Hi all, new here and newly diagnosed. My stats:
PSA 8.035, Gleason Score - 4 + 3 = 7
4 of 10 cores positive.
right mid medial - 3 + 3 = 6
right apex - 3 + 3 = 6
left base lateral - 4 + 3 =7
left mid lateral - 4 + 3 = 7
EPE- 2mm left base to mid peripheral
no seminal vesicle invasion
calculated prostate volume 66.9 ml
Partin table says 25% chance cancer is organ confined...how worried should I be?
Scheduled to start PBT late May - started ADT late March-
Should I be reconsidering options?
The EPE was MRI-detected, I presume. MRIs aren't very good at detecting small amounts of EPE. The 2 mm extension is below the resolution of the MRI. A small extension is no problem for any kind of external beam radiation or HDR brachy because they treat a margin outside of the capsule anyway. If you were having a prostatectomy, it would be a good idea for a pathologist to be standing by to examine frozen sections if the surgeon had to cut wider.
The kind of prostate cancer you have is called "unfavorable intermediate risk." This article shows the relative success of various therapies for unfavorable intermediate risk:
prostatecancer.news/2018/10...
PBT is probably no different from IMRT in terms of oncological control and toxicity.
Hello Waldo.
As I understand it, "organ confined" means all of the cancer is in your prostate. None has spread outside the prostate.
You can look at the Partin Table calculator from Johns Hopkins at: hopkinsmedicine.org/brady-u...
It looks like the pathologist who wrote up your report used the most conservative estimates of your biopsy results, choosing "4+3 or 8" as your Gleason score.
So, your cancer could be outside the prostate as well as in, though, hopefully, if it is outside it's still very close by and easily treated at the same time as your prostate is treated.
I was diagnosed in 2003 with a similar condition. I was treated with a combination of HDR brachytherapy, external beam therapy, and Lupron. The brachytherapy seeds were planted in the prostate proper and in an extension of one of the tumors that extended outside the prostate. I was told that the external beam x-rays were aimed at the area 1 centimeter all around the prostate. I never needed any other treatment and, so far, I have not had a recurrence of the cancer. When I was treated, proton beam therapy was new and not yet well proven, however I think it has been developed over the last 18 years and is probably about as good as other kinds of radiation treatment.
Here's what I recommend:
Go over the biopsy report with your radiation oncologist.
Ask him whether he can tell if the cancer is outside the prostate organ, and if so, where and how far outside. My guess is that he won't be able to provide a definite answer but, from his experience and study of other cases, he may be able to give a good estimate of the likelihood, danger, and probable locations of any extended disease.
Ask him what he will do about that. Does he plan to do any more diagnostic scans? Why or why not? Does he plan to treat any tissue outside the prostate? If so, where and how, If not, why not? Does he still think proton beam therapy is the best treatment for you?
Does he thinks that you should get "neoadjuvant" androgen deprivation therapy (i.e., testosterone suppression starting some weeks or months before treatment), why or why not? It could weaken the cancer prior to radiation making the radiation treatment more effective. It may also stop the spread of any cancer while you're waiting for radiation treatment.
I know this is frightening, but I think you have a good chance at a complete cure and, even if that fails, you have a good chance of controlling the cancer for many years, maybe decades, and never experiencing any symptoms of the disease.
I wish you the best of luck.
Alan
Thank you Allen’s for the great advice and for taking the time to give it!have been lurking on this site for a few weeks and already know to read everything that you two have to say on this awful subject! The study that Tall cited states that “use of ADT did not affect recurrence”
Have already started on Lupron and casodex & RO is recommending 18-24 months...don’t want to take any chances but do you think 12 months is viable?( been 2+ weeks & no SE’s as of today?)
There has been discussion about what the chances are of overall survival between 6 months and 18 months of ADT in a study. You have good odds that it won’t make a difference. There’s about a 4% difference. Unless you’re one of the four out of a hundred. Then it would have been better to do it longer.
I have read that ADT has not been found to change outcomes for Gleason 6, low risk cancers but is particularly useful for "intermediate risk", i.e., Gleason 7 cancers - which can be "low intermediate risk" G 3+4 or "high intermediate risk" G 4+3. The pathologist writing your biopsy report clearly thought you had significant high intermediate risk tumors along with some relatively low risk tumors. It's those higher risk tumors that are most important to treat.
I think that medical science is getting better and better but there's still a lot we don't know. We don't always know who will benefit most or least from each of the treatments or how the cancer evades and overcomes them all. But we learn more each year. Survival length has increased significantly since I first learned about PCa and those men who live longer will get chances at still more new treatments. One day, I have no doubt, there will be a cure. I don't expect to see it (I'll be 75 next month), but I believe it's coming.
Best of luck.
Alan
AlanMeyer wrote >>> " I have read that ADT has not been found to change outcomes for Gleason 6, low risk cancers but is particularly useful for "intermediate risk", i.e., Gleason 7 cancers - which can be "low intermediate risk" G 3+4 or "high intermediate risk" G 4+3... "
I recently read >>>
Parsons, J. Kellogg. “Men with High-Risk Prostate Cancer Should Not Undergo Neoadjuvant Therapy Prior to Surgery” November 2020. Accessed Apr 2021. grandroundsinurology.com/me...
typical >> "you're damned if you do and damned if you don't" scenario ???
I don't keep up with the scientific literature, but it used to be the case that neoadjuvant ADT was only rarely used with any surgery and was only recommended for use with radiation. Apparently, interest in it among surgeons has increased, but it's still questionable (if I interpreted the article correctly) whether it provides any survival benefit.
Here is the first page in a recent (Dec. 2020) series of articles on Medscape about the use of neoadjuvant ADT in prostate cancer.
emedicine.medscape.com/arti...
It looks pretty comprehensive. I'll post it as a stand alone posting to the whole group.
This may I’ll be 60.. 75 seems light years away for me . Happy birthday Taurus ♉️.
I would consider a PSMA PET/CT study which could identify cancer outside the prostate. I believe it has been approved for these situations
There is a 25% chance the cancer is confined to the Prostate ..... 75% chance the cancer has left the Prostate. Is adjuvant RT being considered???? Some do adjuvant RT others wait & do Salvage RT later. I agree with Tall_Allen, if this EPE was diagnosed with MRI it was diagnosed on the probabilities given the resolution they had on the MRI study.
Waldo, this from a guy who was Gleason 7(4+3) in 2003........ talk to your MO about micro-metastasis. The stats in 2003 regardless of Brachytherapy and IMRT or Prostectomy were about the same - 92-94% success. I feel into the later as unseen metastatic cells had already escaped..... I post this for awareness and not necessarily concern. I wish you the best.
GD
Greetings Waldo13, besides your numbers would you -
Please tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?
All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.
THANK YOU AND KEEP POSTING!!!
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 04/15/2021 5:29 PM DST
Given that limited info you are not ok to stop at this bus stop. 75% probability of cancer outside the prostate margins calls for either 1) radical prostatectomy which will confirm ECE or not and give you more information. Or 2) radiation to entire prostate and prostate bed and probably also the pelvic lymph node fields. Either extended field IMRT or brachytherapy-boost treatment. Either way I think now is the time for pro-active treatment to protect your life. That is my orientation. Best of luck and much support. Paul
Exactly correct from my experience . Go Mateo!
I was told it did not leave the capsule as well I thought I was cured but six years later it was back CONFUSED did have small positive margin apec right they only took out 3 lypnodes negative >wish I knew the gleason score at margin 3>4 gleason how do you find this out 8 years past
Good news Waldo13.. I thinks it’s the best that you could ask for.with pc .. Live healthy my friend .
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