Prostate Cancer Treatment Advice - Prostate Cancer N...

Prostate Cancer Network

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Prostate Cancer Treatment Advice

GEECGEE
GEECGEE

I was diagnosed with prostate cancer in March 2019. I live in Omaha NE. I had a pre-treatment PSA of 3.8. My biopsy had 50% positive cores (7/14). Gleason 3+4 = 7. Unfavorable intermediate based on number of positive cores. stage II. I was 56 at time of diagnosis and am 57 currently. I was also diagnosed with kidney cancer in January 2019 and had my right kidney removed in February 2019. Subsequent scans for my kidney have been clean. Otherwise in good overall health.

I’ve been under the care of an oncologist and have been taking Bicalutamide since being diagnosed. Had been checking my PSA every three months and now it’s extended to every six months. December 2019 PSA was 2.3. April 2020 PSA was 2.2. Will go back to Oncologist for 6 month check up next week. Also had a full body PET scan in 2019 and my bones were clean.

I’ve also been visiting a urologist who recommended active surveillance. In addition I’ve visited with a radiologist who recommends surgery. My oncologist recommends continuing active monitoring while taking Bicalutamide, as long as PSA is decreasing or not increasing.

At this time I don’t have a treatment plan beyond what I described. Happily married and lifestyle is important to me. Interested in your thoughts of treatment and timing? Thanks for your help.

11 Replies

You seem to have too high a cancer volume of GS 3+4 for active surveillance.

Now that the kidney cancer is out of the way, you can focus on getting rid of the prostate cancer too. Good idea to get Epstein to take another look at your biopsy slides, since you are borderline:

pathology.jhu.edu/departmen...

Options you should investigate are surgery, SBRT, and brachytherapy. I don't know what is available in Nebraska. You may have to travel to get your preferred treatment.

What are the prostate MRI results?

I think you are doing great stay on casodex as long as your PSA is low. There are a lot of other treatments out thereso don't panic.

maley2711
maley2711 in reply to Magnus1964

wouldn't ADT treatments normally be used for cases of detected metatases, or PSA increases after surgery , radiation, TULSA, or other initial treatments?

Magnus1964
Magnus1964 in reply to maley2711

Not necessarily. Everyone is different and circumstances are different, age, health, etc.

LowT, you asked of my MRI results - below:

The prostate gland is 3.6 x 4.2 x 3.0 cm. This is a volume of 9 mL. The rectal prostate angle is acute. There is no asymmetric bulging of the prostate gland. Seminal vesicles show normal signal and morphology and appears symmetric. The urinary bladder is incompletely distended and partially included but appears normal.

Transitional zone: There is circumscribed hypointense/heterogeneous appearance.

In the anterior mid gland involving the anterior stroma area there is a area of T2 hypointensity that is 1.9 x 0.7 cm that has somewhat of the lentiform appearance. This is seen on series 501 image 12, TZA/AS, bilateral. There is associated decreased ADC map signal and heterogeneous T2 isointense high B0 value diffusion weighted signal.

Peripheral zone: In the mid left peripheral zone, PZpl, there is a area of mild hypointense T2 signal on series 501 image 12. There is moderate decreased ADC map signal and increased high B0 value DWI signal. This is seen on series 702 image 84 for example in series 501 image 12. This is approximately 0.89 0.7 cm.

Remainder of the transitional zone appears homogeneous on T2 images. No other definite diffusion signal abnormality.

IMPRESSION:

1. PI-RADS 4, left transitional zone - high (clinically significant cancer is likely to be present)

2. PI-RADS 4, anterior transitional zone, anterior stroma - high (clinically significant cancer is likely to be present)

HIFU might be a treatment option. Most urologists are unfamiliar with it.

was your biopsy targeted at those PIRADS lesions?

G(3+4=7) Grade 2 is a Favourable Intermediate Risk and I calculated the volume of your prostate with the numbers you gave and it is 23.75 cm.

I am 73 y.o. and my G(4+3=7) Grade 3 as Unfavourable Intermediate Risk. Had VMAT Hypofractionnated RT 3Gy X 20 treatments and ADT Casodex 50 mg X 30 days and Lupron Depot 22.5 mg/12 weeks X 2.

With that my PSA went from 20.4 to 0.03 ug/L and my Testosterone went from 15 to < 0.2 nmol/L or <5.7684 ng/dL. BTW I still have my prostate, too many other heath problems.

My PCa is dead.

You spent a great deal of time in your life studying. High School and maybe college? This is an important time in your life and what you do is very important. Not just for you but for your family. thanks to the internet, there are unlimited sources for you to study, Not just in the USA but world wide. For instance, HIFU was available for YEARS in Canada and Mexico before it was available in the US. The point is, don't jump to a wrong conclusion. STUDY, STUDY , STUDY. You have taken a good first step in going to a forum. that should just be your first step. Skip watching a football game onTV and spend that time on searching and studying the vast number of options for you. Learn about herbs, roots and berries, Diet (eliminate sugar) oxygen, etc.

Good luck and keep us posted. Ask tons of questions. Keep notes. Do NOT give up if you get "information overload".

Dwight

At 57 you should have surgery! I was 59 years old with a Gleason 8 and a PSA of 5.2 when I had my surgery 2.5 years ago. Now it’s like it never happened! No ED and no incontinence. PSA been <0.02 ever since! The key and I stress this is find a surgeon who has done thousands of surgeries. I used Dr. Thomas Ahlering at UCI in Orange, CA. Check him out on-line. He is world renown. One of only a handful of surgeons who has a video of one of his surgeries on youtube! People fly in from all over the world for him to do their surgery! You would be wise to do the same!

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