Posted 10/26/2018 7:27 AM (GMT 0)
randyd:
Surgery is only a cure for prostate cancer when the exact location of all cancer is identified, and the surgeon can remove the cancer without leaving any behind.
Unfortunately for all of us, there is no test available anywhere in the world that is able to detect the earliest bundles of spreading prostate cancer, which are microscopically small.
The mainstream standard of care calls for a pelvic-abdominal CT scan and a bone scan for a person with your Gleason/PSA score to look for metastasis (spread). These scans can only detect relatively large irregularities. You hope for a finding of "clear", which means the scans are clear, but does not necessarily mean that your body is clear.
There are experimental scans with better detection capabilities that can sometimes be obtained with sufficient research/persistence/payment, but as said above, there is no scan for which a finding of "clear" guarantees you are actually clear.
That is why practitioners make use of Gleason score and PSA score to guide treatment decisions. By studying results of treatment over long periods of time, they have observed that certain combinations of Gleason score and PSA score have elevated risk of local, regional, and distant metastasis at the time of diagnosis, even when the pelvic-abdominal CT scan and bone scan return findings of "clear".
For this reason, many are recommending against or ruling out surgery when Gleason scores and PSA scores reach certain thresholds, even when cancer outside the prostate is not proven. It is assumed.
When surgery is ruled out, the decision logic remains very complex. With Gleason 10, I would not be relying on whomever is conveniently nearby for any phase of diagnosis/treatment, but would be looking for top practitioners at so-called centers of excellence.