Hubby G4+5 @ 57yo

Hello, I'm sad I'm on this post but I'm hoping I can help my husband who is 57 yrs old. He was recently diagnosed with Prostate Cancer. His biopsy diagnosis was Adenocarcinoma, Gleason 4+5, grade group 5 with perineural invasion. Gleason 9 left base and mid and Gleason 6 on right base and high grade prostataic intraepithelial neoplasia on right mid. Bone scan negative and CT scan negative. He suggested no surgery. Brachy therapy, hormones and possible beam.
We are wondering about surgery, why it wouldn't be best to just have it removed, but he said he would probably have to have radiation and hormones even after surgery.
He suggested that if we are considering surgery he would like for us to get a second opinion at Vanderbilt.
Any help you can provide would be grateful. We are in the beginning stages and really don't know where to look for best answers as far as treatment.
I'm also dealing with a 82 year old mother who has been diagnosed with kidney disease, failing kidneys and just went on dialysis.

(added a subject)

Post Edited By Moderator (142) : 5/22/2018 11:48:46 PM (GMT-6)

Welcome to HW, sorry you need to be here.

at G9 you've got a tough case and need to throw at lot at it. What was his PSA level? That plays a bit with the treatment plan. One reason not to do surgery is that if the PC is on the margins of the prostate or if it's outside the prostate, surgery might not get all the PC and you'll need RT anyway. RT and surgery are both curative if used as a primary treatment - no need to do both and if there's a high likelihood of needing RT, start there. Also you can combine HT (hormone treatment) with radiation to weaken the PC for a maximum effect. If there are already metastasis, surgery wouldn't do anything to help.

The G9 crew will be along soon with better information.

This is all confusing and likely you both in a bit of shock over all this. Then with your mother's situation this has to be a difficult situation to navigate. None of this is easy, but you can get through it.

Ask all the questions you have,
We're here most days.
Andrew

about 70% of the men diagnosed with PC are diagnosed with G-6, a completely different ball-game than G-9 ..The trouble with G-9 is that it metastasizes quickly and spreads outside the prostate where as G-6 does not...Surgery CAN cure your husbands cancer but for that to happen you have to get lucky and catch it before it has metastasized outside of the prostate.. Radiation, especially Brachy combined with beam radiation covers a larger area and has a better chance of getting it all..Just my personnel opinion, This is a decision both you and your husband will have to sit down and agonize over in the days ahead..Talk to a good Radiation Oncologist and get his viewpoints. Try to find one that does Brachy, not all of them do..

Best of luck to you..

Look at my signature. A lot of high risk and three surgeons all said no to surgery. I used HDR brachytherapy, IMRT external beam radiation and a few years on ADT. The combination is the very best for high risk. I am cancer free and side effect free after more than 7 years.
Let me know how I can help.

A lot of us g9 guys end up getting ADT and Radiation after Surgery my advice from my own personal experience is get a great team in place be your own advocate look at all the treatments then decide on one and then proceed. Wishing you the best!

Larry

motpnh, welcome. Your husband is lucky to have you seeking information for him! This forum is a great place to find support and help. I've added you to the "G9 Crew" roster on the thread we have for those facing this diagnosis. It's a gathering place for people to share concerns, successes, and so on. With these high-risk cases the concerns are generally about aggressive treatment plans, and not as much about dealing with inconvenient side effects. Anyway, check it out if you haven't, as you'll find many of us there with most doing pretty well. There's a lot of hope! Here's the link:
The Gleason 9 (and 10) Crew - Welcome and how ya doin'? (Part 3, continued thread)

I had a somewhat similar situation, though all 6 of my positive cores were G9 with extensive perineural invasion (cells grow along the nerve pathways to get out). By MRI I was stage cT3a. With all of that in play, we decided surgery was unlikely to be curative. I ultimately chose radiation and ADT.

Specifically, I had all of my diagnosis and treatment actually done at Vanderbilt, so may be able to help with questions about their facility. I was very pleased with their work. They are quite conservative, which I liked. However, if you want the experimental, cutting edge, "let's try this maybe it will work" approach, that's not their style. They are a regional referral hospital, so they're especially familiar with those struggling with side effects from treatment received elsewhere. That's partly why they're conservative, having seen just what can go wrong.

I don't know the urologists there anymore, but my RO was Dr. Eric Shinohara. I would recommend him for a consult about radiation if you're interested. He patiently answered my oh-so-many questions! Vanderbilt had multiple physicists on staff to develop their radiation plans, and I have had very few radiation-related side effects.

I've seen guys here start hormone therapy while making their decisions. And if you do go the radiation route, you'll be on HT anyway. That said, I doubt that waiting until June 11 would matter much even with a G9. I took about two months to make a treatment decision. But I know I felt vulnerable during the period before I started treatment so I can certainly relate to how you're feeling.

FWIW, I also had a long time to get into seeing a doctor that I was very anxious to see. So I called every day asking if there was a cancellation--turned out there was and I got in a few weeks earlier.

Motpnh

I started ADT before I made a final treatment decision

I got a second opinion at Vanderbilt a few weeks after a Lupron injection.

I also had my biopsy slides re-checked at Vanderbilt

They recommended surgery but told me that with a Gleason 8 rating, I was probably going to need radiation at some point.

I used Dr Jim Grey at Cenntenial in Nashville as my RO.

My husband was diagnosed similarly last year at age 57 (age 57, no symptoms, G9, PNI).
He went with the triple play (HT, a HDR brachytherapy boost, and 5 weeks of IMRT).

Starting HT prior to treatment is typical - the HT makes the cancer more radiosensitive, so my hubby had to be on the HT for 2 months before we could actually DO anything anyway, so in my view, starting the HT and buying yourself some decision time makes sense and won't cause you to lose any time really.

You are on the right track, asking all the right questions. Good for you. The early days of diagnosis are the hardest, it will get easier.