Newly diagnosed. No metastasis. What treatments should I take.

[VHB1969]

Diagnosed 26 November with prostrate cancer, Gleason score 9. Bone scan and abd. Ct scan 3 Jan. Results no metastasis. Seeing urologist Thursday 1/9/20. What can I expect?

[Magnus1964]

A lot will depend on your age, weight and general health. If you could provide that information I might be able to provide a heads up on some things.

[VHB1969 in reply to Magnus1964]

Age 68. Weight 306. Ht. 5-10. Diabetes controlled, sleep apnea use CPAP. Three stents places 2 yr ago. General good health.

[Magnus1964 in reply to VHB1969]

At you age and weight I would assume you will be offered radiation treatments. You might be placed on Lupron and/or Zytiga prior to the treatments. These are ADT drugs to kill off any second line cells.

[Tall_Allen]

There is one therapy that has better outcomes than all others for men with localized high risk PC. It is a combination of external beam radiation with hormone therapy and a brachytherapy boost to the prostate:

pcnrv.blogspot.com/2018/03/...

[A0007720 in reply to Tall_Allen]

Hey Tall_Allen,

For cases like this one of VHB1969, what do you think of the following article, which actually shows RP doing better than the "Kishan" treatment path for people with high Gleason number and low PSA?

For the case of VHB1969, I agree that the Kishan result & treatment path are probably the best. I myself am using that treatment path right now, with the HDR brachy boost still ahead of me. But darn it, when I read this article by Guo et al, in Frontiers in Oncology, I really start to question my own decision about treatment path I should have taken!

FYI, at diagnosis, earlier this yea my status was: age 57, Gleason 4+5=9, PSA 7.4, no metastatsis detected in MRI and bone scans, to extent that these scans can see; no other health problems.

Not sure if you realize it, but you're the Master Jedi to many of us on this site. Thanks for that.

frontiersin.org/articles/10...

[A0007720 in reply to A0007720]

My name's Steve, not sure why I chose to use my email address as my name on this site. Blame it on the damned ADT.

[A0007720 in reply to A0007720]

Another point, I had at first ignored that article by Guo. I saw all the Asian author names, and I immediately & stupidly assumed that the patient population was also an Asian population, the results of which would not be applicable to my own European American diet and genetics. Then I realized that these authors, from a Shanghai China hospital, used the US SEER database just as was used in other US authored studies such as that by Kishan.

[Tall_Allen in reply to A0007720]

Hi Steve,

I'm glad if I can tap into the light side of the Force.

You can't go by an analysis of the SEER database- it lacks the data needed for a valid comparison. Kishan used propensity score matching on data collected from top institutions (which have data that SEER lacks), and is about the best one can do without a randomized clinical trial. While they are both subject to selection bias, propensity score matching on a large, well documented sample easily trumps what Guo did.

[lavis]

Hi 1969!

I was in a similar situation and condition that you are in.

Diagnosed in 2012.

I was 70 at the time.

Had a Gleason of 9, PSA 8.

My urologist explained my treatment options.

I liked the idea of avoiding surgery and so did my Urologist.

I took Lupron shots every 3 months for 2 years and guided Radiation treatment for 8 weeks.

My PSA has been pretty steady at 0.12.

I feel very good.

Started exercising and lost weight.

It seems to be working for me.

You might want to seriously consider Tall Allen's advice.

His posts are quite impressive.

Good Luck!

[westof in reply to lavis]

Hmm... Hey Lavis, thanks for lifting my spirits!

My dx was 8/18 and I just turned 71.

G9,S3, high PSA 28 and no mets.

So far, I've had HDR Brachy, 25 days of IMRT, and Lupron, Zytiga and pred.

Basically, no SE's (except for libido, etc) and I lost 10 lbs (lost the desserts, kept the beer)!

PSA 0.014 and the rest my tests are better than before APC. Well...except for hemo ,My MSK Mo said ("very slight anemia").

Keep on truckin!

Best,

AJ

[lavis in reply to westof]

Hey, AJ!

Looks like your doing great.

I envy your PSA number.

Best of luck to you!

Lavis

[Handdrummer777]

Follow Tall_Allen's excellent advice. The treatment trifecta he's describing also has clearly better outcomes for erectile preservation vs RP. ADT can be a big challenge in that area but there are certainly ways to deal with it.

Best of luck to you! Keep us updated.

And of course, stay safe.