Other Gleason 8 guys, I see in studies, research and in on going trials, Radical Prostatectomy shows better over all survival

[Shorehousejam]

On another site yana, ( you are not alone, a prostate survival story site)

a site of survival stores all the Gleason 8 with Radiology Prostatectomy, have longer survival, some guys are still alive after 10, 12 years and I talk to a few that actually had RP after metastatic spread… There are now trials on this and RT

So. doing this observation, what have other Gleason 8 or guys with ductal or crib form architecture have done?

I am hoping I can be a candidate for radical prostatectomy 

Please give your advice, experience and research… 

My Story Bio Caucasian Male DOB: 1961 

I have had Severe Plaque Psoriasis since 2003 

I have received Embrel, Stelera and Tremfya biologics but, no longer on an immune suppressant as of 03/18/2022 due to concern of advanced metastatic prostate cancer. 

Just started a pde4 inhibitor Otelza

Diagnosed By PSA Score 942.40 06/24-2022-07/06/2022 

Advance Metastatic De Novo Prostate Cancer with Ductal subtype with focal cribform architecture in carcinoma (it is rare, unfortunately aggressive) 

4 cores out of 15 with another questionable core with necrosis and questionable atypical cells 

Stage 4 Gleason 8 3 Lytic Lesions (unusual or rare) 

CT Scan, Pylarify Pet Scan, Bone Scan, 3T 3D guided MRI with write over 07/15/2022

Transperineal Biopsy Biopsy 07/15/2022 Prostate cancer (C61)

 DIAGNOSIS : 

A. Prostate core, left anterior apex, biopsy: Prostatic adenocarcinoma, Grade Group 4 (Gleason score 4+4=8) with ductal features, involving 5% (1 mm) of 1/1 core. 

B. Prostate core, left anterior base, biopsy: Prostatic adenocarcinoma, Grade Group 4 (Gleason score 4+4=8) with ductal features, involving 95% (13 mm) of 1/1 core. 

E. Prostate core,midline apex, biopsy: Prostatic adenocarcinoma, Grade Group 4 (Gleason score 4+4=8) with ductal features, involving 70% (9 mm) of 1/1 core. 

O. Prostate, MR target prostate core x5, biopsy: Prostatic adenocarcinoma, Grade Group 4 (Gleason score 4+4=8) with ductal features, involving 30%, 10% (2 mm, 1 mm) of 2/5 core fragments. 

K. Prostate core, left lateral apex x2, biopsy: Benign fibromuscular tissue with hemorrhage and rare atypical cells; cannot exclude reactive myofibroblasts.

 Started Firmagon 7/6/2022 Zytiga with Prednisone

7/20/2022 and Docetaxel Chemotherapy on

08/11/2022 Ductal Prostate Cancer is aggressive, it cannot be monitored by psa score alone. 

As it can still spread by low non existing psa numbers. 

My MO states that I express a lot of PSA

PSA 942.40 7/6/2022 

To 2.87 08/03/2022 

To 1.07 08/11/2022 

To 0.41 09/01/2022 

To 0.34 09/13/2022 Testosterone <7 

To 0.24 10/18/2022 Testosterone <7 

To 0.20 11/08/2022 Testosterone <7 

Started Extended release Metformin 11/15/2022

Started Otelza for psoriasis and that May of moved my PSA up,

I hope to God I’m not failing already,

MO is not concerned Up To 0.26 11/29/2022 Testosterone <7

Last cycle of 6 of Docetaxel on 12/20/2022

Emerging role of CRP with Metastases

tau.amegroups.com/article/v...

Emerging role of RP

misjournal.net/article/view...

To evaluate the oncological outcomes of ductal adenocarcinoma of the prostate (DAC) managed with radical prostatectomy (RP) or radiotherapy (RT) and optimize the proper treatment modality to DAC comprehensively.

.Conclusion

Among patients with DAC, treatment with RP was associated with better survival outcomes in comparison with RT. Patients with DAC in the middle tertile of the age and with lower tertile PSA level benefited the most from RP.

sciencedirect.com/science/a...

redjournal.org/article/S036...

[Jancapper]

I feel for you brother. Very difficult case. I am Gl 4+5 and for me, 2 yrs of ADT + HDBT + 25 sessions of EBRT offer me the best chance. I had my HDBT last week and begin my EBRT next week. Best of luck.

[Shorehousejam in reply to Jancapper]

Did you explore a RP option? How did you get to your decision of treatment?

[Jancapper in reply to Shorehousejam]

I did and my urologist actually talked me out of the RP and investigate radiation. I was deemed a good candidate for the HDBT boost and that is what I chose. You can compare different outcomes on this web site: cancer patient free.org

[Shorehousejam in reply to Jancapper]

I can’t seem to find cancerpatientfree.org

[OldVTGuy in reply to Shorehousejam]

I am in similar position as Jancapper. G 4+5 contained to prostate. Location of tumor made me not a good candidate for RP plus everything I read states similar cure rates using modern radiation techniques. I will start ADT in January radiation in March I expect. Every case is different you really need to do a lot of research

[Jancapper]

So sorry, must be the Lupron. Try prostate cancer free.org

[Shorehousejam in reply to Jancapper]

know the feeling…thanks

[DesertDaisy]

My husband has Gleason 9 with both ductal and acinar. He had an RP in April 2021 and is doing well. The cancer was mostly contained, but found in one lymph node. You can read the details in my profile. He is doing well and feels good.

[DMohr011]

Have you done any genetic testing? I have broken MSH2 and EPCAM genes. These gene deletions usually mean colon cancer is in my future (50% chance), but for now APC is my first, and hopefully last cancer.

Gleason 9/10, grade 5, ductal form. Tumor was huge and protruded into my rectum leaving RT my only option. I chose Proton Beam. First treatment was the soc, lupron + zytiga, then cancer spread and removed from zytiga, added Keytruda, then 24 RT sessions.

1 year later I remain undetectable, and no meds since March. Still having lower end issues, radiation colitis, but I am A OK if that is it!

I wish you the best!

[Don_1213]

Looking at the chart for high-risk patients on prostatecancerfree.org - it appears surgery (RP) had the worst results. I'm confused.. are you referring to the same chart? The best results, as Tall-Allen will often mention seemed to be EBRT/Brachy/ADT.

It is also a bit of an issue - that results for current radiation treatments simply haven't been done long enough ago to gather long-term results. And since EBRT is a rapidly changing technology (new machines, new targeting programs, new diagnostic techniques allowing for better targeting..) it doesn't seem that issue will be resolved - ever. Studies with 10 year results are obviously using the treatment techniques of 10 years ago. Those techniques were abandoned years ago as better treatments evolved.

[Shorehousejam in reply to Don_1213]

When I look at 60yrs of age and surgery, I see 15 year survival, what do you see? As this chart is very confusing, I un clicked all and started over

[Don_1213 in reply to Shorehousejam]

Where do you see 60 years of age? There is no age component on the chart.

[Shorehousejam in reply to Don_1213]

Yes, I see that with ebrt, it’s all based on older models….now trials are going on with RP for Metastases

[Don_1213 in reply to Shorehousejam]

If you go to: prostatecancerfree.org/comp... - and turn everything off except EBRT ADT, you'll see that the success of more recent treatments is much higher than the success of treatments given 10 years ago. That can mean two things, and perhaps both: Newer treatments are more effective; and/or - as the treatment ages it becomes much less effective.

Then if you add "Surgery" to the chart - you'll see a similar looking curve, but the success rate is never as high as EBRT ADT - and the success decreases fairly radically with age. Since surgery has changed with DiVinci being more commonly used - that could mean the DiVinci is just better than open RP, or it could mean that surgery in general isn't as effective a treatment as other options.

Finally - if you click on EBRT Seeds & ADT - you'll see a curve that absolutely outperforms surgery at any time period after treatment, and in general it outperforms many of the other treatment options. Despite that - if you look again at the EBRT ADT curve and look at 5 year results - they're close to equal to the 10 year EBRT Seeds ADT curve, meaning one of two things - the newer EBRT treatments (SBRT & high-dose boost) may be as effective as EBRT Seeds & ADT, or simply the effectiveness wanes with time.

I agree it's a confusing chart - but it also gives a lot of food for thought. The general conclusion I would make from it is - there are less-invasive and non-invasive treatment options other than surgery that seem to provide better success than surgery, which brings up the question of why do surgery (something the Prostate Cancer Research Institute has pointed out in some of the videos they have produced)?

[Shorehousejam in reply to Don_1213]

Yes, now I see that, it’s a difficult decision, so they are other options with radiation too…I’m going to have to do more research

[Shorehousejam]

 Tall_Allen and I’m reading this wrong, it looks good

To evaluate the oncological outcomes of ductal adenocarcinoma of the prostate (DAC) managed with radical prostatectomy (RP) or radiotherapy (RT) and optimize the proper treatment modality to DAC comprehensively..

ConclusionAmong patients with DAC, treatment with RP was associated with better survival outcomes in comparison with RT. Patients with DAC in the middle tertile of the age and with lower tertile PSA level benefited the most from RP.sciencedirect.com/science/a...

sciencedirect.com/science/a...

[Don_1213 in reply to Shorehousejam]

I would take into account that the SEER database data right now (as of April 2022) is from reported data from 1975-2019. So the newest data in the database is 3 years old. Is that significant? I can't say, but I can say there have been a number of rather significant changes in EBRT in that time period. In the study you quote - it appears they were using data going back as far as 150 months ago (12.5 years) - I would comment that it's certain that RT treatments given in 2010 are not considered state of the art today - and they were likely much less effective than current treatments, so the poor results from the older data may not be something you can make a valid comparison to.

I'll leave it to Allen who knows way more about the SEER database than I ever will - perhaps he might comment on the use of it. I have seen criticism about it's use due to inadequate uniformity of data collection, with some reporting institutions simply not providing what could be significant patient data (perhaps because they never recorded it.)

If I was diagnosed with ductal adenocarcinoma I'd consult with the smartest medical oncologist who is current on treatment options and results and seek their advice. You'll probably find that sort of doctor at a major cancer center or a university medical school. I tend towards Columbia/Presbyterian/Weill-Cornell in NYC - they are very good and not difficult to get to for me. Hopefully, there is an equivalent near you.

[Don_1213]

Just a funny thing - I subscribe to a service that sends me papers meeting certain criteria. Today it sent me this one: academia.edu/21474189/Long_...

It is 8 years old - but it gives some interesting 5 year results for EBRT/ADT - as done 13 years ago. The latest treatments are a bit different - using a "BOOST" phase of the EBRT directly addressing the tumor(s) in the prostate. This became possible with better imaging and the radiation planning software that utilized the better imaging. I have seen results for the EBRT/BOOST/ADT treatment that are even better than these numbers at 5 years.

All is not doom and gloom - there is a lot of rapid progress being made in PCa treatments - what would have been a 2 year prediction of death 20 years ago now is often survivable and sometimes curable.

[Shorehousejam in reply to Don_1213]

From your mouth to God’s ears….I’ll take a look, appreciate your input