HealingWell
Search Close Search
☰

AS candidate or too risky?

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 5/27/2013 10:07 PM (GMT 0)
Got the Gleason 7 news a month ago. One in 12 cores showed adenocarcinoma at 5%. Original report was a 4,3 and I sent the slides to Bostwick which came back as 3,4. Because I'm 62, the urologist that did the biopsy is for RP. Not too excited about RP as I've read enough about it. In the last 13 years, the highest my PSA ever got was an 8 but its generally in the 4.8 - 6.5 range. The first biopsy was in 2010 and this is only my second biopsy.

I understand that the window of curability could be lost if I decide on AS, diet and supplements. Was curious on what kind of feedback I could get here? After all, I'm not a Gleason 6. I will consult with an IMRT physician soon. Anyone want to comment on TIP as a treatment, please do so.
Posted 5/27/2013 10:44 PM (GMT 0)
Any Gleason 4 in your mix precludes AS, at least that is the usual wisdom. I wouldn't chance it if it were me (and I was close to your stats and had a recurrence).
Jeff
Posted 5/27/2013 10:45 PM (GMT 0)
Included signature this time...
Posted 5/27/2013 10:53 PM (GMT 0)
There are some AS programs that would accept you because of your low volume but, personally, I can't recommend it. My biopsy diagnosis was less alarming than yours and I came up with a high-volume G9(4+5) on my post-op pathology. I just don't trust AS if there are any Gleason Grade 4 cells present at all.
Posted 5/27/2013 10:59 PM (GMT 0)
Welcome to HW. Sorry you need to be here but it's a great place to be and to ask questions.

You should talk to a radiation oncologist before deciding. With your numbers you'd be a candidate for IMRT and Brachytherapy. The radiation options would likely work just as well as surgery for a cure in your case.

The question of AS would really come down to you're doubling time - how long has it taken you PSA to double - as a measure of how aggressive the PC is. At G7 I think a lot of doctors would try to talk you out of AS. It might be a bit on the risky side.

In your place, I'd be getting a second opinion and would be seeing a RO and possible a medical oncologist that specializes in PC.

Hang it there,
Andrew
Posted 5/27/2013 11:05 PM (GMT 0)
Stats very similar to yours and fairly close in age. Obviously I chose RP and I wouldn't have done a thing different. My personality is such that I would be wondering if every little ache and pain was the cancer spreading, etc. For me, some sort of treatment was a must. There are many treatment options and I'm sure you find the one right for you.

Best wishes,
Tom
Posted 5/27/2013 11:19 PM (GMT 0)
Gardenz,
At your tender young age (62) and your stats you are an ideal candidate for either "seeds" or IMRT..I'm a wuus but if I were in your situation I would forget about surgery or AS..You may have a long life ahead of you and you don't want the "horse to get out of the barn" or to suffer the serious side effects of incontinence or ED--it happens all to frequently regardless of the surgeon selected..Although I had to go with IMRT since I was too far advanced for seeds at the time, seeds would be my choice..Please remember, I am a relative "newbee" and other members with far more experience may opt for surgery...All the best to you but with a gleason 7 I recommend you do something. You asked!
Bill
Posted 5/27/2013 11:50 PM (GMT 0)
I would not recommend AS to anyone with Gleason 7 showing. The biopsy is but an estimate of your situation, you may have more PC than what the biopsy indicated.

david in sc
Posted 5/28/2013 12:04 AM (GMT 0)
I would not risk it myself with a G7.

Consider brachytherapy if you would. It seems to be kinder than the other treatments with a cure rate equal to, or greater than, them too. There are less side effects and much less of a recovery time too.

My reasoning for not doing surgery myself, aside from the above, was that my PCa could be worse (it is in nearly 30% of biopsies I believe) than it was bx'd at and then I might need salvage radiation post-surgery as well and why would I want to risk potential side effects from both?
Posted 5/28/2013 12:49 AM (GMT 0)
By TIP I assume you are talking about hormone therapy. It could be used and Dr Leibowitz has had some great success in treating low volume tumors with 13 months of ADT3. You could try it as Scholz reports a 30% complete remission on intermediate grade PC with HT alone. All other treatment options would still remain if it failed. This is not commonly used and very few doctors would recommend it.
Regarding AS. It is much more risky with a G7 and if you were over 70 it could be a more viable option.
If the tumor is really that small and is confirmed by a scan, MRI or Color Doppler or saturation biopsy you could consider a targeted focal therapy that treats only the tumor. This would significantly reduce the probability of side effects. Cyberknife and Brachytherapy would also be good alternatives.
Posted 5/28/2013 1:18 AM (GMT 0)
"AS, diet and supplements."---they are not going to get rid of the cancer or prevent it from getting worse. Don't be afraid, get treatment, either surgery, radiation or HT.
Posted 5/28/2013 1:27 AM (GMT 0)

gardenz said...
Got the Gleason 7 news a month ago. One in 12 cores showed adenocarcinoma at 5%. Original report was a 4,3 and I sent the slides to Bostwick which came back as 3,4. Because I'm 62, the urologist that did the biopsy is for RP. Not too excited about RP as I've read enough about it. In the last 13 years, the highest my PSA ever got was an 8 but its generally in the 4.8 - 6.5 range. The first biopsy was in 2010 and this is only my second biopsy.

I understand that the window of curability could be lost if I decide on AS, diet and supplements. Was curious on what kind of feedback I could get here? After all, I'm not a Gleason 6. I will consult with an IMRT physician soon. Anyone want to comment on TIP as a treatment, please do so.

Have you considered BT?
Posted 5/28/2013 5:01 AM (GMT 0)
+1 for John T's comments.....
Posted 5/28/2013 5:47 AM (GMT 0)
+1 for Fairwind's +1 of John T

I'd start with a multiparametric 3T MRI with endorectal coil read by a superb radiologist or a color doppler ultrasound read by Lee, Bahn or Ukimura. Most often - 80% of the time - it's really multifocal (tiny bits of cancer throughout the prostate), but even then, destroying the index tumor can at least slow it down. So will a year of ADT, although it's far from proven, and has many nasty SEs.

SBRT and HDR brachy monotherapy have excellent cure rates for intermediate risk PC, while providing the lowest rates of sexual and other SEs of any radical therapy.

Intermediate-Risk Patients With Organ-Confined Prostate Cancer Have High Cancer-Free Survival Rate After Stereotactic Body Radiation Therapy

High dose brachytherapy as monotherapy for intermediate risk prostate cancer.
Posted 5/28/2013 7:24 AM (GMT 0)
I appreciate all the feedback. I noticed a lot of positive comments about brachytherapy which I need to look at again. I glossed over SBRT in the books that I've read but I like what I've read at the UCLA site.

I expected a thumbs down on AS given that Type 4 cells are trying to elbow their way around inside of me, but I was interested in seeing the replies. You guys are great -- the prompt responses have helped a lot.
✚ New Topic ✚ Reply