Husband newly diagnosed
My husband is newly diagnosed with PC. He's had four PSA tests done from 6/1-8/30 with results of 12.1, 9.9, 15.2, and 13.0. The first two were done at different labs and the last two were done at the urologist's lab.
He is 67 y.o, and still employed full time as a truck driver. He has type 2 diabetes which is well controlled, and was diagnosed with CHF after a bout with Covid when he ended up in the hospital for over two weeks in July-Aug 2020.
He had biopsy on 9/15 with cancer in 10 of the 12 cores. Here are the results:
Prostate, right base, core biopsies:
- Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade group 1).
- Involves 1 of 2 cores and 10% of tissue.
- Perineural invasion is not identified.
Prostate, right mid, core biopsies:
- Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade group 2).
- Involves 2 of 2 cores and 20% of tissue.
- 5% pattern 4 and cribriform glands are absent.
- Perineural invasion is not identified.
Prostate, right apex, core biopsies:
- Predominantly fibromuscular tissue with no diagnostic abnormality.
Prostate, left base, core biopsies:
- Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade group 1).
- Involves 2 of 2 cores and 20% of tissue.
- Perineural invasion is not identified.
Prostate, left mid, core biopsies:
- Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade group 2).
- Involves 2 of 2 cores and 40% of tissue.
- 5% pattern 4 and cribriform glands are absent.
- Perineural invasion is not identified.
Prostate, left apex, core biopsies:
- Prostatic adenocarcinoma, Gleason score 3+4=7 (Grade group 2).
- Involves 2 of 2 cores and 50% of tissue.
- 5% pattern 4 and cribriform glands are absent.
- Perineural invasion is not identified.
As you can see, two are grade group 1 and three are grade group 2.
The urologist called today and we are going to set up a bone scan and possibly an MRI and will see him again in 2-3 weeks. In the meantime, he wants us to research methods of treatment so that we can have an informed discussion when we see him. I am trying to do that, but are not sure where to really start. I've been reading about radiation and surgery, but I think treatment will rely a lot on whether it has metastasized or not.
I'm sure there are more appropriate treatments depending on the stage of the cancer and I don't want to waste a lot of time researching something that wouldn't be applicable in this case. So, I'm asking for pointers on what/where to start. With the 1 and 2 grades I've read they are more likely to have a better outcome than if it was higher, but it worries me that it appears nearly his whole prostate is involved since they found it in 5 out of 6 sites.
This is all very scary and the more we know what to expect, the better we'll be able deal with everything.
There is no point in overthinking or in letting fear get an upper hand. Doctors can be approached to consider imaging (mpMRI and/or PSMA PET scan) before taking a decision. I don’t know whether doctors where you are have started relying more on PSMA-PET scans than on bone scans. They can be approached on the matter and second opinions taken.
Once the results are all in, an informed decision can be taken if the diagnosis permits your husband to opt for Active Surveillance, focal therapy, prostatectomy or radiotherapy with or without ADT. There is a much wider safety net nowadays as compared to years gone by.
Here’s wishing your husband the best outcome.
remember
Surgery has immediate negative impacts on urine control and sexual function which typically return to normal in about 3 - 6 months. Some men take longer. Negative Radiation effects can take a 3 - 5 years on sexual function and more. Radiation is not fast acting and it CAN take up to 2 years (I am told) to know how effective it was on the cancer.
On average negative outcomes on sexual function and urine control for both radiation or surgery are about the same over time. Your best source of guidance on which way to go are your MD's. IF possible speak to several as you have time to do so. When you and your husband are comfortable then make your decisions.
Prostate Cancer is a treatable disease and it sure sounds like you are on top of it. IF it has spread beyond the prostate bed your urologist most likely will suggest radiation along with some form of hormone therapy. Best advice is take this one day at a time and wait for information before acting. My initial run in with prostate cancer was almost 10 years ago and for better or worse I am still here 😀 Dennis (ProstateCancer.net TEAM)Thanks for the replies peekaafighter and Dennis. We are waiting to be contacted about getting a bone scan and another test (don't know whether it's an MRI or a CT scan) and then meet with the urologist in a couple weeks. Right now we are leaning toward LDR Brachytherapy if the doctor thinks that is suitable. His younger brother had that when he was diagnosed some years ago and so far, so good with him. It's just really hard to make an informed decision until all the facts are presented. The waiting to get the ball rolling is terrible!
Yes you are in the in-between place now - and it is not easy on the nerves and emotions - just try to take comfort in knowing that PCs a not a rapidly spreading cancer. Dennis (Prostate-Cancer.net TEAM)
I see some great responses above !
Please do take comfort in knowing that his Gleason scores are such that (pending the MRI and bone scan) he should have a choice of options which is a good thing. 2 years ago I had some Gleason 9 scores, had only two choices Surgery or Radiation. I chose Surgery and am doing quite well today. There is some great support and advice on this forum. Wishing the best for your husband (and yourself).What many folks do not recognize at first is Prostate Cancer is not just a man's disease. The whole process from diagnosis to treatment and more can have significant impacts on family relationships (spouse and children) friends and business connections.
My former financial advisor was diagnosed with a G9 at the same time I was diagnosed with the same score. He refused treatment over concerns of potential loss of clients due to questions over his long term health. Great both of you are being pro-active. Dennis(ProstateCancer.net TEAM)
