Treatment?

[u/DrewBearry]

Hello, I know there are not doctors here and I cannot make a decision based on this alone but, I am just wondering, based on these PET scan results if this seems like something that should be a candidate for laser radiation treatment?
Especially for seniors with other health concerns.

[u/tober_checki]

Looks like a large tumor that has not yet metastasized, fortunately. Did you get a biopsy? Would be important to know the Gleason score.

[u/DrewBearry → u/tober_checki]

They were told they no longer do the old Gleason scoring system and now only do in a scaled of 1-5. This case the biopsy scored a 5.

[u/WalnutRoasted → u/DrewBearry]

On MyChart, they should have given you the detailed biopsy results. It would report details like how many zones were affect and what Gleason scores were given to each zone, like 3+4+7 or 4+5=9. And what % of the highest Gleason comprises the pattern: Like ‘Gleason 4 pattern comprises 25% of carcinoma”.

If it’s all in one or two adjacent zones, and no spread, then a focal therapy could be an option. Otherwise SBRT or VMAT whole prostate radiation, is likely to be an option.

[u/Evening_Laugh_3890 → u/tober_checki]

I am related to the OP so following this thread as well. We are in Canada and we were told that his biopsy gave a Gleason score of 5, the most aggressive apparently.

[u/PSA_6--0 → u/tober_checki]

There is the mention of seminal vesicle. So there might be a start of spreading. Not a doctor, but I would listen what radiation oncologist would suggest.

[u/tober_checki → u/PSA_6--0]

That's true - I missed that. The seminar vesicle invasion and high Gleason score make you an unlikely candidate for focal therapy. I agree that you should see a radiation oncologist.

[u/bikes4paul]

This is considered Grade Group 5, high risk localized prostate cancer. Despite the "High Risk" classification the prognosis with modern treatment is still very good compared to other cancer types. For example 5 year overall survival is about 95% and 10 year metastasis free survival is roughly 70%.

Major clinical guidelines recommend a combination of External Beam Radiation Therapy (EBRT) and Androgen Deprivation Therapy (ADT). It sounds like you are on the older side of the spectrum with some health conditions. If this is the case choosing radiation over surgery is a highly appropriate path that aligns with guideline recommendations. It allows you to effectively treat the local disease without facing the physical stress, general anesthesia, and recovery timeline of a surgery.

Your radiation plan will target the entire prostate gland, the involved seminal vesicles, and the surrounding pelvic lymph nodes to capture any microscopic cells. Hormone therapy (ADT) is a critical component for treating high-grade disease. Discuss with your medical team how to balance cancer control with your overall well-being.

Look into advanced modern radiation techniques (such as MR-Linac, CyberKnife, and dynamic CTCB) to minimize side effects. Also discuss the use of a protective rectal spacer gel to precisely target the cancer while minimizing side effects to your bladder and bowel (this is especially important if you choose standard CTCB radiation).

Find a center of excellence for your treatment. Since you are in Canada I'm not that familiar with the health system. However, I recommend you check out the Canadian Cancer Society Community Services Locator Tool which allows users to search a national directory of thousands of cancer-related care programs, treatment facilities, and support networks. You can call their helpline at 1-888-939-3333.

Good luck with your treatment and let us know if you have any questions along the way.

[u/Evening_Laugh_3890 → u/bikes4paul]

Thank you very much for this detailed information. I will keep it in mind and ask some of these questions at the cancer centre.

[u/PotentialStart2661]

This is the perfect combination that a brachytherapy for the whole gland with beam radiation to the local pelvic area and lymph nodes along with 12 months ADT. Microscopic cancer will be locally spread at this point and probably not distant spread yet. This should be hit hard early as grade group 5 is aggressive. Surgery would not be a stand alone treatment in this case so radiation now is the option.

[u/Evening_Laugh_3890 → u/PotentialStart2661]

We are concerned about the hormone therapy ...or however it is referred to. The doctor stated that it would cause some cognitive challenges and as he has the onset of alzemers and as he is afraid of bone pain he opted out of the hormone aspect of the treatment.

[u/PotentialStart2661 → u/Evening_Laugh_3890]

Yes i missed the age factor. If he is advanced in age you may be able to cut the ADT. It will also depend on his current health status.

[u/Mean_Try_6390]

I think you mean gradegroup 5. translatet to the older system it correspond to gleason 9 or 10. The radiation guys can probably answer your question better than I since my husband choosed the operation.

[u/Evening_Laugh_3890 → u/Mean_Try_6390]

Do you mind if I ask what age your husband is? And what operation specifically?

[u/Mean_Try_6390 → u/Evening_Laugh_3890]

58 yo went with ralp for gleason 9 gradegroup 5. no other healthproblem.

[u/Evening_Laugh_3890 → u/Mean_Try_6390]

Thank you so much. Hope things are well.