Help stl... Prostate cancer .. Gleason 8...

Newly diagnosed 52 year old with prostate cancer and a Gleason number of 8 and PSA of 24. Had PSMA and showed it's only in the gland.... recommend radiation of 44 treatments 79 to 81 grade followed up with two years of hormones lubpron and zytiga.... just wondering 1st oncologist recommendations in St Louis for second opinion just looking for like anyone else the best treatment but the least evasive to my body. Any help is appreciated...

The proposed treatment is well within standard of care for your situation. With the G8, you're likely stuck with at least a year or two of Lupron/ADT therapy.

HD Brachy is an option for you...there are several men on the forum who had that with high risk cancers and have done quite well.

Are you working with Siteman or one of the other centers in the area?

Sounds reasonable. I opted for SBRT after about six imrt sessions. The reason was two fold. One issue was chronic pain and lying on the hard table for so many sessions.
The other issue was I developed a paraphimosis after I had urinary retention.
SBRT we was only about six sessions.

Xxxxooooxxx

Glen

My dx was nearly 2 years ago. G8 by St Lukes. Upgraded to G9 by J Hopkins. Sought treatment at Siteman (where else in STL?) and graded G8. Take your pick.

PMSA Pet indicated my PCa had escaped to one lymph node and to seminal vessels, so I considered RP to be off the table (even tho my original Uro at St Lukes pushed for that). My RO at Siteman got UHC/Medicare Advantage to approve Proton Radiation (after their first denial of it). 44 treatments Mar 15 - May 15, 2022. Also started Eligard (6 mo injections) at that time and added Zytiga in June 2022. PSA immediately was undetectable. So was Testosterone (and libido -- bummer). The weeks of radiation were a breeze other than fatigue, which I attribute more to the ADT.

Fast forward, this week MO agreed to stop the Eligard after 18 months and we will watch the blood test results. I was taken off of Zytiga in March when I had a mild stroke as it has known cardiovascular SE. My time on Zytiga was HORRIBLE. But, I endured as it is seemingly the "silver bullet" for PCa. Physically I feel better. Psychologically, this disease has already been a killer. The depression &/or apathy has been worse than the SE of the disease or the meds. (That's just my psyche and I struggle with it. Hope you do not.) For now, it's "pins and needles" until the next few blood tests.

I loved my RO at Siteman but he (Randall Brenneman) has transferred elsewhere.
I also am very pleased with my MO, Melissa Reimers.
Good luck!

sounds like good plan. i wouldn't question it. just go with it ASAP.

if you have ruled out surgery, I would speak to your doc about having a Decipher Biopsy or OncotypeDx test done on your biopsied tissue. While the indications may be that the cancer is confined to the prostate, a PSA over 20 may indicate otherwise. A genomic test looks at your cancer's RNA and assesses your risk category for metastases and local spread of the cancer. The results might help in establishing the size of the radiation field and total dosage, as well as the length of ADT.

For men opting for surgery, a genomic test done on a sampling of the whole prostate is preferable because it is more accurate than one done on biopsied tissue: a biopsy can miss more serious lesions and underestimate risks. For this reason, I believe the test result for Decipher Biopsy agrees with Decipher RP 70% of the time. Men choosing radiation obviously have to rely on their biopsy for a genomic test.

BTW, were the Gleason scores of 8 of all your biopsy lesions 4+4, or were any of them a 5+3 or a 3+5?

Djin

I was diagnosed in my 40s, in a similar age bracket that you are now.

My case called for a proactive, multi-tiered treatment approach.

It's ten years later, and there's a lot more candles on my birthday cake, because I sought out a great medical team, and even added Dr. Kwon at Mayo Clinic to my team.

You have a Gleason 8 diagnosis, with a PSA of 24.

So far, your medical team is suggesting a multi-step treatment approach. This is your window of time to seek that second opinion, get a firm DECISION made, and then move forward with it.

In my case, with a PSA of over 100 that was skyrocketing like a Roman candle on July 4th, I pursued ADT injections, followed by chemotherapy, ZYTIGA (now in generic form known as "Abiraterone Acetate"), and 45 radiation treatments.

Each treatment paid benefits, over time. My case is managed by my local medical team, and co-managed by Mayo Clinic.

When diagnosed, the prostate cancer had already infiltrated both of my lungs.

I didn't have time to dilly-dally, and treatments began immediately on the day I was diagnosed.

I remain on ongoing ADT shots and ZYTIGA, now the generic form, however.

It's important to state that I continue to remain active, and I have continued teaching full-time since diagnosis. I just got back from a Sunday morning trail walk.

I think that's the best story I can share with you today. A story of hope!

Treatments aren't always a "walk in the park" ~ but they can pay enormous dividends. It's great having to buy extra candles for my birthday cake, nowadays.

That's what effective treatments have done for me, and I have followed the course of treatments mapped out by my doctors, every step of the way.

My PSA registered in the "undetectable" range last week. Trust me when I say, I never thought with my original diagnosis that this would ever be possible.

My doctors have been an unfailing GODSEND to me, and they look after me like a brother.

I have stood at the point where you find yourself today and will state that the best thing you can do is to summon your MOJO, steely iron will, positive outlook, and determination.

Grab your armor, pick up your silver sword and shield, and walk out onto that battlefield when you get your treatment course and "battle plan" charted out.

I have a lot to be grateful for today. My eyes gaze only one direction ~ FORWARD!

Handshake, support, encouragement ~

CYCLONE ~ # Iowa State University

From one G8 to another. Do your research, ask lots of questions, and choose which way to go, then don’t look back. Most of all, keep a positive attitude and continue to live life to the fullest.
My best wishes for you going forward.
Jack

I was diagnosed gleason 8 with a psa of 26. I had 45 radiation treatments and 18 months of lupron. They radiated my seminal vesicles and lymph nodes as well as my prostate. Three years later my psa is staying low. Best wishes!