How dire is this path report. Gleason 5+4

Insanus

Having urinary issues was on factor in my choice for surgery. Can put out small fires now.

IADT3since2000

There are options to take care of BPH.

For a lower risk case, surgery moves up to equality with RT in my view if there is also a BPH issue.

For your case, surgery is potentially dangerous, as I posted before, and as I'm glad you have noted.

….Jim

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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, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 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.

john_ct1

Thought I'd give a quick update on my treatments thus far. Today I completed 23 total fractions of VMAT/IMRT. I tolerated treatment very well. Outside of a little burning during urination I have no side effects from the radiation. On November 1st I will be getting an HDR Brachy boost. About 5 weeks ago my MO added ZYTIGA+prednisone to my Eligard. I have minimal side effects from the ADT. My hot flashes were resolved almost completely by taking the antidepressant Effexor (it's quite miraculous). At least check my PSA is at <0.05 and my testosterones is undetectable. I will be on ADT for at least 2 years I'm told. I'm happy at how well I'm tolerating ADT! I think I owe this mainly to my rigorous daily exercising... weight lifting (I've actually added muscle mass!) and running, plus hiking and tennis several time per week. I also switched to a whole food plant based diet with a little wild caught salmon thrown in. Tomorrow I'm going for genetic testing. Between treatments and doctor visits I'm gratefully living my life to the fullest. Thank you all that post previously to this thread educating and encouraging me!

-John

__________________
57 yo, family history of PCa, PSA 5.7, Free PSA 8.43%, DRE Neg, 5/26/21 Biopsy: Gleason 9, Grade 5, 16 of 20 cores positive mix of 5+4 and 4+5. Stage IVa, cT2N1M0, CT shows a 3cm x 2cm diseased pelvic lymph node, Bone scan neg, 6/16/20 1st Firmagon injection, 7/14/21 switched to 4 month Eligard injection, 9/15/21 started Zytiga+Prednisone, 10/20/21 completed 23 fractions of Proton VMAT/IMRT, 11/01/21 HDR Brachy Boost, 10/21/21 47 gene mutations tested all negative.

HighlanderCFH

Hi John,

Thank you for the update. Seems like you are tolerating the treatments well and I hope & pray that this also means you will react -- in a curative fashion -- to the treatments in the same way.

My case was, in no way, as serious as yours. But, if it serves as any inspiration, I had my 10th annual post-op PSA test yesterday & already have the results. Ten years after my treatment, my PSA remains undetectible.

And I pray the same for you!
Chuck

john_ct1

Excellent news Chuck! Thank you!
-John

HighlanderCFH

You're very welcome, John!