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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Re: Hmcg7
Jul 28, 2017
I hope you feel welcome to the Board, though doubtless you did not want to have reason to come here, like the rest of us. Here are some thoughts.

A first and very important question is whether the Gleason score was 3+4 (referred to as favorable risk Gleason 7) or 4+3 (unfavorable risk Gleason 7). These days (just the last year or two) doctors are coming to view these situations as quite different, with "active surveillance" (instead of immediate treatment) being increasingly recommended for favorable risk, [I]if[/I] other indicators are encouraging, while treatment is routine for unfavorable risk Gleason 7 (unless the patient has some other serious health concerns such that treatment of prostate cancer would likely not add value).

Therefore a second important question is whether you need a second pathology opinion of the biopsy. Often biopsies are done locally by a general pathologist who handles all comers for all kinds of diseases. What we all need is a pathologist who is fairly expert with prostate cancer biopsies. Usually major university hospitals have such experts, and there are pathology companies with specialists in prostate cancer. My own biopsy was upgraded by one of the foremost experts from a GS 3+4=7 to a GS 4+3=7. Upgrading happens more than downgrading, but either is possible, as is confirmation of the original reading.

Would you mind sharing more details, such as the number of biopsy cores taken, and whether the imaging guidance used was TRUS (Trans Rectal UltraSound) or some other, such as multiparametric MRI?

Regarding your symptoms, usually (but not always) prostate cancer is without symptoms such as you describe until it is fairly far advanced. HOWEVER, prostatitis can easily account for such symptoms. I suspect that is the case, but I am no doctor and have had no enrolled medical education. Prostatitis can also easily explain changes in PSA, which can be rapid and sometimes large, due to prostatitis, and even fairly often have a maddening up and then down pattern, sometimes repeated.

Regarding best treatment: if your doctor is a urologist, the odds are high he will recommend surgery; if your doctor is a radiation oncologist, the odds are high he will recommend radiation. These days, research has pretty much proven (repeatedly) that decently done radiation is just as effective as decently done surgery. That was not the case around 2000 and earlier, where surgery had a clear edge. Fortunately, there have been great improvements in technology. It is now a bogus argument that you can get added insurance by holding radiation in reserve in case surgery first fails; radiation first is at least as good.

If there is evidence your cancer is not contained within the prostate capsule (such as multiparametric MRI evidence), then surgery will likely be insufficient; if contained, surgery would be on par with radiation. Radiation can be highly effective at curing not only the cancer within the prostate but also cancer that has spread a bit beyond it. Usually the spread is not that far beyond and well within the effective range of radiation. There are number of kinds of radiation choices, with some emerging as less burdensome time-wise but as effective and safe.

There are also some other therapy options that may be open depending on your case details.

Side effect profiles are somewhat different for each of the therapy options. That can make a difference to you.

Good luck with this.

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