Gleason 4+4=8 Prostate Cancer Treatments | Ask a Prostate Expert, Mark Scholz, MD

[@peterwbryce]

These Q&As are very helpful for a patient trying to understand and navigating treatment options. Dr Scholz is an incredibly gifted communicator and is the best antidote to fear I have come across. I have completed my seed implant, IMRT, and hormone treatment for high grade PC with a Gleason score of 9. I would note it is not the only determining factor for treatment. So far, so good and I am now trying to regain my previous quality of life.

[@glamup2013]

Which stage do u have??

[@tomswoverland]

Stage 4 4+4 Gleason Firmagon then Lupron then 44 radiation treatments then one more targeted radiation then 2Chryo ablation then 9 chemo treatments now on Abiraterone last 2 checks came up clear. Took 2 years to get this far and feel pretty good. So don’t give up. It’s a long fight.

[@georgerios7491]

God bless ✌️keep strong 💪

[@blackknight125]

Amen it is a fight

[@edg531]

You’ve calmed me after just receiving a Gleason score of 8 in 3 samples. Perhaps the calm is before the storm, but it’s still appreciated.

[@Silverpinstudios]

I can’t tell you all how helpful this is! I was recently diagnosed with stage 1Tc and this information is incredibly helpful

[@岡本良二]

i have gleason score 9 but it is instructive.for us verymuch , indeed instructive

[@OscarGonzalez-vg3cp]

Thanks again. Like the questions and answers. Good program. So far you two the best for me. The doctor and you are good help. 🙂

[@michaelfritz6775]

Like your vids..and your ties…ended therapy last July..now have pain in the testicular area…is this normal side affect? Thanks..making the gym a new thing to get body back from hormone effects..thanks to your telling us what to do…bless you…

[@junejames1495]

Excellent Presentation! The questions are Very Insightful & Responses Very Informative. Thank You👍

[@rolandomedina1981]

Good job. Congratulations!!!

[@DahRealDeal]

The video was helpful, but he created associated questions. Please elaborate on the difference in risk and consequences between a Gleason score of.4+4, 3+5 and 5+3. How would each inform the treatment considerations?

[@veronicarozenberg6572]

Thank you for the very well done and explained movie

[@steve122140]

Thanks as always.

[@gr8ride411]

Recently diagnosed w/ prostate cancer 4+4 (Gleason 8) after a 8.12 psa. I’m 69 yrs old with a prior auto-immune condition (pulmonary sarcoidosis)since 2002. Bone scan was ok, but CT scan revealed suspicious area on left sacrum ilium hip bone. Prior to hip biopsy recommended treatment was 28 weeks IMRT, and daily casodex with Lupron every 3 months for 18 months. At initial appointment was told that if hip bone biopsy revealed metastasis then it could be radiated at same time as prostate. Since hip bone biopsy I’ve been assigned Stage 4 adenocarcinoma. With this result the radiology oncologist wants to include Chemo treatments with taxotere every 3 months for 6-18 months. Before the results 3 different specialists said the radiation with hormone treatment would suffice. I’m still puzzled about one recommendation now to include Chemo, which would begin after radiation therapy. Am I being over treated? I’m just concerned about the change of treatment approach since it was initially addressed. I welcome comments. Thank you, PCRI is a wonderful resource and blessing.👍🏽

[@artmaltman]

Doesn’t radiation damage the nerves so that incontenence and ED will result within a couple years?

[@davidkenworthy1871]

Good stuff

[@shawnbeck2303]

61 years old. 2 years ago. PSA 3.9.2 years later 7.4 then a month later 8.5. Prostate Biopsy 4+4 Stage 4 cancer. Bone scan clear. No Met's as of 6-20-22. Was told to have Radical Robotic Prostate surgery. No Chemo or Radiation for now. I am doing the right thing? Please give all options. Shawn.

[@ThePCRI]

Hello, We have a free helpline staffed by patient advocates that can provide you with some helpful information. For example, the PSMA PET scan is the best available scan for detection of metastases. It is significantly more sensitive and specific compared to the bone scan, and even so, the PSMA PET is not able to detect microscopic spread which can potentially be destroyed with adjuvant hormone therapy. For a bone scan to detect bone metastases, the lesions would have to be pretty large and/or widespread. If you have Gleason 4+4, then your insurance SHOULD cover the PSMA PET scan. You can find locations for that scan at pylarify.com. Also, there are some studies comparing surgery versus combination therapy (brachytherapy + external beam radiation + ADT) for high-risk disease, and our patient advocate can give you information about that. In high-risk cases (i.e. Gleason 8 and higher) surgery, alone, has lower cure rates and an arguably worse permanent side effect profile. You can find our helpline contact information at pcri.org/helpline.

[@BigZWD]

Kinda in the same spot, what did you finally decide on and what was the outcome

[@ana-ruxandrailiescu633]

But so protone radiation is not well tested yet for prostate cancer? How long does a laboratory stock the biopsy slides so that one can request them from them and having someone else look at them?

[@edabreu7871]

I am 70. I am Gleason 9. Metastatic. I have been on hormone therapy for 1 1/2 yrs. I can't handle the 2 shots monthly in the belly anymore. Now i am told to add Xtandi and more radiation and therapy for another 2 years. I was in good physical shape, 50+ years of martial arts. Now I can hardly hammer a nail. Not sure if its worth it.

[@williamfeldner9356]

I think you should get a second opinion from Eugene Kwon MD at Mayo Clinic in Rochester, MN. He has been having excellent results with Metastatic Prostate Cancer………. It would be worth the trip, do not give up, They can make you feel better……….

[@glamup2013]

How many years???

[@MrVasmikey]

What are your thoughts concerning Proton Radiation Therapy. I understand there are facilities at Mayo and the City of Hope in AZ.

[@whocares0316]

In describing the combination of LDR brachytherapy and IMRT or EBRT is Prostrcision a quality example of this approach to PC radiation therapy?

[@peterkilburn452]

Trying to find out what to except towards the end

[@romanjackson3509]

What if I am a return cancer patient with 4+4=8

[@24hourgmtchannel64]

If radiation fails soon or later down the road after treatment, is a prostatectomy still an option

[@rjvagv1]

To confirm status, should get a NM Whole Body Bone Scan and a MRI Pelvic Scan also to make sure it is within the prostate only?

[@ThePCRI]

I will add this question to our list for future videos. I know that in other videos, Dr. Scholz has said that any patient with Gleason 7 or higher should have a PSMA PET scan to check for metastatic spread as part of the staging process and also an MRI to characterize the disease within the gland, which can pick of features like seminal vesicle invasion. If you have any questions, feel free to contact our helpline at pcri.org/helpline.

[@rosemaryrobinson5700]

Is there a cream for radiation burns to skin?

[@elsiethomas8793]

Is cancer stage one if Gleason factor is 4+ 4 or 4+5? What is stage one cancer?

[@MrRoyRichardson]

Two quick questions. I am Gleason 8, 10/13 Cores, T3bN0M0 I have been on Hormone Therapy for a year now (March 2020). PSA reduced from 52.03 (Feb 20) to 0.28 (Jan 21) and otherwise I am fit and healthy with a BMI of 23.1 RT (HDR Brachytherapy + 23 sessions of IMRT Radiotherapy) has been delayed due to poor urine flow and COVID. To fix that my Radiotherapy Oncologist sent me for a HoLEP operation Oct 2020 from which I am now fully recovered, and I now have good urine flow. However my Brachytherapy Oncologist is now saying that due to HoLEP I am now unsuitable for any form of Brachytherapy and will instead just have 37 sessions of IMRT some time after March 21 1. You mention in this video that Brachy + IMRT is the optimum solution - Is Brachytherapy really out of the question? 2. Your thoughts on the viability of using SpaceOAR after a HoLEP operation.

[@ThePCRI]

Hello, our helpline would best be able to help you with your question. You can find our contact information here: pcri.org/helpline

[@100RAV_11]

I have a score 3+5, I need to know what's the situation in that. Because haven't heard about 3+5 anywhere..

[@muaddib878]

There is evidence to suggest 3+5 has a similar prognosis to 4+4=8. However evidence also suggests 5+3=8 acts like a Gleason 9.

[@jodypenn2009]

What about a high gleason (9) with metastases to lymph nodes (stage 4).is a cure possible?

[@ThePCRI]

It is possible, and if a cure is not achieved, it may be possible to achieve an extended and durable (meaning no need for ongoing treatments) remission. It depends a lot on the extent of the lymph node disease, but it is hard to make predictions in these kinds of cases. If you have any questions about optimal treatment based on the latest research, dealing with side effects of treatment, or anything else, feel free to contact our helpline at pcri.org/helpline.

[@glamup2013]

Do u have bone mets???