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Jack; You might use this site in more detail - I wouldn't want to give false hope as a high Gleason is never good news - BUT - never give up all hope! I just did some browsing on the story page and there ARE good results from surgery with high Gleason scores. I would say ten years and still "undetectable" qualifies as a good result with a Gleason "9". Just one story I looked up. Catch it in time and even the most vicious monster can be excised! Nerve sparing - sexual function is VERY disturbing to loose, however, so is life! You can live life without sex, you can't have sex without life! With such a high Gleason, I would opt to error on the cautious side. Best wishes! we are all pulling for you! Jon. R.
I'd reinforce what Jon writes. I'm a Gleason 9 with nine years [plus survival and my onco reckons another 10 is quite possible, pretty much normal life expectation (I'd be 83 then). I've had both bladder and prostate removed. Be positive, never give up hope and make that chronic condition your slave not your master.
I'm a Gleason 9 who has had surgery, radiotherapy and 30 months of hormone therapy. I'd like to reinforce the previous messages about remaining hopeful, being positive and valuing life. Sexual function is important but a Pca diagnosis puts things into perspective. The past 4 years have sometimes been difficult but have also been some of the best years of my life.
I had pain in my bladder area and been for ultrasound, everything is fine.
As far as treatment is concerned all depends on first psa value if its <.2 then I will wait for 2 months for recovery and then start radiation however if its more than that then radiation in 3-4 weeks that will give more time to recover from surgery or if more time is needed adt injection.
However all based on psa due in 2 weeks time (6 weeks in total).
Your question is a good one. You can go to: https://www.mskcc.org/nomograms/prostate/pre-op. You will find that you have around a 99% chance of having extra capsular extension with your gleason 9. So the real question is, Will surgery improve survival? Studies have shown that you improve your survival apx 3% if you have surgery first. You have to decide if that 3% is worth it given the chances of additional side effects. You will very likely require radiation and hormone therapy down the road to maintain control of your cancer.
Your urologist should have told you this and I am disappointed that most don't.
One of my pet peeves is urologist saying that they are treating you with surgery "with curative intent". What does that mean if 99% of gleason 9/10 guys recur.
Keep in mind that you can still live a long time with the addition of systemic therapy.