Gleason 9

My husband story is in 12/2 first urologist biopsied Prostate came back Gleason 6. He said we had time to explore our options and sent us to see radiation dr. We wanted a second opinion so we went to Sloan Memorial. They requested a MRI. Found two more spots. Biopsied, Gleason 9. Had bone scan and cat scan. No signs of spread. Next week meeting with medical,radiation, and surgery doctors. Looking for what the treatments might be. Thank you. So scared, everything I read says only 28 percent chance for 5 years.

I didn’t understand what was supposed to go in those boxes

*IF* you choose surgery and there is no evidence of distant metastases on imaging/scanning, I doubt your docs will advise neoadjuvant ADT (staring hormone therapy before surgery). Standard of care for the surgical route is just that: surgery. Radiation (+/- ADT) is advised only if there are post-op adverse findings that merit it.

Djin

Hello and welcome to our community, but sorry you need to be here. A Gleason 9 is a serious diagnosis (same as mine), but if his cancer is contained, your husband's chances are still quite good. I'm still here 10 years later and at this point, I don't think prostate cancer will be what gets me in.

Can you post more details about your husband's diagnosis, such as his PSA and the number of positive cores that he had?

Those are some significant differences between the two biopsies. I'd recommend that you send the second biopsy slides to Johns Hopkins opinion--it's unlikely to change your course of action, but it's easy to do and it will give you another data point given the dramatic differences between the two biopsies. Sloan should know how to do this and there's also information in the "newly diagnosed" thread here.

I'm glad you're meeting with both surgery and radiation oncologists since they're likely to have different perspectives. If there's indication that the cancer has extended beyond the prostate would generally mean your husband isn't a good candidate for surgery. Another factor would be his age, but these are all questions for the surgeon.

For radiation, with higher Gleason scores like your husband's, a combo radiation treatment involved external radiation and brachytherapy is often used. (That's what I had a a Gleason 9.) Something to ask the radiation oncologist when you meet him/her.

Good luck to you and your husband--hopefully we can be of help through your journey!

Yes as the others have said take a deep breath. If the 28% came from “Dr Google”, you should know that % is if he was diagnosed with Stage IV where the cancer has spread to bone(s). That doesn’t sound like your situation.

PNI invasion does not classify you as Stage IV (I saw you put it in all caps).

Still crummy news, to be sure, but there are guys who are initially diagnosed with psa’s in the hundreds, or even greater than 1000, and their initial symptom is they think they twisted their back.


So hang in there and carefully listen to your team. You will get up to speed on all of the terminology soon enough.

If you believed he has a 28% chance to survive 5 years, everything we can say here will be great news. For localized, or even regional extended, prostate cancer, the survival rate at 5 years is greater then 99%! Although high grade cases have higher risk, they are included in the sample and they represent 10-20% of all cases.
Why localized high grade cancer is still "high risk" ? Because it has a higher chance to return and to require further treatment. If he follows the surgery path, you will have a pathological report and a psa test in 3 months that will give a better idea of where he really stands and what he can expect in, say, 10-15 years. But we sure that, unless distant extension is found, his chances for 5 years will be much higher than that 28%.

Arol, Welcome. Sorry that you have to be here. I am Gleason 9 (5 + 4) as well. Following my biopsy in November 2020 I was diagnosed as Gleason 8 contained in my prostate. Post surgery pathology report showed Gleason 9, outside the prostate and one of eleven lymph nodes involved. Needless to say, my wife and I were quite scared. My first PSA post surgery was <0.05, and so far has remained there. I am on ADT (Lupron) and had 8 weeks of IMRT Radiation. I changed my diet and exercise. I fully expect to be here well beyond 5 years, God willing! While your husband and you certainly have a challenge ahead of you as I do, there is hope and encouragement. This forum is a great place to hear from men who have been in this fight for 10 + years. Take heart, listen to your doctors and God Bless you.