HT and RT advice

Your diagnosis is very similar to mine. I had HT and RT, that was six years ago and all is going well so far. Two years of HT is not good, but I didn't find it too bad. 

There are a few varieties of RT so you need to find out exactly what is on offer. Surgery would be unlikely to work, the only other choice is do nothing but, I don't think you would live more than five years, whereas with treatment 15 or 20 years is more than possible.

Edited by member 27 Oct 2024 at 17:24  | Reason: Not specified

In your situation it most probably is the preferred option. The PSMA PET scan will give you more clarity on spread and if there's lymph nodes involved it might be possible to treat them too, if they're not to distant from the prostate.

The sooner you can get the scan, the better.

I was in a similar situation to you [and Dave64 and Andy] with a locally advanced G9, spread into seminal vesicles and 3 lymph nodes. RT/HT and all clear some 3 years later.

The HT is not a barrel of laughs but it works.

Jules

Most surgeons won't offer surgery for T3b, as the recurrence rate is too high.

If surgery route were to be offered, especially good advice needing a top notch surgeon. I was Gleason 8 and read an NIH study that close to 59% of Gleason 8’s were downgraded to Gleason 7 after surgery. There were other factors that included just two cores or less being Gleason 8 , less than 50% tumor involvement in core, and having a Gleason 3 number on one side or the other in your Gleason cores. I fit that bill, although my Decipher score and ExoDx  score showed likelihood high intermediate to advanced cancer. My being 71 I felt I wanted as much quality of life with my daughter and felt surgery gave me the better option. I don’t know your biopsy report and whether you fit that bill. I met with two Surgical oncologist’s and two Radiation Oncologist’s. One Surgical Oncologist actually encouraged me to seriously even though I planned to, meet with a Radiation Oncologist because of my likely advanced cancer and wanted me to understand I very well might need Radiation treatment and Hormone treatment later right after healing from surgery or a short time later and faced going through the side effects of both treatments. He certainly wanted me to know what I might be facing going the surgery route. I explained though at my age I might miss a window for being able to have surgery (general consensus around 75) as I would get older and even if I was not 75 who knows my health might then preclude me from salvage surgery if after Radiation it came back. He acknowledged again general consensus is it is more difficult to do surgery after Radiation then to do Radiation after Surgery, but said that is changing and salvage surgery is offered by some skilled surgeon’s in that area now.  I was certainly back to all my everyday activities within two weeks of surgery and had no incontinence. I knew the possibility of needing Radiation and HT after but some may say I gambled, but I was accepting of what my outcome would be. I also have read that their are now two schools of thought before starting adjuvant RT or salvage RT. One is post PSA driven treatment watching your PSA go up or doubling to a .2 and now becoming more looked at, image driven treatment waiting until they see where the cancer shows up on a PSMA Pet scan. I also figured I would go the image driven and continue to buy myself more quality of life time. Reaching 75 with a good quality of life is my goal because after that even without cancer your aging brings it down and general life expectancy. If you start two years of RT and HT at 71 it takes you a lot closer to my age cutoff of 75.  Does that mean I want to go at 75, no but I am more willing at that age to accept the quality of life trade offs. That number would likely be different in each person’s unique situation in their mind. For me I ended up in the 59% group, my Gleason 8 was downgraded to a Gleason 7 post surgery and my 3 month PSA was less than .04. My surgery included seminal vesicles, and lymph nodes and although the cancer had focally breeched the capsule EPE, the Surgeon was able to eliminate the initial positive margin. I know everyone’s train of thought is different in their treatment decision, but that is what went into mine.