Gleason 8 on HRT

[Njugs]

I was recently diagnosed with localized prostate cancer Gleason 8, which fortunately was caught early. After initial discussions with my healthcare team, I've begun hormone therapy, receiving my first injection about three to four weeks ago, along with a 28-day course of tablets. This decision came after extensive research, including information from the Prostate Cancer Research Institute.

During a recent consultation with a prostate cancer nurse, we discussed my treatment options in detail. The standard protocol involves hormone suppression for approximately 18 months, followed by 20 sessions of radiotherapy. We also explored alternative treatments, including a clinical trial offering a five-day radiotherapy regimen (currently paused but expected to resume in August) and brachytherapy, which involves inserting radioactive needles into the prostate gland for targeted radiation.

I inquired about the necessity of a PET scan, but the nurse explained that my imaging to date hasn't shown any enlarged lymph nodes of concern. As a result, further imaging wasn't recommended when my case was discussed at the multidisciplinary team meeting. This information reassured me about the localized nature of my cancer and the appropriateness of the proposed treatment options.

The oncolgist compared external radiation and brachytherapy, highlighting that brachytherapy offers more focused treatment with potentially fewer bowel side effects. We discussed practical aspects such as hospital stay duration and recovery time for each option.

For now, I'm continuing with the hormone therapy while I research and consult further. I've been provided with detailed information on both the clinical trial and brachytherapy to review at home. A follow-up appointment is scheduled to finalize my treatment plan.

[Justfor_]

".... that my imaging to date hasn't shown any enlarged lymph nodes of concern. As a result, further imaging wasn't recommended when my case was discussed at the multidisciplinary team meeting."

Did the team warn you that since earth is shaped as a disk, if you get close to the rim you risk falling off to space? Silliness unlimited!!!

[Murk in reply to Justfor_]

Agreed, maybe they were trying to say something different??? I would ask them to explain.

[Justfor_ in reply to Murk]

Don't bother, unless you bump into a truly frank person who will tell you that PSMA PET/CT is an expensive imaging modality and a patient has to fail the primary SoC treatments to be considered for it. If you can afford it, go for it privately and spare the BS.

[maley2711 in reply to Justfor_]

PSMA PET has become SOC for Gleason 8-10 in USA.

[Prostateless2020]

Purely observational, from what I read, most of the long term or more serious issues with PC on this site are with men who opted for non-surgical procedures.

[Tall_Allen]

Unfortunately, UK doesn't yet approve PSMA PET scans for high risk patients. Absent that, you should be treated according to the POP-RT protocol:

prostatecancer.news/2021/08...

[Njugs in reply to Tall_Allen]

Yes, that is my understanding PSMA-PET is an American norm not quite adopted by NHS England.

[Surfer33 in reply to Njugs]

I’m not sure it is the norm here in US either yet. I had pet scan and bone scan , but not PSMA pet.

[NanoMRI]

How do you know it is "localized" without utilizing at least perceived best imaging? Six years ago I learned of PSMA imaging beginning as soon as 0.03 post RP at the Royal Marsden, where I was a private patient.

[Justfor_ in reply to NanoMRI]

They have this "ingenious" method dubbed: "Learn by trial and failure".

[Mgtd]

Nano I understand your point of view but there is a world of difference between the standard of free health care and the private system in England. Not everyone is blessed to have that option.

[NanoMRI in reply to Mgtd]

Yes, I agree. I had a small company and staff in Surrey and lived there too. I paid, out of my greedy capitalistic pockets for my staff's private health care insurance. No health care is free - I paid significant NHS taxes for my staff. (This is not a political statement - just acknowledging the challenges we all face and my experience base). IM humble O our systems are not all that different and we all would be better served taking the best of both.

[Murk]

Njugs, I dont care if your getting freed medical attention, if its paid for or somewhere in-between That statement is so freaking scary. I f they cant explain RUN!!!

".... that my imaging to date hasn't shown any enlarged lymph nodes of concern. As a result, further imaging wasn't recommended when my case was discussed at the multidisciplinary team meeting."

[Njugs in reply to Murk]

My understanding is that it is too late to consider PSMA-PET once you've started on HRT since it interferes with the reading. I completed one month of daily Bicalutamide 50mgs tablets and a Zoladex 10.8mg sub-cut injection.

[Justfor_ in reply to Njugs]

Your understanding is totally wrong. On the contrary, when starting getting an antiandrogen (literature exists for Enzalutamide, but Bicalutamide acts similarly) PSMA expression is boosted, hence, PET detection probability improved.

[Laguy01 in reply to Njugs]

I have been taking Bicalutide and just completed a PSMA a couple of days ago. My cancer has spread to a lymph node on the riggt side.

[babychi]

We are Aussies. We paid for the PSMA PET Scan privately. No Medicare funding in 2017. We wanted to KNOW. Cannot believe some of the absolute crap that nurses/medicos tell their patients. Get up to speed real quick. Your disease can kill if it is really a Gleason 8.

[Mike58]

For what its worth my DX is almost the same as yours. I did have a PSMA / CT scan in August 2023 (free in Australia) - and thankfully localised only. I didn't rush into any treatment, went on a 3 month holiday and then started my first 3 month Eligard injection in Feb 2024. Went on another 9 week holiday in March. Got back in June, PSA was 0.27 and I started 23 sessions EBRT using VMAT at 42GY. I did have barirer gel and gold markers done. 42GY dose is lower than normal because I'm having HDR Brachy. Being a lower dose means less chance of any damage to surrounding tissue.

I'm preparing to have HDR Brachy on Aug 13th and then another 6 + months of Eligard.

So far all going well, minimal SE's with HT. Never slowed me up while spending plenty of time overseas. The 23 sessions of radiation only causing some slight bowel irritation and a few more wee stops than usual. But nothing bad.

I'm expecting a few extra SE's from Brachy - but we will see.

Too be honest i'm feeling pretty well. Fatigue not bad at all. My RO is going for curative and is happy with how things are going at present.

My question is why are you are waiting for 18 months while on HT before you start RT. I believe the standard is 4 months of HT then RT. I'm no expert but my RO would never have suggested being on HT for 18 months b4 starting RT.

Anyway, all the best. Stress less is good and helps with the overall treatment journey.

PS: There's a great contributor on this forum named Tall_Allen - he has a great knowledge and was instrumental in my selection of treatment.

[conbio]

66 yo at diagnosis. G 4+5, localized to gland. I went with what was suggested in the ASCENDE-RT Study and as suggested my oncologist/radiologist for high risk. 18 months ADT (Lupron), 24 sessions of EBRT, and Brachy.

A year out from treatment still strong, climbing, mt biking, backcountry skiing. 2 week Sierra climbing trip in August. 😀

See: redjournal.org/article/S036...

[WisdomSeeking]

An UK user paid £850 for private PSMA PET scan. See: healthunlocked.com/advanced...

[Njugs]

sorry, I have made some mistakes with the initial post. Below is a clearer picture:

Initially in meetings with urologists and nurse I was informed my choice is between radical surgery and hormone therapy + external beam radiotherapy after 3 months. However in subsequent appointment with an Oncologist I was encouraged to consider high dose rate brachytherapy and given a new booklet to read. We also discussed an upcoming clinical trial - PACE NODES. This Trial is evaluating 5-day treatment of just the prostate or prostate and lymph node region.

Diagnosis:

PSA 8.7

MRI scan 43 cc prostate, PI-RADS4 stage T2NO

Transperineal prostate biopsy 8 out of 30 co adenocarcinoma prostate, maximum core length 7 ,

T2NOMO

Otherwise fit and well

Previous cholecystectomy

[maley2711 in reply to Njugs]

That is nuts..... RP, external RT + ADT, and external RT + brachy + ADT are all SOCs!!!!! Some studies have shown brachy boost to have best results. I had external RT +ADT + RT boost to the dominant lesion...there is one or more encouraging studies for that RT boost approach.....brachy boost has higher risk of long-term urinary problems.

Best of luck!!!