Surgery

Hello Margaret123, hopefully someone with Gleason 9 will answer.

If the cancer is well contained within the prostate then surgery seems sensible. If it is in danger of breaking through the prostate capsule then perhaps not so sensible.

It would be useful if you shared more information. What age is the person diagnosed, what is their PSA, how many cores are affected, where are any tumours located, are they in good health otherwise?

Best wishes,

Hi Margaret. Do you have any biopsy results to put alongside these numbers? I am also a Gleason 9 and was diagnosed with a PSA of 38. Very best wishes, Jonathan.

Thanks for your reply. Trus biopsies left 4+5 =9 group 5  4/7 cores 8% involvement. Right 4+4=8 grade 4  3/5 cores 5% involvement. Psa of 50. Hope this helps and has anyone had surgery with these results please.

Thanks

Sorry forgot to say my partner is 67 years old and is in excellent health. 

Thanks

Thank you Margaret. There are both similarities and differences between your partner and myself. I am 62 and also in good general health. My biopsy revealed cancerous presence in all 12 core samples taken. There was no detectable cancerous presence outside the capsule. HOWEVER, not all cancerous presence is detectable. Micro-tumours are frequently missed. So, some decisions regarding treatment plans are made on the basis of probabilities rather than verifiable facts. My high Gleason score together with the presence of cancer within all my biopsy core samples indicated to my oncologist the distinct possibility that there may be undetectable cancer spread beyond my prostate capsule. This despite my bones showing as unaffected ('escaped' prostate cancer cells apparently frequently attach to bone tissue). It was explained to me that a high Gleason score such as ours indicates cancer cells that are prone to break free and travel within the body. Low Gleason scores indicate what are often termed 'sticky' cancer cells that are more likely to remain within tumours rather than drift off elsewhere. For these reasons an operation was discarded as an option in my case. In order for an operation to be a generally advisable course of action it would appear that oncologists need to feel that any spread beyond the prostate capsule is unlikely to have taken place. In my case, my numbers appeared to indicate a strong possibility of undetectable spread. Accordingly, following a period on hormone therapy to arrest cancerous developments, my more heavy duty treatment began with chemotherapy, in an attempt to mop up any possibly 'escaped' cancer cells. Following a recovery period I then received brachytherapy, which introduces radioactivity directly into the prostate via an operation. This was followed by more conventional radiotherapy to the prostate and surrounding area. I am now recovering from all this treatment, which took place over the course of a calendar year. My PSA is currently undetectable. I am however to remain on hormone therapy for a further two years. Please get back to me if you have any questions. I'd be very happy to try to help. Very best wishes to you both.

Many thanks for your prompt and full reply. How long ago was this and at which hospital did it take place. We are due to see oncologist on Wednesday and think we will be offered 20 sessions of radiotherapy having been on hormone therapy for three months and this will continue for a while yet. But it is good to find out what other treatments are available. Many thanks. 

Hi Margaret.

My treatments have taken place across various hospitals within West Sussex. I have been very happy with the standard of care offered and the reasoning that lay behind the treatment choices that were recommended. Many patients appear to favour operations to remove a cancerous prostate in the belief that it will most efficiently rid them of their problem. They just want rid of their tumour/s. However, the removal of the tumour/s may not necessarily deal with the cause of the tumour/s, nor indeed entirely eliminate all the cancerous presence, and, the long term consequences of such operations can be difficult to live with, so it is really worthwhile taking a look at all your available options.

Very best wishes,

Jonathan.

Thank you, see oncologist tomorrow would have been willing to travel any distance but in the current climate that is not possible.

Thanks again. 

Just been to oncologist going to have 37 sessions of radiotherapy to include lymph nodes which is what we wanted because psa was 50 even though the scans were clear. Only problem is that we will have to wait up to 6 months instead of the normal 3 oh well cannot be helped because of corona virus. People on hormones with prostate cancer are seen as safe hope this right. Psa now down to 11 so not too bad after 10 weeks on hormones only another 2years and 10ths to go. All good.

Thanks

Good luck to all

Very good new Margaret.

I'm sorry about the wait. Waits are always stressful. As far as I'm aware, what I've always been told, and also in line with my own personal experience, yes, hormone therapy does arrest any prostate cancer development for quite some time. Over extremely lengthy time spans (way, way beyond your 3 month delay) I have read and heard that they can, in some cases, cease to be effective, but at that point there are still one or two alternative testosterone suppressants that generally prove highly effective.

Very happy for you. You must feel tremendously relieved.

Very best wishes,

Jonathan.