What's the chance of Mets.

My bone scan was clean a couple of times. It wasn't until they did a Pet scan they found METS

beazerman said...
Is the Gleason 10 a death sentence, or is this still potentially a treatable situation?

No it is not an automatic death sentence. If it remains capsule confined you have a decent shot at wiping it out.

Dont look back. Look forward. These biopsies are not perfect. They only sample tiny slivers. Did the urologist say what % of the troubled cores were cancerous?

You will get great advice here if you can share what the pathology report said (type it word for word).

You can't do any better than Dr. Chris King. He is a world class RO with an open, unbiased outlook.

Note that I, too have ulcerative colitis, and a number of RO's and MO's suggested surgery, which I had. My G was lower than yours', at 3+4. Trouble is a large tumor remained on my cavity wall, and I had to go through SRT, anyway. It fired up my colitis, added radiation proctitis on to of that, and it took me almost a year to come through that miserly.

Adding insult to injury, even after SRT my PSA never went undetectable. Do a lot of in-depth research quickly, get as many professional opinions as you can, and go with your gut. Take anecdotal suggestions, from those without your complications, as well meaning theories. Good luck!!

Bone scan was in November.

I have an MRI scheduled for later this week. Unfortunately, it is for a different issue. An ultrasound spotted a 3/4" diameter mass on my liver, and the MRI is to evaluate that. I'm trying to get the different doctors to work with my insurance company to expand the scope of the MRI to include by pelvic area so they can include the prostate. It makes perfect sense to me, requiring me to only have to endure the MRI once. Ultimately, it seems like it would be a cost savings to the insurance company also, but this is probably thinking outside the box a little bit. Of course, I'm hoping I don't also have cancer in the liver . . .

From what I have read, the trifecta approach seems likely with IMRT, brachy, and hormone therapy. Geez. What will the side effects of all of that? I was intending to advocate for the SpaceOAR because of my UC. Not sure if that is still called for with brachy.

Today has definitely been a wake up call. My peace comes from my faith in Christ and trust that my life on this earth is only transitory anyway. But still, I am hoping that a treatment plan can be implemented that will prolong my life that is characterized by quality so I an be there for my family.

A big decision looms. I've been aiming to work another couple of years to get vested in my employer's retirement plan. With all of this on the plate, I just may need to have a change of plans.

Hi beazerman. I would place great weight on expert opinion at a prostate center of excellent regarding their advice for your particular status. However, I would not rule out surgery from consideration unless, of course, your docs do. Your scan results will probably figure into their advice for your best treatment options.

Surgical management versus combination radiotherapy in Gleason score 9-10 prostate cancer (2020)

"Background: For men with Gleason score 9-10 prostate cancer, studies have demonstrated conflicting results on the outcomes from combination radiation therapy (ComboRT) with external beam radiation therapy plus brachytherapy boost versus radical prostatectomy (RP), with or without adjuvant radiation therapy (ART). Differences in patient selection and management may explain some of the disparate outcomes of prior reports. Methods: The Surveillance, Epidemiology, and End Results database identified 10,396 men managed with ComboRT versus RP (+/-ART). Competing-risks regression analysis with treatment propensity adjustment defined hazard ratios (aHR) for prostate cancer-specific mortality (PCSM), controlling for patient-specific demographic factors. To explore the possible effect of patient selection, analyses were conducted before and after excluding men from analysis if they had evidence-based indications for ART (adverse pathology, i.e. pT3-T4 or positive margins) but did not receive it. Results: Median age was 64 years; median follow-up was 69 months. Five-year PCSM was similar between patients treated with RP (with or without ART, regardless of pathologic features, N=8,934) and ComboRT (N=1,462) (6.9% vs 8.1%, aHR=0.94, 95% confidence interval [CI] 0.78–1.13, P=0.51). After excluding RP-treated men with adverse pathology who did not receive ART (N=4,527 excluded), patients treated with RP+/-ART (N=4,407) had improved 5-year PCSM compared with those treated with ComboRT (5.3% vs 8.1%, aHR=0.74, 95% CI 0.60–0.91, P=0.004). Conclusions: For Gleason 9-10 prostate cancer, ComboRT was associated with similar PCSM compared to RP, but risk-tailored surgical management may be associated with superior PCSM."

[Emphasis mine]

Keep in mind, as the Abstract explains, that the good results in the RP group applies to those men who either (1) had no adverse findings after RP or (2) had an adverse finding and completed their primary treatment with adjuvant RT. Excluded were men with post-op adverse findings who declined adjuvant RT. Note also that today most G9-10 men opting for RT have what is known as MaxRT: external RT + brachy boost + 12 months (avg.) ADT.

Djin

You're very welcome. Please understand that even though I opted for surgery after a G10 diagnosis, my intention is not to lure you away from radiation and push you toward surgery -- I think the RP and the RT routes in many high-risk cases may be equally valid. Even if your docs agree, you should, of course, make your own decision based on the many factors which I'm sure you're already reading about. I only brought surgery up because you didn't, and it tends to get a bum rap from many -- but not all -- here

Djin

Post Edited (DjinTonic) : 4/4/2021 8:24:36 AM (GMT-6)