Can someone tell me what the G8 with 70% involvement portends? I guess it could have been worse if the 2 G6s were G8.
But if you have one g8 70% does it mean I am T the same risk as if it were 3G8s?
For all practical purposes you can ignore the two G6's and think of the result as one G8 70%, not 3 of them.
First have your biopsy sent to Johns Hopkins for a confirmation by Dr. Jonathan Epsteinpathology.jhu.edu/department/services/secondopinion.cfm
Depending on your age, your three options at this point seem to be:
1. hormonal therapy to shrink the tumor (RO's prefer this, surgeons not so much)
2. Surgery to remove the prostate
3. Radiation (if you go this route, I would recommend SBRT by Dr. Chris King at UCLA that can be done in a week and a half rather than 7 weeks five per week)
There are several other forms of radiation, low dose seeds brachy, high dose HDR brachy, IMRT etc. but most of them elapse 7 weeks 5 days a week.
If you have not already done so, have a TRUS trans rectal ultrasound, not painful, to measure the size of your prostate and then you can calculate your PSA density.
The results of bone scan and CT scan whether still contained within the prostate or escaped, etc will help with your decision.
Another thing to consider is who besides your spouse to tell. Male heirs old enough to underand, yes, elderly parents possibly not.
We chose to tell everyone as you never know who knows somebody who knew somebody that leads to an optimal treatment, plus you can never have too many people praying for a good outcome.
In your case you have clients so more considerations than I did, as was already unemployed/retired.
Seek out a medical oncologist and a radiation oncologst in addition to a surgeon or two as your medical team, and have the MO be the quarterback with you reserving the right to call audibles after hearing what each recommends.
Going on hormonal therapy first arrests future growth of the PCa while you have a finite amount of time to do your research and be comfortable with your treatment decision and timing.
MO's generally are of two types:
1. Monotherapy -milk Lupron as long as you can and then successively try other treatments one at a time until all remedies are exhausted. Given what we have today and what is in the pipeline, men can often die with prostate cancer rather than from it, but thoughts of death are way premature at this point once you get over the initial shock.
2. Cocktail approach. Throw everything you can at the beast hoping it cannot combat all of them. The downside is that if this fails (seems to have worked for me but as a G9 you never know) not much to fall back on.
I have an MO in Gainesville FL at Univ of FL & Shands who subscribes to the monotherapy appraoch and an MO in Marina del Rey CA at Prostate Onoclogy (Dr Jeffrey Turner an associate of Dr. Mark Scholz and Dr. Richard Lam at Prostate Oncvology Associates) who advocates the cocktail approach.
I still see both of them to keep a balance.
66 - DX 64 2/13 PSA 3.68 (6 mo doubling) Gleason 9 (4+5)
T1CN0M1B stage IV w. 7 of 12 cores worst ones 70% right PNI
oligometastatic at Dx 5 tumors 1 right sacro, 2 on
T4 & T9, none visible on 5-21-14 whole bodyscan
1st Lupron 4 month 3-28-13,
PSA down was 3.68, Zytiga June 2014
PSA < 0.01, T < 6 on 10/14,
Prostate shrunk from 50.4 to 15.0
Provenge in Sept & SBRT Radiation in Oct
Post Edited (LupronJim) : 11/10/2014 11:32:57 AM (GMT-7)