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  • How dire is this path report. Gleason 5+4

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    Old 06-07-2021, 06:55 PM   #16
    IADT3since2000
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    Re: How dire is this path report. Gleason 5+4

    Hi Djin and thanks for responding to my earlier question. I hope that John and others will benefit as we seek to sort through this issue. I hope to look at this in more detail soon, but I have some immediate thoughts. You wrote in part:

    Quote:
    Originally Posted by DjinTonic View Post
    Radical prostatectomy versus external beam

    radiation therapy for high-grade, clinically localized prostate cancer: Emulation of a target clinical trial
    (2021, Full Text)

    https://www.sciencedirect.com/science/article/pii/S1078143921001277?casa_token=QeJqvl0i2d8 AAAAA:tJOeWvuWzKPEcQ7ZElXqBs1O_qsCpW20Kj fsQWzYrGY92kPkgI2yKUb5t1ijTuAAIggUOYKW

    "Highlights

    • We conducted observational analyses to emulate a hypothetical target clinical trial of RP versus EBRT+ADT for high-grade prostate cancer

    • RP was associated with improved OS compared to EBRT+ADT (HR 0.54;95% CI 0.48-0.62; P<0.001), with 5- and 10-year OS of 93% vs 87%, and 76% vs 60%, respectively

    • RP was associated with improved OS across all categories of Gleason score, PSA, cT stage, age, and Charlson comorbidity index examined"...
    There is a strong whiff of something very fishy here. First of all, this is an emulation of a trial rather than a true trial, where results for high-risk cases look noticeably favorable for radiation; I hope to address the validity of PSA recurrence data shortly. Second, the overall survival (OS) figures used, even with short follow-up of five years, are really poor for the projected results for both surgery at 93% and radiation at 76% compared to typical overall survival odds I am seeing in research based figures, which are close to 100% survival at five years for men who would have been getting curative attempts with surgery and radiation. Something is up here, and we need to find out what it is.

    Looking forward to the hunt,

    Also, what you posted about less aggressive high-Gleason cases is something I hadn't run into before but looks plausible. I'm interested in pursuing that. We live in a rapidly changing prostate caner world.

    Jim

     
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    Old 06-08-2021, 08:49 AM   #17
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    Re: How dire is this path report. Gleason 5+4

    It is my understanding the surgery/radiation/ADT combination is the most successful when applied to the profile who benefit the most.

    It's obvious one must approach this choice with an eye to overtreatment. If it's what you need, there is no proven substitute for it, at the moment and imo.

    Regarding the smell test, I'm not yet convinced radiation/ADT is the best one size fits all treatment mode. I couldn't be happier with my surgical prostate cancer cure; no BPH; no radiation and risk of radiation's side effects immediate or long term; no deprivation of my dwindling testosterone; no ED; no incontinence. My life expectancy is 20 more years. My mother just turned 100 years old. Grandfather lived until his mid 90's after early RP surgery. 5 year survival rates is not a high enough bar for me. Maybe a 5 year recurrence free stat might turn my head. But, I'm interested in a 10 year and more free of recurrence stat.

    The only real loss, for me, is the prostate's erogenous zone. Nothing there to tickle anymore.
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    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
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    1-15-21 PSA less than 0.02; zero club 4.5 yrs

     
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    Old 06-08-2021, 12:50 PM   #18
    Terry G
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    Re: How dire is this path report. Gleason 5+4

    John, with your challenging diagnosis I would recommend seeking out the advice of the highly skilled radiation team at team at Fox Chase. The very best can make a huge difference. Micro metastasis cannot be picked up by scans and no one can guarantee the degree of spread. Surgery as a monotherapy even by the best surgeon probably has a 50% success rate.
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    Old 06-08-2021, 12:59 PM   #19
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    Re: How dire is this path report. Gleason 5+4

    Thanks Terry! That's my goal... go with the best team that I can find.

     
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    Old 06-08-2021, 01:05 PM   #20
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    Re: How dire is this path report. Gleason 5+4

    Quote:
    Originally Posted by Terry G View Post
    John, with your challenging diagnosis I would recommend seeking out the advice of the highly skilled radiation team at team at Fox Chase. The very best can make a huge difference. Micro metastasis cannot be picked up by scans and no one can guarantee the degree of spread. Surgery as a monotherapy even be the best surgeon probably has a 50% success rate.
    Surgery is monotherapy for high-grade disease only if the path report indicates the PCa was prostate-confined and there is no persistent PSA. If not, in the conditions I posted above, adjuvant RT (+/- ADT) completes primary treatment.

    ADT for invisible micromets outside the pelvis is no different for men having RR or RT. The difference is that post-RP PSA is a precise measure of what's going on; PSA post primary RT definitely is not. This is a crucial difference.

    Whether surgery alone was successful is known shortly after surgery. ADT is needed to render PCa cells more sensitive for men choosing RT. Micromets outside the pelvis will make their presence known; ADT isn't going to eliminate them and ADT is not given prophylactically for men like me, for whom RP was successful monotherapy. Two years of ADT is no walk in the park.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 06-08-2021, 02:13 PM   #21
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    Re: How dire is this path report. Gleason 5+4

    Hi Djin,

    I know you have given the surgery versus radiation question a lot of thought and have concluded that surgery is a worthy option for high-risk cases, as have some experts. Here is my view of your comments from a viewpoint that sees radiation first, skipping surgery, as a sound option.

    Quote:
    Originally Posted by DjinTonic View Post
    Surgery is monotherapy for high-grade disease only if the path report indicates the PCa was prostate-confined and there is no persistent PSA. If not, in the conditions I posted above, adjuvant RT (+/- ADT) completes primary treatment.
    Yes, that mostly makes good sense to me. I'll go further and say that positive margins often prove harmless in the long term, not requiring treatment. By "persistent PSA" I take your meaning as an ultrasensitive PSA that is rising, especially when it passes 0.04 and continues upward.

    Quote:
    Originally Posted by DjinTonic View Post
    ADT for invisible micromets outside the pelvis is no different for men having RR or RT. The difference is that post-RP PSA is a precise measure of what's going on; PSA post primary RT definitely is not. This is a crucial difference.
    You are focusing on micromets outside the pelvis. Inside the pelvis, there is a definite difference, with many of us at sufficient risk having both our prostates and pelvis treated by radiation, even though there are no specific targets in the pelvis. That difference looks important to me, because research in the past half dozen years, using our now powerful, advanced scans, has shown that a large proportion of metastases early on are in the pelvis and therefore within the kill range of pelvic radiation. My own treatment involved 78 Gy of radiation to the prostate and 46 Gy to the pelvis.

    So I agree that there is no difference between RP and RT for invisible micromets outside the pelvis, but the issue is a lot smaller for those who get pelvic radiation, thanks to what we now know about location of early metastases. RP patients are clearly running an added risk regarding invisible micro mets in the pelvis.

    I agree that PSA post treatment is much more precise for RP patients than for RT patients, but a lot is known about PSA patterns after radiation, and early clues about potential recurrence can now often be addressed with imaging and other testing. To me, the difference is in terms of usefulness rather than being critical, but it may be a "glass half empty/half full thing".


    Quote:
    Originally Posted by DjinTonic View Post
    Whether surgery alone was successful is known shortly after surgery.
    Most unfortunately, recurrences after surgery occur for many years; I've seen research indicating they can occur up to fifteen years after surgery, and that was the longest follow-up studied. Many of these will be quite mild, but some will be serious and potentially lethal if not dealt with, and sometimes even when they are dealt with. There is an abundance of research that demonstrates the long tail of recurrences after surgery and radiation, though prospects are usually better if the recurrences occur after a number of years have passed. I can provide links to studies if you wish to see them.



    Quote:
    Originally Posted by DjinTonic View Post
    ADT is needed to render PCa cells more sensitive for men choosing RT.
    That is partially true, partially false. Research has proven that patients do better who have intermediate-risk prostate cancer with a short course of radiation, and a longer course for high-risk patients, but patients at low risk (generally active surveillance would be the best course) and some favorable intermediate-risk patients do just as well with no ADT as they do with ADT, so ADT has been judged unnecessary.

    Quote:
    Originally Posted by DjinTonic View Post
    Micromets outside the pelvis will make their presence known;
    The trouble is that they often do not make their presence known for a long time, during which they often seed more metastases. Now, with advanced scans, these mets can often be spotted at a very early stage when there are fewer than a handful of them. To me, if a patient is at risk, it is wise to search out potential early mets with scans rather than waiting to be clobbered with serious, extensive cancer. I'm sure that makes sense to you too.

    Quote:
    Originally Posted by DjinTonic View Post
    ADT isn't going to eliminate them and ADT is not given prophylactically for men like me, for whom RP was successful monotherapy.
    While ADT won't eliminate micro mets, it often does knock them back, perhaps into a dormant state, though not forever.

    Regarding ADT to support RP for higher-risk patients, until recently research indicated there was no benefit. But I've seen mentions of recent research showing some benefit of supportive ADT for some RP patients, which runs counter to what we have accepted as conventional wisdom. I would like to learn more about that.

    Quote:
    Originally Posted by DjinTonic View Post
    Two years of ADT is no walk in the park.
    That is true for most but not all patients. I've heard experts state that about 10% of ADT patients get the benefits with virtually no side effects. (Unfortunately, not I.) However, effective use of known countermeasures will substantially reduce or eliminate most side effects, making ADT quite tolerable for many of us, including me. I am especially interested in the old diabetes drug metformin for countering a subset of ADT side effects, such as weight gain, increase in blood pressure, and the likelihood of metabolic syndrome. Metformin also appears to foster even better results from radiation, though the trial to prove that has not completed.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 06-08-2021, 02:32 PM   #22
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    Re: How dire is this path report. Gleason 5+4

    Jim,

    "However, effective use of known countermeasures will substantially reduce or eliminate most side effects, making ADT quite tolerable for many of us, including me."

    What countermeasures did you employ? I keep hearing that consistent and intense weight training is very effective.

     
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    Old 06-08-2021, 05:02 PM   #23
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    Re: How dire is this path report. Gleason 5+4

    Jim, "persistent PSA" occurs when a the post-RP PSA is detectable on the standard PSA test (i.e. the results are not <0.1) after an adequate waiting period, of course. This generally means that the are significant remaining sources of PSA that need to be investigated. For high-risk men, it often signals the need for adjuvant treatment. It is a term of art and is the subject of studies, which I believe use a criteria of post-RP PSA greater or equal to 0.1. In other words, a high-risk guy who is pT2 R0 N0 is still going to be advised adjuvant therapy if there is persistent PSA.

    Choosing RT instead of RP as primary treatment certainly is a valid option! I have always said that the major treatment algorithms/guidelines list both as basically equally valid options (barring specifics in one's status that clearly makes one a better choice). My point is that too many dismiss RP out of hand. I do not think that anyone choosing primary RT is making a bad choice.

    Please keep in mind that I am specifically interested in, and addressing, treatment for high-risk/high-grade disease. For these men, my point was that 2 years is a long time for those for who do not react well to ADT. And in my case, e.g. it may have been 2 years of overtreatment regardless of the effects (or perhaps not -- I'm not at all clear what's happening to pattern 5 PCa in the time it takes RT to exert its full effect).

    I agree fully about scans, and a newer-type scan may well be part of the workup after a high-risk diagnosis. D'Amico's validation of RP for high-risk is for prostate-confined or locally advanced high-risk/high-grade disease. I'm not saying RP is the way to go if distant mets (of any size) are identified at diagnosis.


    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 06-09-2021, 02:00 PM   #24
    john_ct1
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    Re: How dire is this path report. Gleason 5+4

    Well guys things just keep getting worse for me! I had a CT and Bone scan this morning. Bone scan was negative but the CT scan showed an enlarged pelvic lymph node measuring 3 cm x 2 cm... "Neoplastic etiology is suspected".

    So it looks like cancer has gotten out. I'm waiting for a call from my urologist. Does this rule out surgery and only leave RT, Hormones and/or chemo? I'm quite a mess right now.

     
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    Old 06-09-2021, 02:37 PM   #25
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    Re: How dire is this path report. Gleason 5+4

    GS 5+4 is very serious and you do have a high volume of cancer, so there is definitely a high degree of negativity.

    But on the positive side, your PSA score is only moderately elevated so there would seem to be a chance its still confined to the prostate. In addition, your cancer is an "adenocarcinoma" and that is a more typical, garden variety of PC that is very common.

    Due to your high risk situation, you'll definitely want to go to a top cancer center.

     
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    Old 06-09-2021, 03:57 PM   #26
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    Re: How dire is this path report. Gleason 5+4

    Hi again John. You posted:

    Quote:
    Originally Posted by john_ct1 View Post
    Well guys things just keep getting worse for me! I had a CT and Bone scan this morning. Bone scan was negative but the CT scan showed an enlarged pelvic lymph node measuring 3 cm x 2 cm... "Neoplastic etiology is suspected".

    So it looks like cancer has gotten out. I'm waiting for a call from my urologist. Does this rule out surgery and only leave RT, Hormones and/or chemo? I'm quite a mess right now.
    I'm sorry you got this disturbing news, but there is a silver lining.

    Yes and no on the surgery. IF that node is the only metastatic site for cancer, then you could have a radical prostatectomy plus either radiation or surgery to eliminate the cancer in the node. Surgery might still be a viable option if there are a few more micro mets that could also be eliminated.

    However, as neither the traditional technetium99 bone scan nor the CT scan are very sensitive, they very well may have missed additional tumors that are smaller - still relatively large, perhaps - than what they can pick up. The very good news is that you do not have widespread bone or soft tissue mets that can be detected by these conventional scans.

    As an informed layman, but still a layman, I would expect your doctor to want a definitive scan such as a Ga68 PSMA PET scan, an Axumin scan, one of the C-11 scans, or the new PyL scan to check for very small bone and soft tissue mets.

    Also, modern radiation is at least as effective as surgery and has an excellent side effect profile.

    Is the detected spot within the pelvis where radiation could wipe it out?

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

    Last edited by IADT3since2000; 06-09-2021 at 05:28 PM. Reason: Typo

     
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    Old 06-09-2021, 04:27 PM   #27
    john_ct1
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    Re: How dire is this path report. Gleason 5+4

    Jim,

    The node in question is in the pelvis. Since no matter what I would have to have radiation treatments then what about using radiation is the primary treatment and avoid all the trauma of a RP, especially when outcomes are fairly similar?

    Thanks.

    -John

     
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    Old 06-09-2021, 05:18 PM   #28
    DjinTonic
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    Re: How dire is this path report. Gleason 5+4

    Quote:
    Originally Posted by john_ct1 View Post
    Jim,

    The node in question is in the pelvis. Since no matter what I would have to have radiation treatments then what about using radiation is the primary treatment and avoid all the trauma of a RP, especially when outcomes are fairly similar?

    Thanks.

    -John
    Yes, you certainly could. (The RT regimes are different for RT when it is the primary treatment and when it is adjuvant after RP. The length of ADT may also differ.)

    If this were me, I would want a consul at a prostate center of excellence. There are quite a few around the country. An advanced scan could contribute much information about where any other mets are located. Given the severity of your status, I would want a consul that was tailored to me, rather than have to rely on general statistics. A center of excellence could give you their results with various treatment for men with similar diagnostic workups.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 06-09-2021, 06:00 PM   #29
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    Re: How dire is this path report. Gleason 5+4

    Hi John. You wrote:
    Quote:
    Originally Posted by john_ct1 View Post
    Jim,

    The node in question is in the pelvis. Since no matter what I would have to have radiation treatments then what about using radiation is the primary treatment and avoid all the trauma of a RP, especially when outcomes are fairly similar?

    Thanks.

    -John
    That's good news indeed!

    I see it the same way Djin does, and you are seeing your situation the same way that I am.

    Radiation technology has advanced since my treatment in 2013 when I had a dose to the pelvis as well as to the prostate. The big change is that SBRT, given over a period from 5 to 10 days, is the typical way cancer is knocked out in the prostate, whereas I, in contrast had 39 sessions over a period of 8 weeks. Those 39 sessions delivered doses of 2 Gy per day to the prostate for the full 39 days; during the first 23 sessions, an additional dose of 2 Gy per day was delivered to the pelvis, totaling 46 Gy. I could tell the difference on the 24th day when I no longer had the extra dose to the pelvis: the radiation machine took a shorter time to deliver the doses. That was the only difference I noticed. I've forgotten the time it took, maybe about 15 minutes on the table at the start including set-up and positioning, and I was off the table several minutes earlier from the 24th day and onward. These days, with a Gleason 5+4=9 cancer, you would probably be getting a combo of ADT plus seed implants plus IMRT or SBRT. If you decide on that route, or on any radiation route with ADT, it would be wise to discuss the value of being on metformin.

    Also, while the outcomes for surgery and radiation plus ADT are roughly similar, it looks to me like you get a substantial edge with radiation for high risk cases - it's not just a few percentage points higher recurrence rates with surgery, it's more in the range of 10 to 20 points depending on what studies you look at. Logically it makes sense as radiation can reach places that surgery cannot and can knock out cancer in the pelvis that cannot even be seen with scans. That said, surgery does cure a hefty percentage of men with high-risk prostate cancer.

    .....Jim


    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 06-09-2021, 06:08 PM   #30
    john_ct1
    Junior Member
     
    Join Date: Sep 2005
    Posts: 20
    john_ct1 HB User
    Re: How dire is this path report. Gleason 5+4

    Next week I'm consulting with the head of Urology at UPENN in Phildalphia.
    Thx -John
    PS. Just got off the phone with my urologist. He said I'm no longer a candidate for surgery. I'm meeting with a radiation oncologist on Friday.

     
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    The Following User Says Thank You to john_ct1 For This Useful Post:
    Terry G (06-10-2021)
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