Looking for help - newly diagnosed dad

[ChloeSS]

My dad, 70 years old, has been diagnosed with Gleason 7 (4+3) invading the seminal vesicle on the right side. Shocked to find out he is high risk. MRI did not show any enlarged nodes, negative bone scan, last psa 7.8. Has anyone been in this situation and what treatment did you choose? Dad is leaning towards hormone therapy (2 years), brachytherapy followed by ebrt but is also considering surgery. Is this suffice to treat the vesicle spread? I would greatly appreciate any feedback or advice…thank you!

[Tall_Allen]

I'm not sure why surgery is even a consideration, given its weaker cure results:

prostatecancer.news/2018/03...

If he can get a PSMA PET scan, he should. Here's the probability that a PSMA PET scan will find metastases:

uclahealth.org/radonc/psma-...

The best kind of brachytherapy for the job is high dose rate brachytherapy because it can reach seminal vesicles whereas low dose rate brachytherapy (seeds) can't. It also has lower risk of side effects. If he is in Toronto, Gerard Morton at Sunnybrook is a good expert to talk to.

[ChloeSS in reply to Tall_Allen]

Thank you! We are not in Toronto but could get there. I am going to look into having him ask for a referral. The HDB was mentioned on Princess Margaret’s page as well as the preferred method for high risk. I don’t want to create delays, but want him to get the best care possible.

[Tall_Allen in reply to ChloeSS]

While he is on ADT, the cancer won't progress. That will give him all the time he needs to make appointments.

[Justfor_]

I was 69.5 yo, PIRADS 5, GS 4+4 as per biopsy, same PSA but slowly mounting. I elected RALP at a top center in Germany. The latter was the strongest decisive factor. First choose where, then what treatment. Pathology revealed GS 4+5=9 and left seminal vesicle invasion. 3 years later I am happy with my initial decision. This forum is opinion skewed towards RT although the vast majority of the members here had RP as primary treatment. I know that I will have to be irradiated some point in the future but try to postpone it due to the late toxicities and possibility of secondary cancers that nobody talks about up front.

[GP24]

I would recommend surgery. This will also remove the seminal vesicles. Plus you do not have to get two years of ADT then.

[London441 in reply to GP24]

Surgery removes the seminal vesicles but is unlikely to remove all the cancer around them. It’s not as good a choice as radiation, but it is good if you are afraid of radiation and don’t mind probably permanently losing your erectile function. You also will likely need radiation later anyway so there’s that.

[tango65]

I would not do any treatment until having a PSMA PET/CT to have the most sensitive staging of the cancer:

urotoday.com/conference-hig...

pubmed.ncbi.nlm.nih.gov/327...

The staging with PSMA PET/CT may change the plan of treatment. If he has several distant metastases local treatment may no be indicated and triple therapy with ADT, chemo and abiraterone should be treatment of choice.

He may have lesions in pelvic lymph nodes and radiation , plus brachytherapy and 2 years of ADT and abiraterone could be the most adequate treatment.

[tad4]

ChloeSS, just to ease your mind a bit, my PSA was 8.6. PSMA-CT Scan followed by biopsies showed a Gleason Scale of 9 (4+5). I then went straight on ADT (Zolodex) for 9mths (because I had heart issues and couldn't have Brachytherapy straight away). I had 3 doses of HDR during my hospital stay, then that was immediately followed by 23 sessions of EBRT. I am now off Zolodex after 12 mths and my PSA is now .008 (after 2x 3monthly PSA Blood tests). I will be having another PSA in August plus a Bone scan, fingers crossed, I will be ok. So all is not lost with your Dad. You need a good Urologist and Oncologist on your team. Good luck.

[Chrisbaird]

H Treatment injection monthly for 3months then on a 3 monthly treatment Zytiga 500gm daily on empty stomach with 5pm prednisone with breakfast an hour later from being PSA 20 2 years ago. I’m last year 0.01> with blood tests monthly good luck with treatments

[maley2711]

ChloeSS -

Memorial Sloan Kettering here has several helpful nomograms that will perhaps put your Dad's situation in perspective......this first nomogram is based on results on thousands of patients treated at MSK and followed for many years..... it gives probabilities for outcomes from surgery based on the variables used in the model........

mskcc.org/nomograms/prostat...

The 2nd nomogram reflects adjustments made for the American population, and is based on a study conducted in Europe of men who at least initially chose to forego treatment. From results I have seen when assuming various risk categories for such men, for most diagnosed non-metastatic men age 70 or older, it appears the risk of dying from the PCa is less than from other causes even when treatment is initially forgone...........

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

The 1st nomogram indicates that risk of dying from the PCa is substantially less when a treatment is pursued.

[BellaS60]

My husband was diagnosed with PSA 455, 13/13 positive G7, T3b-in seminal vesicles, with one suspicious node at 67 yo. Surgery would not "cure" and nerves would not be spared, so he went with radiation and 2 years of hormone therapy to skip the incontinence. He had most of the primary side effects, no mood swings or joint pain, but handled them with patience and humor. He's doing quite well 5 1/2 years from diagnosis with last PSA at 0.21. We do expect a recurrence at some point, but so far so good.

[ChloeSS in reply to BellaS60]

Thank you for the information, I hope he continues to do well!

[tsim]

I was pretty close to the same diagnosis except Gleason 3+4. He's actually very high risk as I was. Agree with TA, HDR brachy and External beam would most likely provide the best results.. I had very good results with only minor side effects and still undetectable PSA five years out. Hopefully no distant mets. Make sure you find the best brachy Doc you can.

[j-o-h-n]

Hello Chloe,

Listen to Tall_Allen.... You have time so do not panic (just like all of us did)....It's a good idea to add your dear Dad's info in the bio area on your/his home page.... Please keep living and laughing...... Your Dad will be around to see his Great grandchildren get married....Keep posting.....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 07/11/2022 12:56 PM DST

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

Thank you for the kind words and advice, it is very much appreciated.

[ShipModeler]

Very similar to my journey. I am 75 and during my annual physical my PSA came back at 8.0. Two weeks later the PSA had risen to 8.5. A PSMA revealed cancer spread to some lymph nodes. I was told I had stage 4 Prostate cancer and a Gleason score of 8. My Oncologist recommended a 3 month LUPRON injection and EBRT. I began with the Lupron to stem the growth of the cancer. Two months later I began a course of 28 EBRT. Two weeks after the last treatment I began taking Zytiga and Prednisone. My PSA has been .04 for the past 6 months. All labs are within normal ranges.