Should I end active surveillance and treat?

[TCbandlover]

I am 72 years old in fairly good health. Elevated PSA in the 5-7 range lead to a MRI which showed no abnormally and later a biopsy on September 16, 2022. The biopsy confirmed cancer in 6 out of 12 cores. All were G6 (3+3) with a t1c grade. Active surveillance was recommended by everyone which I totally agreed with. Decifer score came back low risk. On June 2 of 2023 had a confirmatory biopsy which showed 7 cores cancerous with 5 cores being G6 and 2 cores being G7 (3+4). One of the G7 percent patterns was 4:5% and the other was 4:10%a. One of the G7 cores was an upgrade from an earlier G6 and one was new that was benign originally. One of the G6 in the first biopsy actually came back benign in the second biopsy which makes me think there may be something there that didn't get picked up the 2nd time. Perineural invasion was identified in one of the G6 cores. My dilemma is what to do. This falls somewhere in the intermediate range and the team is calling it intermediate favorable even with two G7's. I had the PSA taken again on September 6 and it is 5.89 which is actually lower than the 6.15 that came back on February 23, 2023. Both the surgeon and the radiologist where I go are saying I could stay on AS or get treated. The fear of course is that it may spread but the potential side effects of treatment (thinking radiation) are scary as well. Has anyone been in this situation that can speak to how you handled this gray area and the outcome. It would be greatly appreciated. Cordmd

[RMontana]

See if this podcast helps...for me a mpMRI would have made a huge difference, but I see that it was inconclusive for you. The take away from this podcast is that, unlike wine, PCa does not get better with age. I had no idea that it continues to migrate from low to high GS...it rarely goes the other way. So, AS will work for a while but sooner or later it will reach GS 4 or 5 and then it migrates... Check this out...

healthunlocked.com/active-s...

My advise, 14 years after I was diagnosed, is to get this thing before it gets outside your prostate...you can do very well with this disease if you get it out. Radiation has pros and cons...here is a good comparison debate of what is best, surgery or radiation...

healthunlocked.com/active-s...

Last, decide where you are with your life regarding sexual health. It that is important, watch out for it as the SOC does not treat this facet of your health...its an afterthought and after your think about it, its often too late to salvage what you were born with. So, if this facet of life is important , YOU have to watch out for yourself; dont expect your health care team to do this. If you want more info on this check out my posts in my space on this site...

Good luck...let us know how all turns out.

[j-o-h-n]

Thank goodness....... for a second I thought your userID was TCbendover.....(glasses do help)..

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 09/18/2023 1.11 PM DST

[MurphyBlack]

I am in very similar situation. Do your homework on 3+3 noting the conflict in the Med community of even calling this cancer. After my biopsy came back similar to yours, it took some time and persistance but I got a PSMA showing no metastisis. Is this a guarantee...NO, but it is better than showing cancer elsewhere. At 69, 2.6 years ago I chose AS and Quality of LIFE not Quantity. I also noted research at my age for those in similar diagnosis conflict, there was little difference in mortality in 5 years and only a bit of an advantage in 10 years between those treated and not treated. I am not dealing with any of the side effects of many of our treated brothers in this arena. I am grateful every day for no side effects and my ability to continue life much the same as before diagnosis. Is this what YOU should do? I can not say. Some further homework on your options and decision about quality vs quantity will assist in your big decision about treatment. Finding a doc who appreciates AS and listens to you and your concerns is very helpful but making the final decision and being your own best advocate is all up to you. I went against several docs originally who wanted to do surgery and radiate. After this time with no side effects and seeing all my brothers on the various PCa support group calls who do have lots of side effects, I'm comfortable with my decision so far and I will be very active in my surveillance from here out. Hope this helps.