A gleason 9 with a psa of 21 is an extremely high risk cancer. Since a gleason 9 tumor generates a small amount of psa for it's size there was a very high probability that the pc is growing outside the gland. Many doctors would have refused to do surgery on you. Was surgery done as a debulking procedure? Proton or any other mono therapy would not have been appropriate with your stats.
The next step should have been the first step, go on hormone therapy. Salvage radiation will have a very small chance of curing you and will only cause more side affects. Radiation to the entire lymph system is an option along with HT, and I would talk your oncologist about
it. Seminal Vessicle invasion usually means it has spread to the nodes and this was confirmed. The issue is that the nodes that were sampled are a different path than the nodes fed by the seminal vessicles. This and your psa would indicate more extensive lymphnode involvement.
I would read "Beating Prostate Cancer Hormone Therapy and Diet" or Prostate Cancer Basics" by Dr Stephen Strum. Books or recommendation by surgeons will not help you now as you are now in a stage that is above their training and skill level. Get a good medical oncologist that specializes in PC.
Good luck to you and it would have been better for you and other patients to have this type of information before you chose a treatment and not after.
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.