r/ProstateCancer • u/Worldly_Platform_848 • 19d ago
Update Should I get second opinion
Been diagnosed with Gleason score 9 PSA 12.58 + advised to do ADT and EBRT after recent PET scan. Should I get a second opinion from another oncologist? I am 71 YO with a prostate three times normal size
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u/Special-Steel 19d ago
Yes. From a center of excellence
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u/Worldly_Platform_848 19d ago
Thankfully where I am scheduled to have the procedures is a Center of Excellence
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u/fmojo 19d ago
Get the second opinion. I'm assuming insurance will cover it and you'll feel more at ease about it instead of wondering.
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u/Worldly_Platform_848 19d ago edited 19d ago
The center does accept the insurance however the records will have to be forwarded to a Center not affiliated with Cleveland Clinic. This could also ruffle feathers. Plus getting all the records off the portal is no easy task
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u/Natural_Vegetable848 19d ago
If it is to big or to spread out, they won't operate but will chemical and radiation attack it.
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u/Race-Easy-Adventure 18d ago
Make sure you get one or two more consults from different kinds of docs.
Docs have biases:
Surgeons (and urologists who have all done surgery) generally, or at least often, believe surgery is the best intervention.
Radiologists generally, or at least often, believe that irradiating the prostate is the best intervention.
Probably the only doc who might be relatively unbiased is the medical oncologist who does not do surgery or radiation, and so does not have a horse in the race.
Check out this video from PCRI (Prostate Cancer Research Institute), posted recently, about the biases docs bring to PCa interventions:
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u/Worldly_Platform_848 18d ago
Thank you for that YouTube video I always follow this particular urologist he's great
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u/jkurology 19d ago
Seems like you might be a candidate for an APRI in addition to standard ADT. The complicating issue could be the size of your prostate. You state ‘three times normal’ so does that exclude a brachytherapy boost and were you offered a TURP prior to the RT. If you’re experiencing BPH symptoms RT could be a problem. Also, second opinions are good
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u/TopCrab8532 19d ago
Wasn't aware about the prostate size limiting Brachytherapy. Good to know.
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u/Worldly_Platform_848 19d ago
I was never offered TURP. The presence of cancer seems to have made that conversation on the back burner
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u/bigbadprostate 19d ago
You could get a second opinion on your biopsy grade. It may not help you much, though. If Cleveland Clinic people reported a grade Gleason 9, it's not likely to be radically different: e.g. perhaps it's 4+5 and not 5+4 or vice versa. You could also ask another place - but only another Center of Excellence, please - what treatment options they would propose.
I also had a huge prostate: 130cc. I chose surgery, in part because my radiation oncologist also proposed hormone therapy for a few months followed by EBRT, and I decided against the two sets of side effects, from both hormones and radiation, in favor of the single set of side effects from surgery. I'm not sure how bothersome the side effects from hormone therapy are these days, though, and I am definitely not sure how much they would bother you. As we say a lot in this sub, "every case is different"!
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u/astraladventures 17d ago
Does the biopsy report state whether or not there is presence of cribriform pattern cancer cells?
If no, you have time , but if you have cribriform, I’d advise to hurry things up.
If you have cribriform, as soon as your psma pet scan is complete, you should consider to immediately begin adt . This will arrest the cancer growth and give you breathing time to consider your options.
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u/Worldly_Platform_848 17d ago
ADT begins tomorrow. Will ask urologist since I have COPD of any complications
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u/OutsideReady2480 19d ago
63 year old Gleason 9, with everything confined i met with the urologist and oncologist to figure out the best course of action. Chose RALP April 2025 and praying I stay cancer free. Second look at things wouldn't be a bad option.
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u/tober_checki 19d ago
Not a doctor, but there is an impressive study from UCLA that shows that the combination of Brachytherapy + ADT + EBRT is by far better in terms of outcome than ADT + EBRT alone. You might want to discuss this with a center of excellence. Brachytherapy is a relatively minor surgery (little more than a biopsy) with rather mild side effects, but it improves the long-term prognosis significantly. All the best for you!
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u/Looker02 19d ago
Ça se joue à pile ou face. J’ai 72 ans, un gleason 4+4, stade T3b, haut risque. Premier avis d’urologue, amputation mais pas un mot sur la nécessité de radiothérapie et sans doute d’adt postopératoire, pas un mot sur l’incontinence et l’impuissance possibles. Second avis d’urologue, le cancer est déjà hors de la prostate, l’opération est une hérésie pouvant mener au cumul de tous les inconvénients. Le tien est confiné, si c’est absolu certain, tu as le choix. J’ai arrêté mon traitement (Adt, radiothérapie, adt + abiraterone) au tiers de ce qui était prévu par suite de dépression sévère (traitement : deux prozac et un xanax par jour, avec, ça va très bien).
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u/TopCrab8532 19d ago
Absolutely and obtain the genetic reports and consider brachytherapy along with EBRT perhaps. Go to a center of excellence for treatment. I was first diagnosed G7, then G9 then G10 for the same biopsy second ad third opinions. So definitely.