70 Yrs old , healthy, active and no meds. Always proactive about my health, especially urological care. Upon mri showed some growth in prostate. Biopsies revealed adenocarcinoma In right transition zone, all other areas normal. Pathology also indicated perinueral invasion . Gleason score 4+3=7 .
What would be the most logical direction of treatment ?
Your PNI makes this more risky. Consider brachy boost therapy, but SBRT and HDR brachy monotherapies and surgery are options.
Hi TA,
What is the significance of perineural invasion? I'm a G3+4 and also considering treatment options. All the positive cores were on one side of the prostate and there was evidence of perineural invasion. Hasn't really been explained to me properly how this impacts on treatment options.
Cheers.
For you, not much. It mainly affects treatment vs active surveillance for low risk, and borderline high risk patients:
“A major hurdle to making further progress against prostate cancer is the lack of ways to accurately predict how a person’s disease will progress, making it challenging to know which treatment is best for each patient.”
frontlinegenomics.com/news/...
I do nothing after RARP 11/2017 and persistent PSA from 0,33 to 20,0 (10/2018) and now 13,7.
No symptoms, no pain so far and of course no side effects of treatments. Everybody has to decide for himself, how he wants to live the rest of his life. Fighting and taking the riscs of side effects or enjoying life as long as it may be possible. You can find my case searching for persistent PSA. So far there was nothing there which helped me to decide about treatment. And treatment with a median survival time of some months or even one year is out of the question for me. Somehow everybody has to cope that he will die anyway. By the way, ADT causes in some an aggressive development of the cancer. When those unhappy patients die, are they in the statistics of side effects or will they simpy increase the death rate of prostate cancer? cedars-sinai.org/newsroom/h...
And this isn't new. I found a study about this some years ago. If you go to pubmed you find a lot of studies which go in circles. For me I decided to wait till symptoms occur and then I will (may be) try some recommended treatment.
Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber within the prostate. When this is found on a biopsy, it means that there is a higher chance that the cancer has spread outside the prostate.
A simple RP procedure MIGHT not be the best approach.
Further testing and /or other options should be considered - perhaps seeds / RT even ADT might be considered ...
Sorry to hear of your diagnosis. I had the same 10 years ago at 72. After much reading and talking to men who had various treatments, I decided to have Proton Beam radiation Therapy . Ten years later, no side effects, no incontinence, no ED and no cancer. I invested nine weeks of treatments and the return was a normal healthy life.
Read the posts on this forum, doctors don't tell you the real story. Oh, by the way, Medicare payed for everything, my co-pay was $25.
God bless !
Jim
Hello Jim, This looks like your first post since you joined on May 7, 2016. Hell of a long typing class but I bet you're good at it. I'm glad to see you're 82 and beat the sucker for 10 years. Congratulations and keep on posting. Nice to hear a good story!!!!! BTW where are you located? (BTW = By the way).
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 06/13/2019 6:46 PM DST
75 and similar. I chose radical prostatectomy. My biopsy was a little graver than yours, with G8 in one core and G7 in the other, perineural invasion and involvement of the seminal vesicles on the right side. It was a choice, a bit contrary to the recommendations of the radiation oncologist and the medical oncologist. Time will tell for me. I am seven months post-op with non detectable PSA. A long time to go before I can consider myself in remission. I have achieved good bladder control. No erections as yet. Working on that, too. Good luck. The only "wrong" decision in your case would be to do nothing.
People here will tell you there particular situation and choice of treatment. In your case, with the semi-aggressive 4+3 Gleason, invasive treatment is recommended: either radiation or prostatectomy. Personally I chose RALP, the laparoscopic radical prostatectomy (age 68, Gleason 3+4) and have been psychologically better knowing that the prostate is GONE (post-op dissection of the prostate showed I was actually G 4+3). There is ED with this even with "nerve-sparing" surgery, but this can diminish in several months. Incontinence can occur, but usually subsides in 2 months. Despite what people say here, radiation therapy has its own side effects including ED and incontinence plus some other side effects. In any case, MY suggestion is that you consult with a medical oncologist, urologist, and radiation oncologist. Get their opinions and suggestions for treatment, then make your own decision based on the facts. Surgery was best for me, maybe not for you. But it is best to educate yourself and hear the recommendations of other specialists--especially a medical oncologist with experience with prostate cancer. Do the research. Good luck!
Thanks. Meeting with urologist tomorrow . I failed to mention that pelvic, abdomen and bones scans showed no involvement. Again, my concern is not Gleason score but pni .
I would hope for the 5 treatment Cyberknife radiation with a gleason of 7 it's on the borderline..I'm 72 and my Gleason was 9, had to go with 5 weeks radiation and Lupron injections..so far so good..
Good Luck
always get second and third opinions
I have set up appts. with radiologist and second opinions. If I chose RP, can't get in for consult til 7/31, but this dr is considered excellent in celebration , Fl Can I afford to wait til then for consult or do I need to get RP consult sooner
No hurry for RPD.... Pca is slow growing.....(my unlearned opinion)
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 06/13/2019 6:51 PM DST
Newly diagnosed. No metastasis. What treatments should I take. 
