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High gleason 5+4 and T4

User
Posted 05 Mar 2026 at 08:04

My Dad was recently diagnosed, and i went woth him urology specialist very vague and brushed past questions.

 

We were told that he has high risk, fast growing, locally advanced cancer has spread into his bladder and his scores given to us at the end by the prostate nurse were a gleason score of 5+4=9, and T4 his PSA level 90.6.

 

The doctor said he would start hormone therapy straight away for 28 days then radiotherapy for 6 weeks and "cancer will be gone all will be fine and cured". I questioned this at the time that he was confident that this will be all thats needed and the cancer will be cured? To which he changed his answer to your Dad will live a long while yet. I am just wondering what is the prognosis with this rating of cancer? Any answers are really appreciated

User
Posted 05 Mar 2026 at 12:53
Hi , my husband was diagnosed aged 55 with scores of 4+5 psa 23 . His had spread to his para aorta lymph nodes . This was 10 yrs ago so treatments have changed . He went straight onto hormone injections ( every 12 weeks ) which he is still on now . He had early chemo (6 sessions) then he was selected to go on a trial involving 2 drugs .

Quite early on his psa became undetectable and has stayed there ever since . His life has changed as in fatigue but he still continues to work building marinas around the country,refusing to retire ! We still enjoy multiple holidays a yr and have welcomed 7 ( soon to be 8) grandchildren.

Keep strong .

Debby

User
Posted 05 Mar 2026 at 13:22

Hi,

Prognosis is really difficult to judge because it depends so much on individual factors (age, other illnesses etc.) and just plain luck. 

If I understand correctly, your dad will have undergone CT and bone scans that have ruled out spread to bones and organs (e.g. liver, kidneys, etc.).  I'd expect that he will be prescribed hormone therapy (androgen deprivation therapy or ADT) for longer than 28 days (e.g. 3 years) and probably to be prescribed other hormone therapy as well (e.g. Abiraterone, Enzalutamide, daralutamide or apalutamide).   These would be things to discuss with the Nurse or at the next oncology appointment.

Some of the best evidence on prognosis comes from the Stampede trial. I think this might be the most relevant for your dad:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02437-5/fulltext

It found that the majority of men were alive at 9 years after starting therapy.

It's all a bit overwhelming at first. But hopefully it will become clearer.  Keep on supporting your dad at the meetings.  You can always ask for a different consultant if the one you have isn't communicating clearly.

 

 

 

User
Posted 05 Mar 2026 at 13:25

Thanks, yes he has had a few CT and bone scans, and he said these were clear, then said however there is a shadow on your left lung but we will look at that again in 3 months time, which was a bit of a worry 😟  

 
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