functioning pretty good. Would knock on wood if there was anything made of real wood in this house. Enjoy.

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Well it may be improving soon:

see cujoe's recent post earlier today under the title

"Several PCa Headlines from Genitourinary Cancers Symposium in SanFran"

"Another Win in Nonmetastatic CRPC"

"Treatment with darolutamide led to median metastasis-free survival (MFS) of 40.4 months versus 18.4 months."

medpagetoday.com/meetingcov...

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This is an area of controversy. There is a difference between these two statements:

(1) ADT does not extend overall survival

(2) There is no convincing proof that ADT extends survival

The problem is that to settle the question, one would have to do a randomized clinical trial in which one group of metastatic men got ADT and the other did not. But most of us believe that such a trial would be unethical, which is why it's never been done.

Early trials proved that chemical or physical castration had equivalent survival to estrogen pills, which was the first standard of care.

There was also an important early (1990) randomized trial that showed that the combination of leuprolide and flutamide (an antiandrogen) extended survival more than leuprolide alone.

onlinelibrary.wiley.com/doi...

More recent randomized clinical trials have proven that there is a survival benefit to a GnRH agonist (like Lupron) + a second generation hormonal therapy (Zytiga or Xtandi) over a GnRH agonist alone. Also, we have considerable proof that adding a GnRH agonist or an anti-androgen to radiation improves outcomes over radiation alone.

None of these should be construed to mean that there is no survival benefit to a GnRH agonist alone, but only that the survival benefit is not yet proven and probably will never be. Indeed, the fact that combined hormonal agents extend survival suggests that there is probably some (as yet unproven) survival benefit to a GnRH agonist alone.

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Thank you for this information.

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If that’s true about ADT what do we do? I feel like regardless which treatment plan, or non-treatment plan one’s doctors recommend its essentially just playing Russian roulette. Or does any of it even really make a difference anyway?

I’m so confused and discouraged. My husband is 65 with a Gleason 9 and he’s on ADT after a failed RP. It’s so hard to know what to do. It’s all so discouraging and overwhelming.

I know there are no hard and fast rules but navigating the choices and considering all the variables is mind boggling and all while worrying about one’s life or the life of a loved one.

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It is so hard. We need to just be kind to ourselves going through all this.

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Amen

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Don't despair, we may all beat it yet ! -- in my opinion in the next 8 to 10 years combination immunotherapy with effectively solve our problem -- meanwhile you are doing great -- most everyone in this section is in the same boat - and no one here is a doctor- we are just sharing our journey and research and learning in hopes that it will be helpful to others. I think you are right about Russian roulette -- some men did radiation some did surgery some did ADT and some did nothing and lived to be 100. I read your post about your husbands PCa history -- although others will disagree -- I think you are spot on with all the supplements -- many here including myself are taking the same ones you listed. IMO i can't see how they can do anything but help and maybe immensely. As you just noted if the medical community had anything much better than doing nothing -- once RP or RT fails we would all be doing it -- instead they are all over the place. Since my surgery, I have seen 5 MO and 4 RO and none agree as to what to do. Because of your husbands positive margins, and he is on ADT you might ask another RO -- wait till he heals up from the surgery and try RT to pelvic lymph nodes and prostate bed. Both M D Anderson and Methodist Houston said if I decided to try it -- they would only do my prostate bed and the lymph nodes that drain the prostate to limit side effects as much as possible. One MO said do nothing till PSA reaches 5 or 10 -- whatever my comfort level can stand then IADT. One said chemo .. I was told the radiation is anywhere from 20% to 40% likely to stop BCR and radiographic progression for 5 years ... and who knows it may never metastasize either way.

here is some info I found in my research:

karger.com/Article/FullText...

medicalnewstoday.com/articl...

nature.com/articles/s41467-...

Keep us posted -- I will keep you and your husband in our prayers

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Thank you for the thoughtful reply and the links (and the prayers...I will reciprocate). The links look really interesting.

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Good evening- My 79 y/o Dad was diagnosed in January with advanced PCA w/ bone mets.

His PSA at diagnosis was over 1000. 6 months later at 450. He is on Zytiga, Lupron & Zometa. Due to his age he did not have a RP. Probably a dumb question, but given that he still has his prostate, will his PSA ever drop to zero? He has suffered with rib fractures and Thoracic fractures- treated w/ radiation and now his second infusion of Zometa.

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You might want to research HIFU as an alternative to radiation.

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As for your husband... unless you feed him the poison mushrooms or you catching him messing with another woman... he will be around for many years.... You know there's a saying "about why husbands die before their wives? It's because they want to". In your case, you must be an exceptional wife.

Good Luck, Good Health and Good Humor.

J-o-h-n Sunday 02/17/2019 1:23 PM EST

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you make me smile

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There is no answer to how long w no treatment but w a Gleason score 9 he should really consider the radical prostatectomy, especially if it hasn’t spread yet

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He cannot have surgery

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I hear metastasis to the bones or surrounding area is worse than hormone theray and radiation. What experiences do people have with this? Still trying to figure out to treat or not to treat.

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A Gleason 9 is a high risk factor. No detectable "mets" yet is a relatively good sign.

Anecdotally, I have met elderly men who did well on ADT drugs, and others who became very fatigued and physically weaker, and were eager to get off it as soon as possible after initial treatments.

I think I would also want to think about not only How Long one might live after getting radiation treatment and ADT, but also about what Quality of Life there may be during those remaining years. Some percentage of men do come out of their procedures with side effects, such as urinary incontinence. Many doctors have a tendency to underplay the day-to-day quality of life impact of urinary incontinence following some of their procedures.

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Sunnyvango,

Sorry to hear that a G9 has to come up at that time of your lives.

You didn't mention if it is definable within his prostate such as a T1c tumor. What his PSA is. What type of PSA test was done or hat type of imaging technique was used and who did the imaging?

Dr. Busch in Chattanooga, Tennessee is highly regarded as an expert with the 3.0 MRI in diagnosing prostate cancer by men who have prostate cancer.

Despite being a Gleason 9, a doctor that does Focused Laser Ablation might consider the procedure for your husband because of his age depending on the results of an MRI. FLA ablation is done real time, in bore, using a 3.0 MRI. The side effects of a FLA ablation are minimal.

FLA could possibly, depending if the cancer can be successfully ablated, extend his years. This may not even be possible with a Gleason 9. It wouldn't hurt to inquire but if nothing else, you should get the best testing and imaging to determine whether treatment is viable and what type of treatment he is agreeable to that is the most likely to give the best results.

That he was diagnosed with a Gleason 9 and that hormone therapy and radiation were recommended is reasonable for the conventional docs to recommend at his age. Tall_Allen is the guy ask about radiation and conventional treatment.

At the age of 89, your husband might not greet diet changes and supplements with enthusiasm. Certain lifestyle changes can slow prostate cancer, however, a Gleason 9 is aggressive.

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He's very open to diet change and we already eat a pretty good diet.

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Sunnyvango, The first thing I would get was a 3T mri to see what is really going on. AND use that as a pattern for biopsies, If I did one at all. For almost 9 years Ive taken many different supplements, chinese mushrooms, B17( apricot pits) an for the last 1-1/2 years CBD hemp oil. June 2018 I went to DelRay Beach Fl. for the MRI guided Focal Ablation. For me, My psa went from 32.5 in July of 2017 to 18.5 in June 2018 just before to FLA. In November 2018 my psa was 13.25. Tomorrow I go for a followup MRI. At age 89, Id find some medical cannabis ,(smoke it or eat it for 6 months) an check it again.

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He had an image targeted biopsy, which found active cancer, and bone scan that did not show cancer. Why a 3T mri? Or why not a PSMA PET? Can you send a list of suppliments and dosage?

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Be wary of toxic substances you hear about from random people on the internet.

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