.8 PSA and just diagnosed Gleason 8

welcome. I would think a second and higher level look at that biopsy sample would be in order for starters

Thanks Tall Allen. 2s was the correct number. What about complete removal of the prostate? Guess we won't know that until after the bone scan.

Let me add my welcome, although I'm very sorry that you have to be here.

Yes, the first thing you need to do is get the second opinion on your biopsy slides by Epstein or Bostwick. That's always important, but I think especially so in your case since you have a high Gleason and a low PSA, which is atypical. BTW, I also don't understand the 2s. Each core should that is positive should have a Gleason of 6-10.

Before you decide on a treatment you will need to learn about your options and interview doctors that specialize in each treatment. Besides surgery, there is brachytherapy and SBRT. Depending on your second opinion, you may want to consider a combo approach. If you tell us where you are, we can likely recommend some resources in your area.

And I would agree with thinking positive. Assuming your bone scan is clean (very likely with a low PSA), your chances of a cure are good. But be prepared to spend some time learning about this and we're here to help you do so. Good luck!

Welcome to HW, sorry you need to be here.

Take it one step at a time. Get the next test, you need a bit more info. Surgery might not be the best route for you.

The best thing you can do now is to learn about PC.
Ask all the questions you want - we're here most days,
Andrew

Thanks guys. Am in Meridian, Mississippi. I suppose I could be confused on Gleason there were a few areas on the printout that had only about 20% red color.

Why weren't the G8s reported as "4" or whatever if they were using the new grading ?

Pete, I'll add to the chorus that suggests you look into the radiation therapies as well. If you're a G8, there is a reasonable chance the nasties have escaped from the gland, and surgery won't get it all. I can't speak to who might be near you. I will agree with your direction of heading for a major academic medical center. I'm sure they have a "cancer hotline" you can call to get referrals to specialists. I'd call and see if you can set up a series of appointments on the same day with the surgical, radiation, and oncology specialists.

I'd also suggest you get yourself a spiral notebook and one of those big accordion folders to write down questions, take notes, and keep all the paper you're going to accumulate. It's helpful to take someone with you to appointments to take notes. You'll get a huge amount of information dumped on you and having someone else there to help understand what's going on is vital.

Remember this: surgeons do surgery, and will automatically recommend surgery. Radiation Oncologists do radiation therapy, and will automatically recommend radiation. YOU are the one who gets to decide what you are good with. Low PSA G8 is tricky to treat, and you really, really, need to find one of the true experts. You've only got one chance to get the initial treatment right.

Thanks guys. Treat prostate cancer is all Dr. Tully does. I will know more after my visit. Dr. Anderson at the cancer center here is well known for his radiation prowess if I go that route. Just seems that removal would be best option especially considering my dr was in pretty much the same boat and opted for removal.

Part of making a treatment decision involves getting facts, the other part involves self-assessment. No matter how knowledgeable a doctor is, he does not know you. Only you can figure out that part of the equation (in my case with some help from a psychotherapist and some Mindfulness training). Only you can know how important each of the expected side effects would be to your quality of life,or how important a thing like a path report would be to your piece of mind. Your doctor assessed all this for himself, but can't do it for you. What your doctor decided to do for himself or his brother or his father is irrelevant to your treatment decision. (You can probably find lots o equally good doctors who made different decisions for themselves.)

- Allen

My brother's brother-in-law was a Gleason 9 and PSA of 1. He had surgery t failed Then had to have radiation and that made the surgery side effects worse and uses two pads a day for incontinence.

For high risk, many studies show that radiation is better at cancer control because the cancer is often outside the area the surgeon can remove.

I was high risk with high PSA and a loaded prostate My urologist-surgeon said no surgery as it wouldn't cure me. Two other surgeons agreed. I went with the HDR Brachytherapy, IMRT, and ADT. I am cancer free and essentially no side effects. Please don't take surgery so lightly. Prostate surgery is very difficult and does not cure about one third of the cases. Being a Gleason 8 puts you at a very high risk level.

My PSA was 1.87. The Gleason score was 8. I had robotic surgery March 31. I've had two checks since the surgery. My PSA is 0.00. I'm back to working full time at a very physical job. 66 yrs young. Saw all three grandkids today. Life is good.

I think the key would be if the cancer is contained or not. If it is, surgery would work great. The second question would be does it it look like the doctor needs to cut wide and possibly take some or all of the nerves. That would most likely have an effect on potency.

If it's not 100% contained, if the cancer is still in the prostate bed then the chances of getting it with SRT are still good. Sounds like that was the case for your second friend and glad to know he's doing well. That said, be aware that salvage radiation has the potential to be more damaging than primary radiation.

I was a G9 and after doing some extensive staging with my oncologist, he estimated I had a 50-50 chance of needing SRT after surgery. I decided for the 50% chance of having the SEs of both surgery and radiation, I was just going to go with the radiation as my primary treatment. (HDR brachy and IMRT combo, with HT thrown in since I'm a glutton for punishment.) I'm doing very well three years later with no SEs to speak of.

Deciding on a treatment option was the hardest part of this whole thing for me. Good luck!