Hello, am I on the right track with AS?

[CuriousMF]

I'm a 61 year old male diagnosed in January 2025 with prostate cancer. No symptoms. Process started with PSA rising to 4.3 from 1.4. Prostate MRI and Biopsy after that. Biopsy 1 of 16 cores cancer with the 1 core at 5% and designated 3+3=6 score. My urologist reviewed the possible treatments and I selected AS. I didn't get a 2nd opinion because he said if I went to MSK their only option for me would be AS. I've read tons of studies and watched many webinars. However, even though the survival rate seems to be >99% at 15 years a large percent progress to GG2 or GG3 and the majority of cases end up with some kind of treatment. I have a few questions:

1) Am I looking at this information correctly?

2) If I am...should I just go ahead and get radiation?

3) If yes to #2...am I correct that HDR Brachytherapy Monotherapy would be the selection with the least side effects (especially short term).

I don't recall how I found this group but thank you to whoever administers as this is a great resource.

[pd63]

2nd opinion of the biopsy would be wise if nothing changes then AS looks doable.

What about genetic testing to determine metastasize risk in the future?

[CuriousMF in reply to pd63]

Dr said there wasn’t enough of a sample to do genetic testing. What would be the process to get a second opinion of the biopsy? Request a second person in the same lab to do it? I didn’t think they’d be able to send to a second lab.

[pd63 in reply to CuriousMF]

Not the same lab, John's Hopkins are renowned.You need to ask how to proceed as I'm not US based.

[CuriousMF in reply to pd63]

Thank you pd63. I just received results from a 2nd opinion of the biopsy from MSK and it is in agreement with the first results. Thank you for suggesting this to me. I still need to wait until may to review with a Dr. at MSK but I was able to view the results of the biopsy review already on the patient portal.

[rosenjpj]

The numbers look like you’re a good candidate for AS which is the treatment with best side effect profile (none). Assuming the second opinion verifies the findings of the biopsy, AS would be the best choice as far as side effects are concerned. That depends of course on your risk tolerance. Some patients just want the cancer out. HDR Brachytherapy is not necessarily the radiation treatment with the least side effects. All treatments have side effects and they vary based your age and health and the skill of the doctor. Try to get to a top national cancer center such as MSK, MD Anderson or UCLA if possible. They see and treat far more PCA patients and their experience makes a huge difference.

[CuriousMF in reply to rosenjpj]

Thank you rosenjpj I have an appointment with MSK. At first I was only going to get a second opinion there but I agree with your "treat far more PCA patients" observation so I now intend to stay with them for care for the future.

[Hope4Happiness]

I was on AS with G6 prostate cancer for four years before a little G7 (3+4) was found in a targeted biopsy. I ended up getting SBRT treatment at MSK in NYC.

My advice would be: follow the strict protocol with PSA tests, MRIs, and biopsies.

Right now you are definitely a candidate for AS.

AS can be tough because one's mind does have the tendency to play the 100-question "what if?" game, and then defeats a certain quality of life that you are seeking with AS.

It's best just to take AS in six-month intervals. If your PSA remains stable and future biopsies and MRIs reveal no progression at these points, just enjoy life right in the moment. It is very important to practice "mindfulness" -- this technique keeps you focused on the present and enjoying life as it happens. It helps prevent the endless focus on the "what ifs."

[Estaban2021]

As others have already said, see if you can get a second opinion of the suspicious cores. If that returns a 3+3, then going on A S is a no brainer, why put yourself through a lot of treatment grief and it's possible side affects. The only caveat being, make sure you have your regular PSA tests and regular MRIs, you didn't mention whether your MRI showed a lesion or what PIRADS it was graded. Did you get a repeat PSA done a couple of weeks after the one that was 4.3? PSA jumps up and down and you could have been exposed to an unnecessary biopsy, especially if the MRI showed no lesion.

[CuriousMF in reply to Estaban2021]

I had an MRI that showed a PIRADS 3. I didn’t have a follow up PSA. I am scheduled for a PSA retest in June.

[CuriousMF]

Thank you to everyone that responded because I feel better already. I have an appointment at MSK with Dr. Touijer. The person doing the intake also said that they will retrieve samples from the original lab and have them sent to the MSK lab for review.