Hi Everyone

[pcs4101]

This is my first posting. I'm 71 years old and was diagnosed in 2017, PSA, 4.6 Gleason 6 {3+3) followed by active surveillance. Repeat biopsy in 2018 showed 1 core with Gleason 7 (3+4) PSA 4.6, remained on active surveillance . 2020 MRI showed progression so we started to move toward definitive treatment. Repeat biopsy in April 2021 showed 2 cores of Gleason 9 (4+5). CT & Bone scan negative for metastatic disease. Started ADT Eligard +Casodex in May and switched to Zytiga in July (PSA down to .196 as of 8/23)

Begin Proton Beam Treatment in September.

[Tall_Allen]

I hope you will also be getting whole pelvic radiation.

[pcs4101 in reply to Tall_Allen]

While I didn't show any lymph node involvement, I do believe that the RO plans to include them in the treatment plan just to be sure.

[Tall_Allen in reply to pcs4101]

Good idea!

prostatecancer.news/2021/08...

[Aussieguy1 in reply to Tall_Allen]

Hi Tall_Allen

Is this progressive change in Gleason score a development of the cancer cells or have the past biopsies missed the higher graded targets? I understood that Gleason 6 cells couldn’t develop into a higher Grade? Am I wrong in this assumption?

My brother was also initially diagnosed Gleason 6 but on second biopsy 12 months later they found Gleason 8 cells. I thought it was because they had hit an area containing Gleason 8 cells, not that the cells had developed from a 6 to an 8.

I am a Gleason 6 diagnosed in 2019. My urologist has never repeated the biopsy as he says my PSA is 6 and my PIRADS score hasn’t changed from a PIRADS 4. I had 2 cores of 80% adenocarcinoma and 1 at 5%. Plus PIN in others. Should I have another biopsy.

Sorry everyone for posting in the Advanced Prostate Cancer thread, just following thread from above.

Thanks

Ian.

[Tall_Allen in reply to Aussieguy1]

It is only true that Gleason 6 can't metastasize. It is not true that it can't progress or come from a common ancestor that can:

prostatecancer.news/2017/11...

In your brother's case, they obviously missed the higher grade cancer. Have you gotten a Decipher test?

[pcs4101 in reply to Tall_Allen]

My original biopsy was the random 12 core variety but the 2nd and third were MRI guided with 25 cores so the chance of missing something should be minimized. also, the two Gleason 9 cores were from lesions that were originally Gleason 6.

[Aussieguy1 in reply to pcs4101]

Thank you pcs4101 for posting this, sorry for jumping onto your thread. You have by sharing clarified for me my misunderstanding.

I wish you all the best in your future treatment. Great to see the dropping of your PSA. Sorry to hear about your progression, it brings home to me though about the need for Active Surveillance in order to pick up the signs of progression to commence treatment.

All the best.

Ian.

[Tall_Allen in reply to pcs4101]

Even 25 cores can miss and high grade areas can be close to low grade areas. Look at the study showing GS6 and 8 emerged from common progenitors. I think Decipher is necessary before deciding not to biopsy.

[Aussieguy1 in reply to Tall_Allen]

Thank you for your quick response and your clarifications on your prostatecancer.news site. This makes sense to me now. I have obviously not comprehended my urologist explanations, as I understood from him that there was basically no risk of progression of my Gleason 6 diagnosis. It clarifies the need for ongoing Active Surveillance.

Should I insist on another biopsy? Or are the Prostate MRI annually a good diagnostic tool to track progression if any was to occur, then a biopsy would go ahead at my insistence anyway.

No I have not had a Decipher test, but I have considered it.

I had my biopsy performed at a local public hospital here in Australia, would they still have my biopsy slides? I’m not so sure, but I’ll investigate.

Do you know who offers the Decipher testing in Australia?

Thanks again for answering promptly and correcting my misunderstanding.

Ian

[Tall_Allen in reply to Aussieguy1]

Decipher is offered by GenomeDx Biosciences. Prolaris is an alternative. OncotypeDx seems to be not as good. Maybe ask your doctor which is available in OZ. Here, hospitals archive biopsy tissue for 5 years.

[leach234 in reply to Aussieguy1]

Get an MRI of your prostate!

[Aussieguy1 in reply to leach234]

Thanks leach234.

Yes I’ve had several since 2019 when first diagnosed. Another due in November. All have shown PIRADS 4 encapsulated within the prostate, 0.3mm growth since 2019. BPH as well.

Appreciate your reply

Thanks

Ian.

[maley2711]

PCS -

I'm pretty much looking at the same situation as you have encountered. 4+5 10% one core of 12 standard and benign 6 cores of PIRADS 5, PSA 7.5, scans negative, nothing else concerning in new 3T MRI done 2 weeks ago....well, there is thickening of bladder neck and bowel diverticulosis......RO wants a colonoscopy.

As far as I know, and as I believe the urologist and RO are agreeing, the "success" rates for ADT + radiation and surgery are approx equal........brachy boost better , but more consequential side effects.......RO did not advise at age 73.

What led you to choose radiation + ADT? I am agonizing re almost certain side effects of ADT for 18 months, but surgery also seems very unappealing. Without ADT, radiation would be an easy decision for me, but ADT??? Thanks for your thoughts/experiences!!

[pcs4101 in reply to maley2711]

maley2711My decision was based on long discussions with my MO. He did not feel like i was a good candidate for surgery and i would probably have to come back for salvage radiation. thus the decision to go ahead with radiation and try to get it done in one step. I’m sure that ADT hits everyone differently but I can’t say that I’ve had that much trouble. Mostly fatigue, brain fog and some hot flashes. I’ve tried to stay active and get as much excessive as i can. Of course I’ve only been on ADT since May so that could change.

Good luck with your battle!

[maley2711 in reply to pcs4101]

Thank you PCS !! So , did you initially see MO in connection with doing the ADT....or basically connect with an MO(not RO, correct?) as a 3rd party unbiased opinion? anything specifically that made you NOT a good candidate for surgery, which at least has a widely available and uncontested salvage treatment of radiation, where salvage seems more controversial?

Continued good luck ? with the ADT !!! Was there any discussion of radiation without ADT?

[pcs4101 in reply to maley2711]

I originally saw a urologist and I went to the MO for a 2nd opinion, then eventually moved to the MO for my care.

MO not considering me a good candidate for surgery hinged on his belief that the chance of success with my Gleason 9 cancer was very low and would most likely require salvage radiation.

No discussion of not doing ADT. My prostate was very large and needed to be shrunk before the proton treatment and also clinical trials have shown very favorable results from ADT ahead of radiation in cases of high risk cancer.

[maley2711 in reply to pcs4101]

yes, best studies show ADT +radiation has approx same long-term success as surgery. and yes, we are both stuck in the high risk category with Gleason 9. Did either the MO or RO discuss the option of addding brachytherapy to the IMRT + ADT? The problem is, of course, even more SEs, but results have been superior, and NCCN guidelines now advise that , but maybe not so much for older men?

[pcs4101 in reply to maley2711]

No, we never considered brachytherapy.

[j-o-h-n]

Greetings pcs4101,

Please tell us your bio. Location? Treatment center(s)? 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 Sunday 08/29/2021 12:07 PM DST

[pcs4101 in reply to j-o-h-n]

john

I live in Little Rock, Arkansas, all my scans, MRI’s and biopsies have been performed at several different local facilities. My proton treatment will be done at the Proton Center in Dallas

[j-o-h-n in reply to pcs4101]

Thank you for your quick and informative reply. You have come to the right place for Pca information and comradery. May you be successful in beating the beast. Keep Posting.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 08/29/2021 8:12 PM DST

[pcs4101]

UpdateI completed my 44 proton full pelvic treatments last week. The whole process went very smooth and was much easier than i was prepared for. I went to The Texas Center For Proton Therapy in Dallas and can not say enough great things about their professionalism and compassion for their patients. I was lucky enough to have a son that lives in Dallas where i was able to stay during my treatment so that helped a lot.

Now I’ll be continuing on my eligard & zytiga for a total on about 24 months and pray that everything continues to go well. My thanks to this group for lots of information as I continue thru this journey!