Jay, well, that sucks. But there is hope. Lots of it. There are lots of 8s living out there for 15 years, sometimes a whole lot longer. There is hope. Definitely.
You asked about
surgery. Since you're probably in no mood to hit google scholar, I found this 2011 study using 2009 data:
"Patients with pathological Gleason score 8–10, seminal vesicle invasion or lymph node metastasis are at a substantially increased risk of PCSM [prostate cancer-specific mortality] compared to those without these features.
However, the 15-year PCSM in these high-risk men was lower than expected, ranging from 22–37%. This finding is significant as men with these pathological features were thought to be incurable (based on the 70–85% reported rates of BCR),9, 10 and previously considered by some to be unsuitable candidates for radical prostatectomy. ... We are unable to compare the effectiveness of radical prostatectomy to other therapies."
europepmc.org/articles/pmc4058776In other words, 63%-82% survived to 15 years.
And this 2011 study:
"From 1992 to 2008, 3052 underwent radical retropubic prostatectomy and pelvic lymphadenectomy (PLND) by a single surgeon (PCW). Of these men, we retrospectively identified 186 who met the D’Amico high-risk criteria: PSA level >20 ng/ml, Gleason score of 8 to 10, or clinical stage ≥T2c.
At a median follow-up of 8 years (range, 1–16), 51 (29%) had biochemical progression, 6 (3.4%) had local recurrence, 23 (13%) developed metastatic disease, and 10 (6%) died from prostate cancer. Figure 1 shows the Kaplan-Meier curves for PFS, MFS, and CSS in the overall study population.
At 10 years, biochemical recurrence-free survival was 68%, metastasis-free survival was 84%, and prostate cancer-specific survival was 92%. In addition, the 10-year rate of freedom from any hormonal therapy was 71%.The optimal management for patients with high-risk prostate cancer remains controversial. An increasing proportion of high-risk patients are treated with combined radiation and hormonal therapy, in light of evidence from randomized controlled trials demonstrating an advantage over radiation alone.
In 1997, Bolla et al. reported on this issue in 415 men with clinical stage T3 or poorly-differentiated clinical stage T1–T2.6 At 5 years, overall survival was 62% with radiation monotherapy, versus 79% for radiation therapy with hormonal therapy (p<0.001).
Subsequently, D’Amico et al. validated these findings in 206 patients with clinically localized intermediate to high-risk prostate cancer randomized to EBRT alone versus EBRT plus six months of hormonal therapy.7 Prostate cancer-specific mortality was significantly higher with EBRT alone, and the 5-year overall survival rates were 78% and 88% in the EBRT and combination therapy groups, respectively.
Today however many men wish to avoid the side effects associated with long-term hormonal therapy, including oste
openia, impaired cognitive function, hot flashes, impotence, loss of libido, gynecomastia and potential increased risk of cardiovascular events.9,10
For this reason for many patients, especially young men, the alternative option of primary surgical therapy for high-risk patients is attractive.Our results and those of others suggest that radical prostatectomy is a viable treatment option for selected high-risk men. Although some patients ultimately required a multimodality approach, a considerable proportion were free from progression at 10 years with surgical monotherapy. Nevertheless, high-risk patients considering radical prostatectomy should be counseled on the possibility of multimodality therapy, depending on their pathology features and postoperative PSA levels. Additional prospective studies are needed to directly compare the results of radical prostatectomy to external beam radiation therapy with hormonal therapy in high-risk men."
www.ncbi.nlm.nih.gov/pmc/articles/PMC2889156/I found this thread on another excellent PCa site you may want to check out:
"The following article was posted in the "Renal & Urology News" on March 17, 2014:
Radical prostatectomy (RP) is associated with excellent long-term outcomes in patients with high-grade prostate cancer (PCa), according to researchers.
In a study of 30,379 men (mean age 62.5 years) who underwent RP for Gleason 8-10 non-metastatic PCa, Naveen Pokala, MD, and colleagues at the University of Missouri-Columbia School of Medicine in Columbia found that the overall survival rates at 5, 10, 15, 20, and 25 years were 92.8%, 78.6%, 59.5%, 38.6%, and 20.0%, respectively.
Cancer-specific survival rates were 96.4%, 89.5%, 82.0%, 72.9%, and 68.8%, respectively, the researchers reported online ahead of print in the World Journal of Urology.
“This is the first study to demonstrate excellent 20-year cancer-specific survival of men with Gleason 8-10 prostate cancer,” the authors wrote." https://www.inspire.com/groups/us-too-prostate-cancer/discussion/study-supports-surgery-for-high-risk-prostate-cancer/Jay, someone once told me that anyone can row a boat in still water. You have hit rough water, but you're strong enough to navigate these waters and select the best treatment option for you. There is hope.
Try not to ruminate over the weekend. Yep, easier said than done. But there are options. That's the very good news. You may want to return to Dr. Lee to get his thoughts about
his experience treating patients such as yourself. You may also want to go to NYC and see the RO docs at Sloan Kettering for a second opinion.
We're here for you.