recent diagnois

Hi, bitguy, and welcome to the club none of us volunteered to join. I'm a relative newcomer myself, so I can't offer a lot of technical information.

I will, however, remind you that one of the characteristics of PCa is that it is multifocal. This means that where there is one focus of cancer, there is usually more. They may be too small to catch on biopsy, but they are likely there. With this in mind, I would think twice about using a focal treatment for primary therapy for G8 PCa. I would feel that it is just too likely that there is more cancer there, but your biopsy just didn't find it. If you choose a focal therapy, you will only be treating the area that is found already, and would miss any others that were not specifically identified on biopsy.

Obviously it is your choice, but I would probably also research the various whole-gland treatment modes (LDR Brachy, HDR Brachy, IMRT, SBRT, surgery, etc., etc.)

I would also consult with at least one, preferably more than one each surgeon and radiation oncologist, so that you can get the benefit of the advice of specialists in various techniques of surgery and radiation. In doing this, you will also learn which therapies these experts feel would be appropriate to your case.

Obviously, with G8 pathology time is not on your side, but as we say here, you only get one shot at primary therapy. Be sure you make a choice that is right for you.

Sorry to hear about your diagnosis. I'm not a doctor, but I'm another high-risk guy and I feel you're best served by throwing the kitchen sink at your cancer, as opposed to a focal therapy. (In fact, I'm not sure if you would qualify for a focal therapy.)

Track 1 would be surgery for you, with the risk being that with an aggressive cancer that you could need follow-up radiation. That could still work well, but it does mean you could have the SEs of both surgery and radiation.

Track 2 would be to cut to the chase and start with radiation. (Tall Allen had some very great comments on the "Compilers friends" thread about the advantages of radiation for high risk guys. I'd recommend you check it out.) There's different options for radiation, with many of us high risk guys opting for a combo external beam radiation, coupled with brachytherapy. You'd likely have to do hormone therapy with radiation as well.

Glad you're getting a second opinion on the biopsy slides since it would be good to know for sure you're high risk.

Good luck to you and let us know how we can help.

Sorry that you are here. I also am a Gleason 8 (4+4), with one pelvic lymph node being "100% cancer". In general a Gleason score of eight or higher means that it is agressive and you (and me) will never be cured. You need to be agressive in your treatment.

Normally surgery would be ruled out for high Gleason scores. However some recent studies have shown benefits even with locally metathizied cancer. Even if you have surgery please know that you must follow it up with additional treatments. For me that was DaVinci surgery followed by hormonal and radiation treatments. Chemo is in the back pocket when (not if) my PSA goes up.

Bob,

even if fighting the cancer is currently the main concern one should keep an eye on the side effects since whatever you do the cancer will probably return sooner or later anyway.

I agree with an IMRT brachy combo and ADT following that. Radiating all pelvic lymph nodes could cause a lot of side effects. Since bitguy's PCa seems to be confined to the gland, otherwise the MRI would have detected the extension, I would not do that yet.

George

Hi bit guy. Welcome to HealingWell, sorry you have to be here. Good you are getting the 2nd opinion and doing your research. You got some great advice about hitting the cancer hard with maybe a combo treatment. Things for you to think about. I wish you luck on your journey. Take care. -JR