considering Treatment Options

[Tacker]

I am a 61 year old man of otherwise good health. In December 2022 my PSA came back at around 10. Since then I have had 2 other PSAs, one at 9.4 and one at 11. My Gleason is 6. My prostate is only modestly enlarged (about 30%). I am only having minor symptoms, and frankly could live with these for the rest of my life without much difficulty. My father, brother and a number of my cousins, aunts and uncles have all died of cancer of various types, although I am not aware of any who had prostate cancer.

My urologist and oncologist have laid out what they present as 3 equally viable options, radical prostatectomy , radiation (external or seed) and active monitoring. They have told me that my case is a low to moderate risk case.

I am torn on which way to go and would be interested to hear from other men who have faced a similar choice and how they came to a decision.

[RMontana]

Tacker, the missing piece of this puzzle for me (if you have not done so already) is genomic testing. In my humble opinion without this type of testing you dont know how aggressive the cancer type is for the cells you have. The visual grading is just that; genomic testing categorizes your tumor at the cellular level, then using algorithms with millions of men's prostate cancer results predicts your outcome. It will provide you a percent chance of metastasis at 5 years and CSM (cancer specific mortality) at 10 years. Decipher is pretty darn accurate for this type of prediction...see NIH PMC ID 4859922 Urology Role of Decipher in PCa Management.

NIH Article; Decipher Prostate Cancer Test Results Obtained From Prostate Biopsy Specimens - " Biopsy-based Decipher scores had a c-index of 0.80 (95% CI, 0.58–0.95) for prediction of metastases at 10 years, compared with 0.75 (95% CI, 0.64–0.87) by NCCN risk stratification. Adding Decipher results to NCCN risk stratification improved the c-index to 0.88 (95% CI, 0.76–0.96)." (A c-index of 1.0 is a perfect predictor)

My story; I had a RP (radical prostatectomy) and had my tumor specimen tested using Decipher...my GL (Gleason) was a 4-3, which on a Decipher scale from 0.0 to 1.0 (most severe) meant my genomic test should have come back just over 0.50 (say 0.55-0.60)...it came back 0.97 almost max! This meant that my visual grading of 4-3 had a genetic rating equivalent to a GL 5-5!!!

On top of the NIH article, check out two other podcasts I recommend...again, in my humble opinion, using GL only is not enough anymore...you need to know not just what grade of cancer you have but how aggressive it is at the cellular level. GL is not going to give you that...what does this change; TREATMENT options!

1. Youtube Title; Decipher Prostate Cancer Classifier to Predict Metastasis and Mortality

2. Youtube Title; Decipher, SelectMDx, and 4K Score in Active Surveillance & Intermediate Prostate Cancer

For me after I had my prostate removed and had recurrent PSA (low at 0.13 but present) I knew via Decipher that I had a lethal cancer cell type which needed very aggressive treatment...so I threw the kitchen sink at it...

For you, if you game this out and send a specimen of your tumor to Decipher (I would it over other genomic testing), and it comes back a 0.15 or 0.20, then your visual GL matches the genetic make up of the cell...forbid it, but if your Decipher comes back like mine at 0.85 or higher then you may not want to continue 'watchful waiting,' as there is a mismatch between your visual GL grade and cell type aggressiveness...then you would have evidence of a very aggressive cancer cell type that should it escape the prostate (via blood for example) you would wind up with a very different problem...

Hope this makes sense...sorry for the long message...good luck and advise how things turn out...my suggestion; get genomic testing and see at least two doctors (catch the suggestion on one podcast to have a 2d reading done on your biopsy looking for any GL 4 patterns)...

PS the medical facility should have samples of your tumor in storage...I think they have to keep them for 10 years...if your interested you can find out...

161231 NIH PMC ID 4859922 Urology Role of Decipher in PCa Management ABSTRACT...NIH study

[Tacker in reply to RMontana]

Thanks. My Oncologist mentioned genomic testing as an aid in deciding. I will look into it.

[EJC61]

Did you have an MRI for additional information? I also agree with the genomic testing and had OncoDX. More data the better.

[Tacker in reply to EJC61]

Had an MRI. Also had a needle biopsy. Waiting to hear from the doctor about the test. They have not done it before and are waiting for info on it.

[Tacker]

Gnomic test came back low risk. Going with Active Surveillance

[newyorkman1107]

@Tacker did you have only one biopsy? If so, it sounds as if it was random, not MRI guided since you had the MRI afterwards? How many cores were Gleason 6?

[Tacker]

MRI was first and it was MRI guided.