Hi Meddyone,

Welcome to Cancer Chat. I'm sorry to read of what you're going through at the moment.

Firstly do make sure to discuss treatment options with your specialist, especially re potential side effects and any other questions you have, as it's important you have all the information you need.

My reply here will boost your post so more people will see it, and if anyone has similar experience to share then hopefully they'll be along soon. It may also help to browse or search the forum for other potentially similar discussions.

Wishing you all the best,

Ben
Cancer Chat Moderator

Hi Meddyone, I have just been diagnosed with same 4-3 on scale,My PSA was 15 but another blood test a month later was 16.I've had biopsy,MRI scan,bone scan,c.t scan( they found something,not sure what,having another next week).I've look at different options,surgery,hormone treatment,chemo and watch and monitor.With all options,except,watch and monitor,there is a chance of losing sex drive and bowel problems.I'm 70 but i would not like to lose any sexual urges,we still get them at 70s,we'll I do anyway.If my c.t. scan comes back,ok,i am going to go for watch and monitor.You have blood test and that every 3 to 6 month,but if your Gleason score is a lot higher u can't go for this option.Hope this post as helped u,i always think no matter whats wrong with u,there is always someone out there,that's in a worse situation.I saw a post on here with a lady 29 diagnosed with breast cancer,that's no age,i was going to post and say something to cheer her up ,but what do I know about breast cancer.One final thing,if any man gets any sort of cancer,they says prostate is the easiest to treat.Look after yourself,hope my post helped.   All the best john.

Hi, 

My Dad had this. 15 yrs ago. He was 62 at the time and went for the radical prostatectomy option. He has done really well and no recurrence as of now. No chemo or radiotherapy needed. My father in law also had exactly the same at the same age , he is now 22 yrs post op with no recurrence.
As for the sexual side of things- sorry, can't inform there, certainly am not going to ask him (:. I think he has a 'bit of leakage' in the urine department, but it certainly does not stop him doing anything.

As ever treatments have probably moved on a lot. Best wishes to you.

Hi there thanks for that- my score is also 4-3 & had the bone scan last week so waiting for those results so staying positive- I would love the watch & monitor option but will have to wait & see- if I have to have treatment I'm leaning towards the Brachytherapy which might have less side effects. All the best & take care

Hope everything goes well for u,if after CT scan i can't have watch and monitor i might consider the brachytherapy as well.Hope your results come back positive,have a great life. Best wishes, john.

hi my husband was dianosed last November.  Stated hormone tablets that day.  has now had 2 MRI and 1 CT plus prostrate bioposies .  Started Prostap injections in January.  Told no Chemo because of Covid and will start on Enzalutamide in April after 2nd Prostap injection   Radiotherapy planned for May.

gleason score 9  has broken capsule and in pelvis  

i am worried that not having Chemo will lessen his chances of survival.  I am aslo concerned that removal of prostrate is not considered necessary and there has been no mention of bone scan.

would love to hear what others think, especially if you are gleason score 9.  his PSA was 48.85 in October- hasn't been checked since then?

Hi sis,Its a worry with all these option,u don't know what's best.I am edging towards watch & monitor but if they do find anything on my 2nd CT scan i think that's ruled out.My PSA was 15 and a few weeks later it was 16.Not sure how they work out Gleason score but mine was 4 + 3,(group 3).Was told I could have hormone treatment for 6 months and start chemo in summer if I chose it but its all up in the air with waiting for another CT scan.The good thing is they have started the ball rolling,with your husbands PSA and Gleason score being high and skipped the bone scan.With starting hormone treatment in November it must be standard practise because in April it would be 6 months and that is what I was told. For a bone scan u have an injection and have to wait 3 hours before scan, it will make u smile when I tell u what happened to me.I grab a thick jumper, the one I had on had a metal zip up front and u can't have any metal on u for bone scan.I had the scan and that night i took the jumper off and a wooden peg dropped out.,one of those small wooden ones with spring in middle,it must have been at back of jumper while I had scan.It could only happen to me.When I went for results i had to tell doctor about it in case it showed up,they found two hot spots on my ribs so I said I only a 1 peg in my jumper so it can't be that..Try not to worry and next time he see's doctor ask why he as had no bone scan if it is worrying you.Look after each other,I'm sure everything will work out.Keep me posted how u go on. Best wishes john.

Hi Everyone.  If you're new here then welcome to the forum.

I had prostate cancer surgery a little over 10 years ago. I'm not a doctor and I have no medical qualification, however, I am a committee member of a local prostate cancer support group.

This information is to the best of my knowledge and applies only to men who have a diagnosed prostate cancer.  If you're not yet diagnosed then it doesn't apply to you.

When it comes to assessing how early or advanced is a cancer, there are a number of important figures:

- PSA. This is a key number because in general, the lower the number, the earlier the cancer has been discovered.  A number of ten or less generally indicates an early cancer ... but early cancers can have higher PSA.

- Gleason score.  This is two numbers, traditionally separated by a + sign, for example 3+4.  For historical reasons, only the number 3, 4 and 5 are used. These numbers are an indication of the aggressiveness of the cancer cells.

The order is significant!  A 3+4 is not the same as a 4+3!  3+3 is least aggressive; 3+4 is mainly non-aggressive, but with some aggressive cells found; 4+4 is medium aggressive.  The most aggressive cancers have a 5, such as 4+5, 5+4, or 5+5. 

Sometimes, the sum is given instead of the pair of numbers, but this conveys less information; a Gleason sum of 7 could be either 3+4 or 4+3, but 3+4 is definitely less aggressive. Similarly, a Gleason sum of 9 could be either 4+5 or 5+4, which again may have implications.  If your consultant only tells you the sum then ask for the two numbers and the order in which they appear.

- The Stage.  This is a T with number: T1, T2, T3, T4.   There will be other letters which convey more information, but for most patients, it's the number that's important.  This indicates how far the cancer has advanced: 1 and 2 mean that the cancer is (apparently) confined to the prostate itself; 3 means that it's broken out of the prostate and is in the local area; 4 means that it's spread more widely around the body.

What does this all mean?  If you're newly diagnosed then the medical team will generally try to fill in the gaps. After an initial MRI and biopsy (which will give the Gleason score, and a visual indication of whether or not the prostate looks intact), the medical team will use this information, together with your PSA reading, to decide what further tests you need.  This is why some men will get a bone scan, CT scan, etc and others won't. 

If you've been diagnosed with prostate cancer, then I recommend you find out these three pieces of information and mention them when discussing your case.  Saying that you've got a 3+4 cancer isn't sufficient.  Without the PSA and the T stage, it's only one piece of the jigsaw. 

Thanks John. What is the watch and monitor. I haven't heard of it.  Enjoyed the peg story.  lol

Hi Meddyone.  If you've read my earlier post about PSA, Gleason and staging then you'll know that I had prostate cancer surgery just over 10 years ago when I was 56 at the time.

I hope the post I'm about to write will address your specific question about treatment options.  I'm not a medic so it's more of personal opinion based on my experience and what I've learned from members of my prostate cancer group.  Take it with a pinch of salt and listen to the experiences of other men.

Surgery is by far the most common treatment for early stage prostate cancer.  I believe that most such surgeries take place in a limited number of specialist hospitals using Da Vinci robots.  The lead surgeons carry out a hundred or so such operations each year, and they will, of course, be training less experienced surgeons in the techniques.  The advantages of surgery are that it's a single treatment which usually fixes the problem; the removed organ and any other tissues can be examined in the path lab to confirm the staging and check that the surgical margins are clear of cancer; and if it works then your PSA drops to less than 0.1 within 6 weeks (0.1 is the detection limit of most PSA machines), and as long as it stays undetectable you know you're fine and no further cancer treatment is needed. The downside is that it's major surgery, so you're unable to drive for weeks and there's a fairly long recovery period, plus there is an inevitable period of urinary incontinence lasting a minimum of 6 months, and of course a risk of erectile difficulties (more later).  Ten years after surgery, I claim to be 99.9999% continent; on the very rare occasions I have a little leak, it's just a small drop which as often as not doesn't get as far as my underpants. When it happens, I do my pelvic floor exercises for a few days.

The other common treatment is external beam radio-therapy.  You're given 30 or so doses (or "fractions") of radiation over a number a weeks.  The beam is carefully aimed at the prostate for each fraction and adjusted to try to minimise the damage to other nearby tissues. You can have this as a primary treatment for early stage cancer, or as a follow on ("adjuvant") therapy after surgery if your PSA hasn't dropped to an undetactable level (less than 0.1).  To the best of my knowledge, it's as good at curing the cancer as surgery, but has at least as many risks of side effects, including bowel, urinary and sexual side-effects.  I have long standing Irritable Bowel Syndrome and I was warned NOT to opt for radiotherapy because it would make it worse!  There is another down-side which is that you don't actually know if it's worked!  Your PSA doesn't drop to an undetectable level, but instead drops to some low level, and then can go up and down at each test. There is also a well-known phenomenon of the PSA "bounce" where the level rises 18 months or so after treatment.  I know for a fact that this uncertainty would drive me bonkers!  In the first few years, I took great comfort in getting an undetactable reading every 3 months. 

The other options you might hear about are brachytherapy and High Intensity Focussed Ultrasound (HIFU). These were relatively new when I was diagnosed.  They're still available, but I think that if they were significantly better than surgery then they would have become the standard treatment, but that hasn't happened.  It's well worth seeking the experiences of men who've been through these treatments, but be sure to compare there PSA, Gleason and staging with yours.

Now onto the tricky part of prostate cancer - the risk to sexual function.  If you go on to American forums, you'll probably hear about "bi-lateral nerve sparing" surgery.  This is common the US, but most of the men who have it have 3+3 Gleason scores.  My understanding is that nerve sparing does carry the risk of leaving some cancer behind.  In my own case, my Gleason was 3+4 and I had nerve sparing on one side only. 

It turns out that my one-sided nerve sparing didn't work and my little soldier no longer stands to attention.  Even with Viagra, Cialis, etc, plus other treatments, nothing has worked.  So you might think that this gets me down... but there is an unexpected bonus in all this.  First off, you don't need an erection to get an orgasm, and secondly ... well, the orgasms are really so much better than before surgery!  They're also a lot less messy.   I think you'll have to expect that sex will be different after treatment, but with a bit of experimentation, there's no reason to think it will be any less satisfying for either partner.  You can both pretend you're *** teenagers again.