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October 2007 had a DRE and a blood test after the blood test which showed a psa of 27.5 I was sent to department of urology at my local Hospital to see a consultant urologist who carried out a biopsy
The biopsy showed a Gleason 4+3=7 anenocarcinoma. This is a bilateral involving 50% on the right and 70% on the left along with perineural invasion.
Gleason 7 and the high volume of tumour, was told that surgery or radiotherapy depending on the results of ct and bone scans, that radiotherapy is the most likely option for me in view of the high volume disease together with perineural infiltration.
THE LETTER SENT TO MY DOCTOR after my ct and bone scans 11/12/2007
His bone scan I am pleased to report was reassuringly normal his ct scan was interesting it is essentially normal with the exception of some lymphadenopathy, the lymphadenopathy was in a slightly abnormal position.
We are going to recommend treatment with hormonal manipulation
I am confused as to the treatment as I thought it would be radiotherapy I don’t quite grasp the situation myself, just looking for any kind of guidelines or anyone who can offer some input who might have been in my position.
just an update been to Hospital 12/2/08 today my PSA down to 2.8 was 27.5
3 months ago, now being put on 3 monthly HT implants to be done at my own GPs, with a visit to the hospital every 3 months the hospital was quite pleased with my new PSA. I Have asked my GP to get me a second opinion just to put my mind at rest l feel I should be on RT at some stage or at least have another scan to check my nodes, The doctor at the hospital feels as the PSA has gone down my nodes should have as well
Surely a scan would confirm this
I found myself in a similar situation to yours in August of 07.
Biopsy was 4+3 and my prostate was enlarged to about twice normal size.
The main difference was that my PSA was substantially higher at 98.9
My Bone and CT scan came back normal.
My urologist recommended radiotherapy and referred me to a Radiation Oncologist.
I was not sure that I was willing to let go of the surgical option so the oncologist sent me for an MRI to give us a better picture of how far the tumor may have spread. There were some enlarged nodes but no definate sign of metastasis.
It was decided that although there was no absolute proof that the tumor had escaped the prostate, the best course of action would be two months of Hormone Therapy to shrink the tumor, followed by an aggressive course of external radiation (IMRT). The radiation was wide field to encompass the lymph nodes and destroy any micrometastasis that may exist. This was followed by a radiation boost to the prostate only.
In your case, if the CT showed signs of lymph node mets, the default position of the urologist may be to keep you on hormone therapy and call it a day.
I would want to know a lot more about this "slightly abnormal lymphadenopathy".
If I were in your position (and I was) I would insist on a consult with the best radio oncologist available. Then demand an MRI. You need to have a clearer picture of your status to make an informed decision on how to proceed.
You have already been on HT long enough to prepare you for a radiation protocol.