G6 and 7 momotherapy usually works, if there is a progression, such as rising PSA then radiation or HT can be given depending on local or systemic reoccurrance. A grade 4 is still regarded as an agressive cancer prone to advance, a grade 5 is worse.
The common opinion is that immediate HT will increase the cure rate, but others say wait until psa starts to rise. The faster you start HT the better the progonosis. Usually it is ADT3, Lupron, Casodex and Proscar for 13 months; new recommendations favor 24 months. There are other protocols like DES, but I don't know much about those or their effectiveness.
The best advise is to get an opinion from a prostate oncologist, where do you live? I have a list of Oncologists by area if it would be useful. You may have to travel to see a good one, but any recommended treatments can be done locally. The specialist can follow your treatment progress by email or phone consults, so you can have the best doctor following your treatment without having to travel.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.