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Thread: New diagnosis - Gleason 9, psa 20

  1. #31
    Senior User
    Join Date
    Feb 2017
    Posts
    130
    I was diagnosed locally and had a RALP in the local cancer center. After an ugly pathology report, I headed to Johns Hopkins 18 months ago. My doctor put me into a stage II clinical trial. I started ADT immediately, then began chemo - 4 sessions of Docetaxel (I had a couple of lymph nodes that were involved). I went to radiation next. 69 Gy over a period of around 7 weeks. The toughest part has been the Lupron. The side effects are just ugly. I have been very involved in my treatment plan and I have a really top clinical researcher whose motto is “Kill Cancer.” IN addition, he’s a super great guy. I’m sure you’ll be well taken at MD Anderson and participating in a clinical trial exposes your husband to cutting edge treatment as well as the potential to help others. A great combo!

    Please keep us informed on how things are progressing.
    2010-PSA 3.59; 2011-PSA 3.58; 2012-PSA 5.28, 4.26; 2013-PSA 5.98, 7.37; 2014-PSA 5.90, 4.70; 2015-PSA 5.18, 7.35
    RALP 16 March 17, Wesley Long Hospital, Greensboro, NC
    Pathology: pT3a, pN1 Gleason 4+5=9 adenocarcinoma with + surgical margin at bladder neck; 3 of 16 lymph nodes positive; neg seminal vesicles, vasa deferens
    Referral to Dr. Ken Pienta, Clinical Dir Research, Brady Center, Johns Hopkins
    Enrolled in Clinical Trial IRB002120414 ďPhase II Study of definitive therapy for oligometastatic prostate cancer post surgery"
    Completed: Docetaxel 12 Jun 17, 3 Jul 17, 24 Jul 17, 14 Aug 17, 15 Sep 17
    Lupron every 90 days. 1st injection 12 Jun 17, 2d 15 Sep 17, 3d 18 Dec 17, 4th 6 Mar 18, 5th 5 Sep 18; 17 Dec 18
    Bone/Body Scans - 15 Sep 17 - neg
    EBRT: 69 Gy total (46 to fossa, 23 boost to suspect areas) 1st treatment 28 Sep 17, last 22 Nov 17
    PSA: 25 May 17=0.2; 5 Sep 17=0.1; 18 Dec 17=0.1; 6 Mar 18=0.1; 29 May 18=0.1; 5 Sep 18=0.1; 17 Dec 18=0.1; 12 Mar 19=0.1; 25 Mar=0.1

  2. #32
    Quote Originally Posted by Garden View Post
    UPDATE: new diagnosis, Gleason 9

    Good news! Visited M D Anderson last week. My husbandís bone scan showed a couple of spots which required further testing to rule out that the cancer had spread. This past Friday he had an MRI of the spine which indicated he had spondylosis - osteoarthritis we get from aging. What a relief! Yes, itís painful, but to find out the cancer had not metastasized was a red letter moment!

    It seems from all the imaging that the cancer is confined to the prostate. He had three options on how to handle this and chose to have a month of immunotherapy followed by a prostatectomy. Once a week for 4 weeks we will go to Houston for I.V. Therapy. He will participate in a clinical trial study of a new medication for aggressive prostate cancer which has been showing great promise. The study is under Jim Allison, Ph.D., the MD Anderson scientist who recently was co-awarded the Nobel prize in Medicine for his work in immunology and Dr. Sumit Subudhi. I was already aware of his work and was interested in his approach. (See this article https://www.usatoday.com/story/news/...ne/1485103002/). My husband is excited to participate in the study which focuses on aggressive prostate cancer.

    Then, on week 6 he will have a prostatectomy at MD Anderson, by Dr. Pisters. Should be a 2 day hospital stay. The surgery will define where the lines of the cancer are.

    Is anyone familiar with either of these two doctors?

    At MDA, your husband is at the right place to get cutting edge treatment.

    I don't know these particular doctors, but a fellow poster on a non-medical internet forum I used to go on, had nothing but praise for the treatment he got at MDA.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3

  3. #33
    Regular User
    Join Date
    Dec 2018
    Posts
    21
    BAB, your treatment sounded very tough. Thank you for sharing your experience. Hoping the chemo/immune therapy is not too difficult. Four weeks, then surgery. Counting the days.
    January 18 2019 PSA 60.8
    November 2018 PSA 22.5
    October 2018 PSA 10
    March 2018 PSA 5.65
    Biopsy Nov 27, 2018
    Gleason score 9; Right prostate - negative; Left prostate - prostate adenocarcinoma 4+5=9/10; percent involved 35%
    Biopsy noted chronic prostatitis
    MD Anderson on Jan. 7, 2019 - Dr. Suduhi
    MRI of spine negative
    bone scan negative
    CT body scan findings - 1/23/2019
    Retroperitoneal, left common iliac and left internal iliac adenopathy.
    Nodule in the prostate gland, consistent with the known primary malignancy
    Hormone therapy planned

  4. #34
    Regular User
    Join Date
    Dec 2018
    Posts
    21
    Glad to hear the endorsement. Praying all goes well.
    January 18 2019 PSA 60.8
    November 2018 PSA 22.5
    October 2018 PSA 10
    March 2018 PSA 5.65
    Biopsy Nov 27, 2018
    Gleason score 9; Right prostate - negative; Left prostate - prostate adenocarcinoma 4+5=9/10; percent involved 35%
    Biopsy noted chronic prostatitis
    MD Anderson on Jan. 7, 2019 - Dr. Suduhi
    MRI of spine negative
    bone scan negative
    CT body scan findings - 1/23/2019
    Retroperitoneal, left common iliac and left internal iliac adenopathy.
    Nodule in the prostate gland, consistent with the known primary malignancy
    Hormone therapy planned

  5. #35
    Regular User
    Join Date
    Dec 2018
    Posts
    21
    We received bad news yesterday. My husbandís PSA climbed from 22 to 60 in 3 months time. The doctor did a CT scan of the entire body. It looks like cancer is in the lymph nodes. He has biopsy of the lymph nodes next week. If verified, he will begin hormone therapy. No surgery. He will have a hormone shot and start degarelix. Second month he will have hormone shot and start leuprolide. The third month he will have labs and body scan.

    I may sound like Iím reaching - because I am- but I canít help but wonder if the PSA is rising so fast because he still has prostatitis and perhaps the enlarged lymph nodes are from the inflammation. In any case, we get the biopsy next week.

    Of course, Iím concerned. We want to do what is right, what is best treatment, and whatever supportive treatment we can do, such as, diet, vitamins to support immune system, etc. I would appreciate your views.

    Sincere thanks.
    January 18 2019 PSA 60.8
    November 2018 PSA 22.5
    October 2018 PSA 10
    March 2018 PSA 5.65
    Biopsy Nov 27, 2018
    Gleason score 9; Right prostate - negative; Left prostate - prostate adenocarcinoma 4+5=9/10; percent involved 35%
    Biopsy noted chronic prostatitis
    MD Anderson on Jan. 7, 2019 - Dr. Suduhi
    MRI of spine negative
    bone scan negative
    CT body scan findings - 1/23/2019
    Retroperitoneal, left common iliac and left internal iliac adenopathy.
    Nodule in the prostate gland, consistent with the known primary malignancy
    Hormone therapy planned

  6. #36
    Garden: Before u get into the diets, supplements, vitamins, etc...what primary treatment have u decided on? U are at MDA, that's good news. Are they doing EBRT with some sort of Brachy therapy? how is the main problem being treated?

    https://pcnrv.blogspot.com/

    https://pcnrv.blogspot.com/2017/02/f...brt-bt-is.html

    I give u these because u said that surgery was not a option. Good Luck
    Last edited by MichiganMan16; 01-24-2019 at 05:12 PM.
    DOB:Feb 1958
    PSA: 9/15: 5.9 PC/Father
    DRE: Negative
    Biopsy: 10/1/15. Second Opinion University of Chicago. 9 of 12 cores positive. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: Ct scan/bone scan- Negative
    Clinical Staging: 10/28/15 T2c
    ( RALP) University of Chicago 12/29/15

    Final Pathology Report; Jan. 6 2016

    15 lymph nodes; no tumor present
    gleason upgraded to 9 ( 4+5)
    +EPE
    +LVI
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PI present
    PM
    pT3bNO
    uPSA 2/9/16 0.05
    uPSA 3/23/16 0.11
    Casodex 4/1/16-8/5/16
    Lupron 4/15/16-5/15/18
    SRT 6/14/16...8/5/16 38Tx
    uPSA 8/10/16---2/14/19 <0.05
    Feb. 2017 Loyola Chicago
    11/15/2018 AUS 800 Implanted
    12/18/18...T Levels...Free T 42.8...Total T...262

  7. #37
    Regular User
    Join Date
    Dec 2018
    Posts
    21
    We were not offered any alternatives. I asked about how to deal with the source of the cancer (prostate) and surgery; the doctor said surgery was not an option. He did not offer radiation or anything but hormone therapy. He said if hormone therapy does not hold it, then he would offer a clinical trial. The clinical trial would include either surgery or chemotherapy, but we would not have a choice of which he would get.

    We seem very limited in what is offered. I donít understand why. We visit the doctor next week and I am making a list of questions for him. If yíall could help me with that, Iíd appreciate it.
    January 18 2019 PSA 60.8
    November 2018 PSA 22.5
    October 2018 PSA 10
    March 2018 PSA 5.65
    Biopsy Nov 27, 2018
    Gleason score 9; Right prostate - negative; Left prostate - prostate adenocarcinoma 4+5=9/10; percent involved 35%
    Biopsy noted chronic prostatitis
    MD Anderson on Jan. 7, 2019 - Dr. Suduhi
    MRI of spine negative
    bone scan negative
    CT body scan findings - 1/23/2019
    Retroperitoneal, left common iliac and left internal iliac adenopathy.
    Nodule in the prostate gland, consistent with the known primary malignancy
    Hormone therapy planned

  8. #38
    Hey Garden: Ok, I see in your signature where the cancer has traveled to the lymph nodes in the stomach area. I thought we were dealing with PCa in the regional LN. They are going to do the biopsy, and then determine what the next course of action will be. I am not sure why they do not want to deal with the main tumor burden with some sort of primary treatment. Perhaps someone else will be chiming in soon. I am assuming they are going to see if it is PCa in the stomach, or some other??, or nothing. MDA is the mecca of places, I would be interested in the game plan, and why?....I am putting together my questions. MM
    DOB:Feb 1958
    PSA: 9/15: 5.9 PC/Father
    DRE: Negative
    Biopsy: 10/1/15. Second Opinion University of Chicago. 9 of 12 cores positive. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: Ct scan/bone scan- Negative
    Clinical Staging: 10/28/15 T2c
    ( RALP) University of Chicago 12/29/15

    Final Pathology Report; Jan. 6 2016

    15 lymph nodes; no tumor present
    gleason upgraded to 9 ( 4+5)
    +EPE
    +LVI
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PI present
    PM
    pT3bNO
    uPSA 2/9/16 0.05
    uPSA 3/23/16 0.11
    Casodex 4/1/16-8/5/16
    Lupron 4/15/16-5/15/18
    SRT 6/14/16...8/5/16 38Tx
    uPSA 8/10/16---2/14/19 <0.05
    Feb. 2017 Loyola Chicago
    11/15/2018 AUS 800 Implanted
    12/18/18...T Levels...Free T 42.8...Total T...262

  9. #39
    Garden: Sent u a PM...
    DOB:Feb 1958
    PSA: 9/15: 5.9 PC/Father
    DRE: Negative
    Biopsy: 10/1/15. Second Opinion University of Chicago. 9 of 12 cores positive. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: Ct scan/bone scan- Negative
    Clinical Staging: 10/28/15 T2c
    ( RALP) University of Chicago 12/29/15

    Final Pathology Report; Jan. 6 2016

    15 lymph nodes; no tumor present
    gleason upgraded to 9 ( 4+5)
    +EPE
    +LVI
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PI present
    PM
    pT3bNO
    uPSA 2/9/16 0.05
    uPSA 3/23/16 0.11
    Casodex 4/1/16-8/5/16
    Lupron 4/15/16-5/15/18
    SRT 6/14/16...8/5/16 38Tx
    uPSA 8/10/16---2/14/19 <0.05
    Feb. 2017 Loyola Chicago
    11/15/2018 AUS 800 Implanted
    12/18/18...T Levels...Free T 42.8...Total T...262

  10. #40
    Regular User
    Join Date
    Dec 2018
    Posts
    21
    MichiganMan16, thank you for addressing this. How do I find the PM?
    January 18 2019 PSA 60.8
    November 2018 PSA 22.5
    October 2018 PSA 10
    March 2018 PSA 5.65
    Biopsy Nov 27, 2018
    Gleason score 9; Right prostate - negative; Left prostate - prostate adenocarcinoma 4+5=9/10; percent involved 35%
    Biopsy noted chronic prostatitis
    MD Anderson on Jan. 7, 2019 - Dr. Suduhi
    MRI of spine negative
    bone scan negative
    CT body scan findings - 1/23/2019
    Retroperitoneal, left common iliac and left internal iliac adenopathy.
    Nodule in the prostate gland, consistent with the known primary malignancy
    Hormone therapy planned

 

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