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Starting out at age 58

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User
Posted 14 Oct 2019 at 20:31

I'm 58 and just starting on this journey.  I had a regular checkup as part of the healthcare provided by my employer. Enlarged prostate and a PSA of 7 led to a meeting with a urologist who scheduled MRI ("equivocal") and then a biopsy.

The biopsy shows a small volume of cancer (1mm of 1 core out of 22 cores), with a Gleason score of 3+4.

I've since met an oncologist and surgeon. Both think radical prostatectomy is excessive at this point and consider either low dose brachytherapy or active surveillance as the preferred options, with the suggestion that the latter approach could allow for 5 or 10 years delay. 

So now I'm just pausing for thought.  I'm generally healthy and on no medications and until the diagnosis, cancer was definitely something that happened only to other people. So much for that. 

I suspect I'll go with active surveillance for now, partly because it means avoiding side-effects for now but also because I'm an expert procrastinator. 

User
Posted 15 Oct 2019 at 10:50

Hi i had Brachytherapy at 70 in 2016 with PSA 2.19 and Gleason 3+4=7 with 5 out of 20 cores positive and was offered radical removal or Brachytherapy .

My PSA is down to 0.22 @ January 2019 with next test in January 2020.

I think the only question i would ask the specialist is at what Gleason score would Brachytherapy drop off the choices of treatment.

If you click my Avatar you can see my journey so far.

Good luck John.

User
Posted 15 Oct 2019 at 23:03

At Gleason >= 8, you become a high risk patient. Brachy is still used with high risk patients, but not by itself - you would get external beam radiotherapy too, and the brachy might be high dose rate (HDR) rather than LDR (seed).

This may not be the case in all hospitals, of course.

Edited by member 15 Oct 2019 at 23:04  | Reason: Not specified

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User
Posted 14 Oct 2019 at 23:17

Well naturally you will want careful follow up and in your place would seek confirmation that the cancer is well contained. Certainly, a lot of men diagnosed early rush into having radical treatment early with potential adverse side effects. On the other hand some men are not diagnosed and treated until the best chance of eradicating the disease is passed. Hopefully from what you say you appear not in the latter camp.

Edited by member 15 Oct 2019 at 23:40  | Reason: Not specified

Barry
User
Posted 14 Oct 2019 at 23:37

Andy,

You might be a good candidate for HIFU, given the cancer is small, one side only, and in the posterior. You might want to read up on HIFU. Given they didn't offer this, they probably don't do it, so you would need to ask to be referred to somewhere that does.

User
Posted 15 Oct 2019 at 08:11

Dear Andy

Sorry to find you here and wish you the very best.

I would re iterate what Barry says. Make sure that the cancer is well contained, if needed with a repeat test such as MRI etc before deciding on AS. Tests may not be foolproof as was my case.

The treatment for PCa when not organ confined is more complicated. 

Gleason 7 puts you in intermediate risk range and is almost accepted that post op pathology is usually one grade more. I am no PCa expert but PSA 7 suggests disease might be more than whats seen now.

HIFU could be a good choice if no obstruction symptoms, but carefully weigh all options and ask repeatedly professionals involved and in this forum. I think there may be some Prostate doctors in here, some of hem seem very knowledgable!

User
Posted 15 Oct 2019 at 10:50

Hi i had Brachytherapy at 70 in 2016 with PSA 2.19 and Gleason 3+4=7 with 5 out of 20 cores positive and was offered radical removal or Brachytherapy .

My PSA is down to 0.22 @ January 2019 with next test in January 2020.

I think the only question i would ask the specialist is at what Gleason score would Brachytherapy drop off the choices of treatment.

If you click my Avatar you can see my journey so far.

Good luck John.

User
Posted 15 Oct 2019 at 23:03

At Gleason >= 8, you become a high risk patient. Brachy is still used with high risk patients, but not by itself - you would get external beam radiotherapy too, and the brachy might be high dose rate (HDR) rather than LDR (seed).

This may not be the case in all hospitals, of course.

Edited by member 15 Oct 2019 at 23:04  | Reason: Not specified

 
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