I am trying to make a decision regarding HT with RT.
I am 78. I have CKD 3b, and a solitary kidney. I am 6.5 years in remission from UTUC kidney cancer. A number of papers indicate that HT could be detrimental to my kidney.
Those with FIR PCa could avoid HT with little risk. The following is defined as:
Favorable Intermediate Risk (FIR):
- NCCN intermediate risk, as defined above, but only those with
- Predominant Gleason grade 3 (i.e., Gleason score 3+4 or 3+3), and
- Percentage of positive biopsy cores <50%, and
- No more than one NCCN intermediate risk factor
Am I FIR,or marginal FIR, or unequivocally UIR? I want to avoid HT.
I believe I am T2c The urologist said T2a because of only a tiny amount of PCa on the right side. I think Tall_ Allen said I was T1c because the DRE was normal - but how good was the urologist in performing the DRE?
Gleason, 3+4, ie 90% of 3 and 10% of 4 on the left side and 3+3 1% on the right side. PSA 13.1 in July 23 and 14.32 Nov 23.
36cc prostate, normal DRE, Grade 2, biopsy 6 out of 15 samples positive. - 9 mm, 5 mm, 1.3 mm - although MRI was 14 mm.
Even if I were UIR, the mean benefit of HT with RT (it will be IMRT) mean overall survival was only 0.7 years longer with ADT. Distant metastasis was improved.
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Nordman
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"Normal DRE" means you are stage T1c, not T2a - your urologist is not following current guidelines. NCCN risk stratification is based on AJCC 8th edition for staging.
The urologist initially said T2a then agreed it could be T2c when I said strictly speaking there was PCa on both sides of the prostate albeit one side was tiny. I take your point re T1c, but I was told that doctors are sometimes not good at DREs. I think you may also have said that. Can I trust T1c? How important is the distinction between T2a and T1c?
Most importantly for me, given my stats shown, am I Favourable Intermediate or Unfavourable Intermediate.? I would really like to get your interpretation. If it was a continuum, am I FIR or URI or hopefully close to FIR? You will gather that I really want it to be FIR or close to it. Due to potential risk to my solitary kidney, I want to avoid HT.
As I wrote, "T stage based on DRE only. Imaging is never used. (Nor is biopsy)." It is certainly not based on a "perfect" DRE that you imagine. Almost all patients are T1c (78%) or T2a (13%).
The definitions are as follows:
The NCCN intermediate-risk group is currently defined as having any of the following:
- Stage T2b or T2c, or
- PSA 10- 20 ng/ml, or
- Gleason score = 7
(If multiple risk factors are present, the clinician may optionally deem it high risk
Unfavorable Intermediate Risk:
- NCCN intermediate risk, as defined above, plus
- Predominant Gleason grade 4 (i.e., Gleason score 4+3), or
- Percentage of positive biopsy cores≥ 50%, or
- Multiple NCCN intermediate-risk factors
Favorable Intermediate Risk:
- NCCN intermediate risk, as defined above, but only those with
- Predominant Gleason grade 3 (i.e., Gleason score 3+4), and
I couldn't quite get a handle on the criteria despite repeat reading. Many thanks for your interpretation Tall_Allen. I respect your knowledge. It has lifted my spirits. I can now go forward with more confidence regarding my preferred treatment.
"Gleason, 3+4, ie 90% of 3 and 10% of 4 on the left side and 3+3 1% on the right side." This is (very) favorable immediate risk. I expect that you will not get bone mets that start to hurt during these 15 years.
You say very favourable intermediate risk, but the UK NICE classification system puts me in the high risk category. The UK Cambridge system puts me in the Group 3 category which is the same grouping for 4+3. Tall_Allen says according to NCCN, I am favourable intermediate. The urologist said I was T2a. When I queried this because of having PCa on 2 sides, he then agreed I was T2c. Tall_Allen says I am T1c because of a non palpable DRE. Another source says that due to my MRI scan showing a 14 mm tumour I am T2c. These different classification systems are all so confusing.
Anyway, being 78 next week, I would love to not have any treatment, and carry on as normal, but am nervous to do that.
My husband is Gleason 7 (4+3) Unfavorable Intermediate, T1c. He also has stage 3 CKD with a solitary kidney. He did 45 rounds of RT along with 6 months of Orgovyx with no issues. Nephrologist says his kidney function is stable and unchanged after treatment.
Effects from 40 doses of external beam radiation were minimal at first and have none now. I had and have the usual side effects from Lupron. 10 years later two major issues are fatigue and hot flashes. My Gleason was 4 + 3 (10 of 12 samples cancerous). Don't recall T stage. I saw a kidney specialist for a number of years and he never mentioned my eGFR . About 5 years ago he said I did not need to see him any longer. I did not research Lupron and kidney function. Neither my urologist (who removed my kidney and did my prostate biopsy) or my radiation oncologist or my kidney specialist mentioned the issue. Your post was the first I heard of it.
You should ask for an eGFR blood test which will indicate how well your solitary kidney is performing. My single kidney eGFR is 42, so functioning at about 42%. They usually only give you a figure of up to 60 and not beyond, so 60 could mean 60% to 100%.
I wouldn't slice and dice the classification any further: Protect your remaining kidney function and skip the ADT. Impact on results of the RT are likely small and a lesser priority IMO.
I am just trying to calculate the risk of no HT, or even opting for A.S. It's a bit of a dilemma. The problem is if I opt for no HT and get recurrence, then it is permanent HT.
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