PSMA PET not good

[u/Goodvida99]

The roller coaster keeps rolling. I was shocked when my 6 PSA became Gleason 8, but relieved when my urologist said any spread was unlikely. More bad news. It’s spread to lymph nodes.
From the report
Prostate: Uptake in the posterior and left prostate, matching the biopsy-proven cancer. It's very avid (SUVmax 21.4), so PSMA PET is detecting this tumor despite its ductal features. That eases the earlier concern about ductal tumors being invisible.
• Two small pelvic lymph nodes read as nodal metastasis: a right perirectal node (0.4 cm, SUV 8.4) and a left external iliac node (0.6 cm, SUV 8.8).
I won’t see my urologist until Monday but looks like surgery is out and radiation and ADT are in. I’m in shock. At 71 years old I’m in the best shape of my life. In the last year I decided I needed to get in shape so I could enjoy my senior years. I’ve lost 35 pounds, work out regularly and eat healthy. On the bright side I know this will help with whatever treatment I need.
I’ve already have appointments scheduled with radiation oncologist.

[u/ThickGur5353]

I just saw your post. Mine was very similar to yours. I was 75 when diagnosed. I quickly decided on radiation. The radiation oncologist make sure that the beam encompassed my lymph nodes. A year later my PSA has gone down to 0.5 from the original 5.8. Radiation has a very very good chance of knocking out your cancer.  Make sure you get the space gel  to help eliminate bowel issues with radiation.

[u/OkCrew8849 → u/ThickGur5353]

Choosing modern radition as the primary treatment to address the cancer inside the prostate and outside the prostate seems a very wise move.

[Guys who choose radical prostatectomy and then need to address the cancer outside the prostate via radiation are often unpleasantly surprised the spacer gel is unavailable to them. For anatomical reasons (the prostate is gone)] .

[u/External_Season_3064 → u/OkCrew8849]

If you choose radiation first and it fails you most likely cannot have prostate surgery. But if you do surgery and it fails you can do radiation

[u/OkCrew8849 → u/External_Season_3064]

If your modern radiation fails you most likely have a reocurrence outside your prostate. Why would you even want surgery to remove your prostate at that point?

The ole 'surgery is better because when it fails you can have radiation' really doesn't stand up to scrutiny (in several directions at once).

It is also true that salvage after radiation (when the reocurrence is inside the prostate) can include focal therapy, cryotherapy, radiation and surgery (the most difficult and therefore least often performed).

This ole surgeon salespitch for surgery was a combo of irrelevancy and misdirection. Now even more so.

[u/planck1313 → u/ThickGur5353]

The space gel isn't always used.  The benefit of it depends on individual anatomy and some radiation oncologists believe that its unnecessary with modern very highly target able radiation.

[u/ThickGur5353 → u/planck1313]

That's a very good point. But for me ,I was going to go under the anesthesia for placement of my markers and the surgeon said no big deal to add the space or gel at the same time.

[u/WalnutRoasted]

Hopefully you can do 5x SBRT or 20x VMAT. After two weeks of sessions you are pretty tired of going another couple of weeks or more.

Try for newer Orgovyx pills instead of Lupron or similar injections. Works faster, no T flair. I tolerated 9 months concurrent ADT reasonably well.

[u/OppositePlatypus9910]

At Gleason 8, you cancer can spread fast, so please get to the radiation oncologist. He/she will probably get you on Orgovyx right away. Working out on this medication will be a godsend. After about a month or so, they will schedule your radiation. The goal is to weaken the cells with adt and then hit them with radiation.
I would expect to be on the adt for two years because of the Gleason score and the lymph node involvement. Chin up, you can do this!

[u/Ok-Priority-7303]

Mine was localized but I'm a bit older and just finished radiation on Tuesday - 28 IMRT sessions. Everything you learn about PC is averages. I had a clean biopsy 4 years ago...now it is Gleason 9. So much for 'slow growing'. Radiation is not a free lunch due to side effects but you can get through it. Good luck.

[u/tober_checki]

Also consider trimodal therapy: external radiation + ADT + internal seed radiation. According to a very impressive UCLA study, much better outcomes for high Gleason than without the internal seeds. All the best to you!

[u/KReddit934]

Just keep exercising through your treatment..especially weight training.

[u/jkurology]

Based on recent outcomes from the PROTEUS Trial surgery isn’t ‘out’. Ask about this trial as well as ATLAS

[u/OkCrew8849 → u/jkurology]

FWIW, OP is now 71.

[u/jkurology → u/OkCrew8849]

That doesn’t exclude him as a surgical candidate

[u/OkCrew8849 → u/jkurology]

Wut? Gleason 8 + Node positive + 71 … I wouldn’t consider surgery.

For each one of those three data points alone I'd avoid surgery since an effective alternative is available. Combining all three data points? Not even close.

I had surgery at age 59.

[u/jkurology → u/[deleted]]

That’s not exclusionary based on recent data from PROTEUS

[u/1readitguy]

Had a PET scan because of lung cancer nodule and my prostate also showed an uptick. Urologist ordered an MRI and insurance has approved the procedure but wont approve the facility repeatedly . I have another (#5) scheduled for next month. Hopefully this one will happen

[u/YouthNational6963]

Best wishes. I am 71 and diagnosed with  prostate cancer in April with a Gleason of 3+4=7. After going through all my opinions a final pet scan showed the cancer wasn't all in one spot. So I decided to yank it out. September 10 i had Robotic surgery. September 18 had catheter removed and i thought i was moving right along but then the fun started.  Besides the incontinence problem, which really sucks, I have been in at first serious pain for about a couple weeks but now five weeks later the pain is down to about a 1-4 out of 10 range. I didn't want radiation because once you do that then your other options are out the window. I am hopeful things will settle down with all this in the next few months. Good luck with your journey. 

[u/OkCrew8849 → u/YouthNational6963]

Yes, at age 71 the major surgery can be quite a challenge in several directions at once. And I’m not sure about your radiation theory (“once you do that then your other options are out the window”) on a number of levels relative to selecting primary treatment for prostate cancer.

Best of luck going forward.

[u/OkCrew8849]

"I was shocked when my 6 PSA became Gleason 8"

 Yes, PSA does not directly correspond to Gleason.

Node positive protocols involving radiation plus hormone therapy are pretty well established at the major centers.

Best of luck going forward.

[u/walkdatalk1818]

I'm in a similar situation, 73 y/o, Gleason 8, spread to local lymph nodes. The exercise and healthy regimen you've already started will pay off big time during treatment! I'm on ADT - Ogovyx with Abiterone and prednisone - for 2 months so far, and that's already lovered my T and PSA to almost nothing. I'm starting radiation soon. Opted for the longer term radiation (8 weeks) as advised by my oncologist to reduce both short and long term side effects (based on locations of cancer to be zapped). So far things are ok. Exercise helps mitigate the ADT side effects a lot.

[u/1945ElCid]

Please .... schedule an appointment with a Medical Oncologist , who specializes in PrCa and is located at a tertiary Med Center. ...they should be managing your care ...not a urologist or a radiation oncologist. It may require a drive and maybe tele-visits at times.... but, you will receive the latest and best care.

[u/Special-Steel]

Good luck. Surgery may not be off the table, but the odds are shifting