Husband Diagnosed 2 months Ago

Hello
My 66 year old husband’s PSA found to be 51.2 approx 3 months ago during routine bloodwork. Followed by a ultrasound guided biopsy. Results came back Gleason score 8 with most cores showing 4+4, Intraductal and seminal vesicles involved.
PMSA scan was negative for metastasis.
His choices now are surgery to remove prostate then radiation and hormone therapy for 2 years with a medical oncologist, or forgo the surgery and just do the radiation and hormone therapy. The medical oncologist also mentioned a pill that he would take to reduce reoccurrence by 50%.
The doctors say he is very high risk with an aggressive form of prostate cancer.
I just don’t understand why the choice is ours. Surgery or no surgery. Wouldn’t it make more sense to do the surgery to remove the bulk of the cancer then carry on with the remaining treatments afterwards?
I’ve been reading about all of your experiences for weeks. If anyone has any advice or suggestions I sure would welcome.

Thank you so much for replying Michael.
Yes the decision is his and he is leaning towards radiation at the moment. Curious to see if the follow up appointment with the urologist changes his mind.
I have a long list of questions for the Dr.

Pitgirl - Not the best news but he is not the first or last to run the high risk gauntlet.

Did he have a MRI as part of his evaluation? Ultrasound and PSMA scans do not provide much detail that the MRI can fill in. Having genomic testing on a sample of the prostate cancer is a good idea for a complete evaluation as well as a second opinion on his pathology to complete the initial analysis.

I am not sure that the “pill that he can take to reduce recurrence 50%” is exactly correct or I would take two of them and be done with it… you may wish to discuss that further.

The stated surgery procedure is not exactly correct unless there is some missing information. The surgery happens first and the prostate is examined to determine exactly what the extent of the PCa is. Next steps usually begin after the first post-op PSA test result as needed. This does not make surgery the best choice by any means but the procedure is not as predetermined as described but can go that way. Radiation for high risk cases generally employs two radiation methods plus hormone therapy for best result which is not offered by all places.

You have reached the point where the serious studying takes place. The shock of the high PSA and post-biopsy diagnosis ruins the first two months. Find the best surgeon and radiation oncologist(s) you can find and get their opinions. If there is a nationally recognized cancer center nearby, check in with them also. He does need to keep the process moving along given his high PSA.

Pitgirl mentioned: ""hormone therapy for 2 years with a medical oncologist, or forgo the surgery and just do the radiation and hormone therapy. The medical oncologist also mentioned a pill that he would take to reduce reoccurrence by 50%.""

I suspect the oncologist was suggesting that in addition to the standard hormone therapy shot, Pitgirl's husband might be prescribed one of the 2nd gen anti-androgens like Zytiga or Xtandi or Erleada.

Pitgirl, a very shocking and stressful two months I'm sure. Considering the Gleason score and high PSA, my feeling is radiation plus the two years of ADT (hormone therapy) could be a good choice. The radiation will work just as well or better at reducing the tumor load, while avoiding the problems from what might be a "wide cut" surgery. The surgery+radiation plan doesn't really make sense to me.

There are plenty of guys who have had similar or worse diagnoses who are still hanging around the forum.

Continue to give us as much information as you have and we will stay with you.

Mumbo said...
Pitgirl - Not the best news but he is not the first or last to run the high risk gauntlet.

Did he have a MRI as part of his evaluation? Ultrasound and PSMA scans do not provide much detail that the MRI can fill in. Having genomic testing on a sample of the prostate cancer is a good idea for a complete evaluation as well as a second opinion on his pathology to complete the initial analysis.

I am not sure that the “pill that he can take to reduce recurrence 50%” is exactly correct or I would take two of them and be done with it… you may wish to discuss that further.

The stated surgery procedure is not exactly correct unless there is some missing information. The surgery happens first and the prostate is examined to determine exactly what the extent of the PCa is. Next steps usually begin after the first post-op PSA test result as needed. This does not make surgery the best choice by any means but the procedure is not as predetermined as described but can go that way. Radiation for high risk cases generally employs two radiation methods plus hormone therapy for best result which is not offered by all places.

You have reached the point where the serious studying takes place. The shock of the high PSA and post-biopsy diagnosis ruins the first two months. Find the best surgeon and radiation oncologist(s) you can find and get their opinions. If there is a nationally recognized cancer center nearby, check in with them also. He does need to keep the process moving along given his high PSA.

I thought the PSMA scan was the best to detect real small cancers? I know my PSMA scan showed hot spots that other scans did not.

Might be time to share a little hope here ...

I was diagnosed in my 40s, with a skyrocketing PSA over 100 ...

By the time all the diagnostics and scans were finished, it was discovered that the original prostate cancer had already infiltrated both my lungs.

My treatments began the day I was diagnosed. There was no time to lose ...

I knew I needed to suit up in armor and grab that silver sword and shield and step out onto that battlefield.

A second opinion is ALWAYS a great idea ... and scans can be shared electronically.

When I was diagnosed, I had to bring a file full of documents, copied by a medical clerk ... things have evolved!

My treatment history is revealed beneath my signature.

I have great doctors & remember the value of family, friends, and faith ~ in whatever form that takes for you.

Surround yourself with top-notch, experienced doctors. Keep an open mind. My lesson learned? My toughest treatments have paid the greatest dividends.

My other lesson learned? I'm not going to promise you it's always going to be easy, but I can promise you it can be worth it.

My tough diagnosis came in 2013. I'm going to take my first steps into the beginning of my 10th year of survivorship this fall.

It's fair to say that there's a lot more little candles on my birthday cake, nowadays. I am grateful for each new little candle ...

I share my story ~ and HOPE ~ with you!

Encouragement, support, & caring thoughts ~
CYCLONE ~ # Iowa State University

Pitgirl - Good to see he is going to a well known cancer center. Like Michael T said, the “triple play” radiation option is quite popular for high risk cases so add that to the list of questions.

Also good to hear about the MRI, it is best to get before biopsy but the early PSMA scan is a win also so you will end up in the same place. MRI guided biopsies are generally preferred to ultrasound only guided biopsies but his results were plenty clear as it is.

tsillik - MRI’s do a more precise soft tissue visualization so things like EPE and lesions can be detected that don’t show up in other scans. PSMA tracer is drawn to small amounts of PCa so they “light up” with concentrated radiation similar to the way a bone scan “lights up” with its tracer but can detect smaller amounts of PCa in areas other than bone. Each serves a specific purpose and don’t check the same things.

Sounds like he is on his way to a good treatment scheme. Tell him he does not need to go through surgery to prove how tough he is and test his endurance. I had surgery and it is no walk in the park. It made sense to me at the time and it also found high risk cancer that I may have not known about otherwise so I treated accordingly after surgery. Your husband already knows he was dealt a bad hand so time to to move on.

They want to start hormone therapy right away since his PSA is high and it should lower it immediately thus ending that concern now while treatment gets underway. Good luck with his upcoming visits.

All of you are wonderful and a Godsend. Thank you for your well wishes and continued wisdom and support. So glad I found you.
We told the urologist this morning that we are going to forgo the surgery and go the ADT/radiation route. He completely understood.
My husband and I both agree that any side effects can be dealt with and accepted as long as it keeps him here with us as long as we can possibly hope for.
I will keep all of you in my prayers and update progress.

Starting the hormone therapy right away will immediately start fighting the cancer cells while you wait for the main treatment to start. Good luck

Hello, Pitgirl. Sorry I'm late to your thread. I think you have gotten some great advice already and have made a sound decision. Good luck to you and hubby as you move forward. Let us know how we can help.

Jim

Sorry for the diagnosis, but it seems that you've done your diligent research and made a good decision. I don't have anything to add (because these other users are smarter and better informed than I am), but I do wish the two of you the best of luck and a happy and healthy outcome.

Pitgirl said...
Today my husband’s radiation oncologist started him on Bicalutimide. Wondering if anyone has any thoughts on that drug.
We have an appointment with medical oncologist in a week. I’m not sure what to expect there.

Bicalutamide is standard prior to Lupron/leuprolide; it will prevent a flare up of testosterone.

More detailed info from the NCI website:
When patients receive an LHRH agonist for the first time, they may experience a phenomenon called "testosterone flare." This temporary increase in testosterone level occurs because LHRH agonists briefly cause the pituitary gland to secrete extra luteinizing hormone before blocking its release. The flare may worsen clinical symptoms (such as bone pain, ureter or bladder outlet obstruction, and spinal cord compression). The increase in testosterone is usually countered by giving another type of hormone therapy, called antiandrogen therapy, along with the LHRH agonist for the first few weeks of treatment

Post Edited (Sr Sailor) : 10/3/2022 6:51:43 PM (GMT-7)