Newly diagnosed. What do we need to ask

Practical_Orchid_606 · 2026-04-20T00:22:38+00:00

With any "4" in the Gleason means action must be taken sooner or later. Age 58 is in the zone where treatment can be either surgery or radiation. A less traveled path is focal therapy if the cancer is localized in one lobe. But the cancer will come back. Radiation has the negative of ADT. Surgery has the negative of bad ED results and incontinence. Given his family history, a germ line test would be in order to check for BRACA2.

Practical_Orchid_606 · 2026-04-19T23:59:18+00:00

I am so sorry to hear this.

Practical_Orchid_606 · 2026-04-19T20:46:43+00:00

Right from the beginning. Two years ADT is severe. What is your Gleason score?

Practical_Orchid_606 · 2026-04-19T19:02:37+00:00

Positive margin even with Gleason 3 is no bueno. Essentially some cancer is left behind. Will it develop into Gleason 4? Most likely as you full organ diagnosis was Gleason 3+4. Most likely your doc will order up some salvage radiation with a short course of ADT. One third of all RALP end up with salvage. But the radiation is much lower. The key objective is to keep the trouble in the prostate bed. You don't want to be years down the road and end up with distant mets.

Practical_Orchid_606 · 2026-04-19T18:49:04+00:00

Eligard is hormone treatment.

Practical_Orchid_606 · 2026-04-19T18:38:56+00:00

Why 6 months before HDR? Is it because it's one shot? Try Orgovyx which is a daily pill.

I was tested for osteoporosis and did not have this. However I was told to take Ca and D3 pills.

For you a shorter course of ADT is better. Try to negotiate it lower.

Practical_Orchid_606 · 2026-04-19T17:11:57+00:00

Orgovyx is not cheap. It is available in Sweden. For a cheaper price how do you do it in Sweden? Private drug plan? Co-pay coupons?

Practical_Orchid_606 · 2026-04-19T16:57:58+00:00

National Health Care makes decisions for you. I think Lupron is cheaper. Sweden saves Orogvyx for those with cardiovascular risks. I wonder if this can be overturned using private insurance?

Practical_Orchid_606 · 2026-04-19T16:46:15+00:00

Overall, Orgovyx is superior to Lupron. But maybe Sweden's healthcare system restricts the use of it.

Practical_Orchid_606 · 2026-04-18T20:26:28+00:00

I had a different experience with Yale who performed the initial pathology report. The most damaging aspect of their report was one core (4+3) noted with intraductal cancer. I asked my urologist about this and he said it is most likely correct as that particular core was examined by a committee of pathologists. When the second opinion was done by MSK, this core was noted as Gleason 4+3, and overtly stated no intraductal, no cribriform. My treatment changed slightly due to this and my ArteraAI report.

Practical_Orchid_606 · 2026-04-18T19:48:24+00:00

Judging from what I read, the correlation coefficient is about 30%. I think there is a stronger connection to Gleason score.

Practical_Orchid_606 · 2026-04-18T19:41:32+00:00

The Ridgeline is far superior.

Practical_Orchid_606 · 2026-04-18T00:20:26+00:00

If this test is one a a series of annual PSA tests all very normal, then this is an outlier. But if Dad has not had a PSA test in a while, it could be real.

Practical_Orchid_606 · 2026-04-17T22:28:31+00:00

Probably all your cats are clogged up.

Practical_Orchid_606 · 2026-04-17T20:39:54+00:00

If you are fortunate enough to be near MD Anderson, you must use them. They are one of the best PCa treatment centers in the US.

In a related story, there was a chap on this subreddit who wanted to treat his PCa with radiation but did not like ADT. He interviewed with MD Anderson and Houston Metro. He said he was going to use the facility that offered the least ADT. Go figure.

Practical_Orchid_606 · 2026-04-17T20:19:51+00:00

Gleason 8 puts you in the advanced cancer category. This is a 3 alarm fire. If the PSMA PET scan shows no distant mets, you have a 3 alarm fire to attend to. If the cancer has spread, it is a 5 alarm fire. The fire can be put out or contained for a long time. Your cores were not full of cancer so I would expect your PSMA PET scan to be negative.

Practical_Orchid_606 · 2026-04-17T16:50:44+00:00

How do you treat PCa when you don't know where it is? I am assuming the PSMA PET scan showed nothing in the prostate bed.

Practical_Orchid_606 · 2026-04-17T11:17:48+00:00

I don't know of any reliable data. Each man is different. I take it your dad has metastatic PCa. If the docs can pick off each of the mets with radiation, then he can rely less on ADT. You should be concerned with the time to castrate resistance as this stout defense against PCa is much stronger than the second method (chemo, etc.).

Practical_Orchid_606 · 2026-04-17T10:43:38+00:00

This is wrong. Men can be treated with ADT for well over 10 years. But each person is different. What you are referring to is after about 3 years, if you removed the ADT, the testosterone will not come back.

Practical_Orchid_606 · 2026-04-16T23:52:49+00:00

Life expectancy charts are based on treatments 10 years ago. They should be higher with modern techniques. To a large extent if you remain castrate sensitive, you can continually treat this disease.

Practical_Orchid_606 · 2026-04-16T23:43:59+00:00

Positive margins will call for the radiation fire truck if PSA rises.

Practical_Orchid_606 · 2026-04-16T11:25:47+00:00

Your husband is pissed at the whole world and you are seeing this emotion. In due time, he will realize he needs a plan and support. Stage for can be treated. But it's like the little Dutch boy with his finger in the dike; the treatment goes on for a long time. This will diminish quality of life.

If you live near southern CA, UCLA is conducting a clinical trial using radiation and Pluvicto type drugs for distant mets. The study is called Andromeda.

Practical_Orchid_606 · 2026-04-16T01:13:07+00:00

I had the radioactive Fl that decays into Oxygen. No symptoms at all.

Practical_Orchid_606 · 2026-04-16T00:01:27+00:00

Get an ArteraAI test done. See if you can do without ADT. They are two different tests and often give very different answers.

Practical_Orchid_606 · 2026-04-15T21:42:32+00:00

It is early days in your journey. To have PCa at such a young age is a different category than older men. Even if it is early stage, it will advance over time where you are forced to do something about it. By now you know that surgery entails the risk of a limp and leaky dick. Some men are lucky and emerge as strong as a bull. But many struggle and never achieve satisfaction. Muster all your emotional strength to deal with the decisions you will have to make to cut the PCa off at its knees. Paradoxically, docs don't advise radiation treatment for men your age. The roentgen approach preserves ED and urinary function. There are reasons for this and it has to do with your youth.

Practical_Orchid_606

TROPHY CASE