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    Gleason 8 - What now?
    AshWarrior posted:
    Just diagnosed with PCa from biopsy of 5+3 on right side and 3+3 on left side so Doc says I am a Gleason 8. DRE is Neg. 12 cores taken. 3 of 6 cores on right side with 15%. PSA went from 3.2 last year to 6.4 this year. Doc says my stage is cT1c (T3?). Will have bone scan and CT of pelvis this Friday. Getting a 2nd opinion on the pathology report from the AFIP. Doc thinks I probably have high risk Ca. Must decide on surgery or IMRT radiation soon. So many possible side affects! I am also looking into Proton Beam treatment. Any suggestions or recommendations?
    RandomPseudoNym responded:
    Well, having any Gleason 5 is certainly bad news. That is "high risk" or "aggressive", and the scans will be trying to figure out if it's really T1c (contained) or worse (not contained.)

    My own, recent, abrupt, education in this disease leads me to think that there are really no good choices, just picking what's least bad to you from a wide range of not-great options. While there are a few folks who had a good experience with each particular procedure, there's no guarantee that you'll have a similar experience with the same procedure - the state of your cancer and your overall health and the luck of the draw all come to play in the end - so beware the testimonial pushing treatment X upon you - evaluate as much as possible yourself, bringing your own concerns into what you decide.

    I've personally chosen cutting it out, but haven't had it done yet. I also have an apparently much lower-risk T1c cancer (Gleason 6 on the biopsy.) I'm also relatively young (47).

    Between rounds of research, get out and walk - there is research indicating that brisk (3 mph or better) walking 30-60 minutes per day can slow cancer growth, and it has other benefits not so related to cancer as well.
    mskite replied to RandomPseudoNym's response:
    My cancer score climbed 4 points from 3 to 7 in 3 months. My DR. said best treatment is radical surgery. It had not spread. Had the surgery Sept. 24/2003 and in about a year count dropped to .00. Today, 8 years later I have not had to have the first treatment of any type and they have found no cancer after surgery. They have run all types tests there is to check it. Only problem I have is leakage from removal of so much stuff. Good luck.
    AshWarrior responded:
    Saw VA Radiation Oncologist today. Bone scan and CT negative. DRE and Ultrasound Neg. Says biopsy Gleason of 8 on right side is high risk (left side 6). Wants me to start Hormone therapy now and IMRT in 2 months. Then continue HT therapy for 28 months. Trying to decide what to do. Still looking at Proton Therapy vice IMRT. VA Doc says side affects slightly less with Proton. Wonder if I would need HT if I go the Proton route if higher Gy.
    Fairwind replied to AshWarrior's response:
    High-risk cases respond well to the combination of HT, seeds and IMRT combined..

    Some doctors like to do all three..Surgery to reduce the tumor volume as much as possible, then HT and IMRT to clean up anything that escaped the surgery..Unfortunately, this also exposes you to the heaviest possible side-effect load...But don't forget, you are fighting for your life here...

    If you are going to do radiation as your primary treatment, more is better and only the seeds/IMRT combo can deliver the very effective 145Gy dose and still limit side-effects..Find a radiation oncologist who does brachytherapy and talk to him about it...
    AshWarrior replied to Fairwind's response:
    VA radiation oncologist thinks I am a bad candidate for surgery and for seeds due to BPH problems/enlarged prostate/high risk cancer. Dr Peter Scardino's Prostate Book also says Seeds are best for low risk cancers and that there is a much higher risk of serious complications with IMRT when combined with Seeds. He generally recommends IMRT with HT for high risk. Proton center in Florida says they would due PT treatment first followed by HT. I am leaning toward PT with HT due to less side affects and good chance for a cure. So many things to consider. PT appears to be the new "gold standard" in treatment.
    Fairwind replied to AshWarrior's response:
    Here is a good study that charts the results of various treatment methods. It's worth reading..

    The poeple who are selling Proton Treatment are the only ones able to find any superiority over photon treatment..Proton radiation has a place in treating small, confined cancers located in difficult places..But when you must open up the beam to treat a larger area, its advantage quickly turns into a disadvantage..Do some more investigating and as with any radiation treatment, get pre-approval from your insurance company..

    Here is the link:
    kennyeg replied to AshWarrior's response:
    After having the prostectomy in July. PSA went from 8.36 to .33 and now down to .14 which it should be showing 0. There is still CA showing in the margins. After seeing 2 radialogitst oncologist both of them stated that they would of done radiation RX. with the IMRT and not the surgery. Also on the HT Rx. I will be starting the IMRT with the Tomo proton beams on Mon. Good luck to you. Do your research on the therapy. Sometimes using the seed Rx. where they are implanted is not a sucess because they can move and the Rx. is not delivered to the area. Know a lot of men out there that had sucess and CA free with the radiation RX. and hormone therapy. Not sure where you are located but I am receiving Rx. with Goshen Ca Center here in South Bend, IN
    AshWarrior replied to kennyeg's response:
    I have now talked to two urologists and two radiation oncologists. None recommended surgery or seeds and all recommended HT with IMRT or Proton Therapy. I did get some good news on the pathology 2nd opinion. My right side Gleason went from a 5 3 to a 3 5. Still an 8 but the 5 is secondary instead of primary. Still looking at getting proton thereapy at the CDH Proton Ctr in Chicago vice IMRT with the VA due to side affects less with proton. Consult appointment coming up this week in Chicago. Did you know that they have a very good Proton Therapy Ctr in Bloomington. Good luck.
    AshWarrior replied to AshWarrior's response:
    Great consult with the CDH Proton Ctr in Chicago. Will go with HT and Proton treatment for my PCa. Started 4 weeks of casodex. After 2 weeks of casodex will get a lupron shot good for 6 months. Two months after lupron shot will start proton treatment for 9 weeks. Will probably stay on HT for 1-2 years. Anybody else gone this route?
    charlieca responded:
    Hi, I had a Gleason score of 9 and the cancer had just started to leave the prostate. I was not a canadate for any thing but surgery to remove the prostate. I examined all of the options, and went for the Da Vince robotic surgery. I had the surgery 3 weeks ago now and I am feeling almost back to pre-op status. The pain after surgery was bearable as I only used extra strength OTC Tynenol for pain. This is not invasive surgery. 5 small puncture wounds which have closed at the skin level already. Total healing should be around 6 weeks. I was up and about the next day. The down side was the Foley catheter for almost 2 weeks but it was not as bad as I thought it would be. I go back to the surgeon on 11/26 to get the pathology reports and see what the next step will be. Hopefully I will be clean, keeping my fingers crossed. My surgeon was great and I have every confidence that I will just be doing PSA's for the rest of my life.. good luck Ash worrior and if you have any questions, post and I will try and answer them
    rjorgeron replied to AshWarrior's response:
    I was diagnosed with PCa this past February, PSA 6.4, up from 4.2 the previous year, Gleason 7 (3 4), DRE negative, bone scan negative. I opted for a treatment called a Nano Knife, technical term is Irreversible Electroporation of the Prostate. This procedure basically consisted of putting electrodes into my prostate and building up an electrical field of 3000 volts. Essentially it killed my prostate. my 3-month checked showed a PSA of undetectable. I have been extremely pleased with my treatment by Dr. Jaime Wong of the Jenkins Clinic in Atlanta. This procedure is only 2 year old, but it was the right decision for me. I had to wear a catheter for a week and took no pain medication. I did have to catheterize myself for about 10 days after the catheter was removed until the swelling of my prostate subsided. I did have some urinary leakage for about a month, but nothing embarrassing. I did wear diapers for about a week and then pads for another week. The only lasting side effect is severe ED. I do have a pump which does work and am fighting with insurance to pay for daily Cialis. All in all, I am very happy with my treatment. I want to wish you the best of luck with your choice of treatment.
    Herzkroet replied to rjorgeron's response:

    please tell me how is your health situation now. I'm 57. From Germany. Gleason 3 4=7. I think about Nanoknife in Germany Prof.Dr.Stehling. I didnot get any feedback from the persons who had done it. You are the first really person who I see.
    But I have one problem more: I want to have a child. That'why it is for me very important. You say it killed your prostata. Why not only carzinom areal?
    Please answer me.

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