Seeking advice for a fellow Warrior

[Doseydoe]

I was asked by the President of our Prostate Support group to help a 75 yr old gentleman who has just been diagnosed with PCa. Gleason score 8, PSA 8.0. I was wondering what everyone thoughts on what his treatment options might be, thanks DD 😎.

[witantric]

TA can comment more. But the best treatment for high risk stage is brachyboost+ADT. I had a friend get it few years back with almost same metrics. He is still doing quite well.

[Doseydoe in reply to witantric]

Thanks for your reply, I'll share it with them in the coming days.

[leach234 in reply to witantric]

I was also Gleason 8 with PSA 5.2. Bone scan and CAT scan showed no metastasis. I had surgery and 5 years later my PSA is still <0.02 with no ED or incontinence. Surgery is the way to go. Radiation can always be used as a follow up if needed.

[London441 in reply to leach234]

We don’t have nearly enough information on this man to know if ‘surgery is the way to go’, but for a 75 year old with a Gleason 8 it almost certainly is not.

[leach234 in reply to London441]

Why not if he’s healthy.

[London441 in reply to leach234]

I was 63 when I had RP and in peak health. I wouldn’t have surgery again if I were 50.

He may be healthy but he’s still 75. Need to know just how healthy, and if sex is still important to him. Even then it also depends on his stage. With Gleason 8 RP will likely not be enough and therefore not worth it, though I’m happy for you.

[leach234 in reply to London441]

That’s your opinion and your entitled to it. But I speak from actual experience being a Gleason 8 with similar PSA and I say surgery is an excellent option.

[London441 in reply to leach234]

My opinion is also based on experience. My contention is that your outcome (from RP alone) is not typical of RP for Gleason 8 cancer. But of course it’s all about spread, or the absence of it.

I’m glad your RP was a success. Mine, although done at a major center of excellence with a top surgeon, left me with a shorter, thinner penis and severely compromised sexual function. Also incontinence so heavy and protracted as to necessitate an artificial urinary sphincter. This despite excellent former function and diligent rehab. Extensive additional treatment was needed also.

The incontinence admittedly is an uncommon side effect of RP. The changes in penis size and function are not, and this is information frequently not given pre op to patients by urologic surgeons.

RP failure rate is 30% statistically, and that includes the poor souls who get it with a Gleason 6, who should be on AS. Taking one’s chances on RP with Gleason 8 would not be an option for me.

[Tall_Allen]

Any idea of his stage? The first order of business is to get a bone scan/CT to stage him.

1. If he is M1, he should discuss triplet therapy, and have prostate radiation after chemo.

2a. If the cancer is localized on a bone scan/CT, he can go ahead with the tried-and-true therapy, which be IMRT with an HDR brachytherapy boost and 1 year of ADT.

If localized on a bone scan/CT, he should also get a PSMA PET/CT:

2b. If N0 on the PET/CT, he can go ahead with the brachy boost therapy+ADT.

2c. His odds of a cure are less with surgery, but that is an option. See this nomogram:

mskcc.org/nomograms/prostat...

2d. If it is N1 on the PET/CT, he should also have whole pelvic IMRT with a boost to the N1 metastases.

2e. If it is M1 on the PET/CT, he should have systemic therapy.

3. If his stage is T2b-3b or N1, on a bone scan/CT, they are running the following clinical trial in Australia, which he should look into:

clinicaltrials.gov/ct2/show...

[Doseydoe in reply to Tall_Allen]

Thanks very much, I'll pass it on.

[Doseydoe in reply to Tall_Allen]

He has had a PET scan and was told it's confined to his prostate. No metastasis. Yet to know yet of his actual stage. He has his first meeting with an oncologist today post the PET and hope to have a cuppa afterwards with he and his wife to talk through his options. Thanks again.

[Tall_Allen in reply to Doseydoe]

Sounds like he's a good candidate for brachy boost therapy+1 year of ADT.

[Magnus1964]

It would depend on his general health other health issues.

[Doseydoe in reply to Magnus1964]

Hi Magnus, I was told today the PET scan highlighted take-up in two lymph nodes and his Gleason score of 8 is Grade 5 - PSA of 8.8. His oncologist has recommended a 3 month Lupron shot and 40 sessions of radiation. Seems pretty drastic, would Casodex be something to consider? He does have underlying heart issues post a previous heart attack.

[Magnus1964 in reply to Doseydoe]

He could try Casodex

It is a older ADT drug with few side effects. Considering hid age and a cardiac condition, plus the cancer has gone beyond the prostate, it's a difficult call. First, why are they doing surgery if if the cancer is outside the prostate? That's a crap shoot, even with the advanced scanning these days.

He could spend the rest of his life on ADT drug and never see chemotherapy.

Magnus

[Darryl Partner]

your 75 year old man should join our online community today. That way he can ask his questions directly when ever he wants. More than a third of our community is 70 and up.

[Doseydoe in reply to Darryl]

Hi Darryl, I have made the suggestion but both he and his wife are not confident to use online forums. I will try to coax them along as it would be best to remove me as the middleman, cheers DD 😎.

[PopCubby]

Has your friend reached out for a second opinion? It made a world of difference in my case.

I was diagnosed as Gleeson 8 at age 73. I then had my biopsy slides sent to Johns Hopkins and Fox Chase for second opinions. They both downgraded me to Gleeson 7. I decided on 2 HDR Brachytherapy implants at Fox Chase just over a year ago. I am now 75, and PSA was down to 0.3 in October. I am pretty active; exercise most days and play softball 2-3 times per week. Also, my sexual function has recently returned to close to my pre treatment level.

Best of luck to your friend.

[j-o-h-n]

75 years old hmmmm It's like living with your girlfriend for a couple of years before you make a decision to marry her or not. Take the wait and see option.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 02/01/2023 9:11 PM DST

[Doseydoe in reply to j-o-h-n]

Hey John, I chose to marry. How about you? DD 😎