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[boxmk]

I have prostate cancer with a gleason score of 6 (3+3) and PSA around 5. I have had two biopsies 1 year apart with similar results. Always two cores with malignancy and all others benign. I have chosen active surveillance with a PSA every 6 months. Any advice?

[Darryl Partner]

Welcome to the group, but, may I also suggest that you join/follow the Prostate Cancer Network group, which has many more men with gleason 6 and low psa healthunlocked.com/prostate...

As for any advice, it would be helpful to know your age and if you have any other health issues.  Also, you might want to ask yourself, what you want out of life...quality of life, etc.

[GeoffNoLongerAS]

I am also on active surveillance.  I was originally diagnosed in November 2008 at age 59.  I did research and found an AS study being conducted in the area, joined the study in August 2009.  

My original diagnosis was on a 12 core biopsy, 2 cores positive, 5% each core, gleason 3+3.  I had the slides read by two other labs that confirmed the original findings.  As a condition of study entry I underwent a confirmation biopsy (very similar results). 

Most of the criteria I have seen for AS is age 60+, PSA < 10, Gleason < 7 (3 +4) depending on the group.

The advise I would give you is to  have your slides read by a different pathologist.  Reading slides is as much an art as a science.  I have known cases where the gleason score has been raised, or possibly lowered.  It helped me to feel more confident about my decision.

Questions I would have is what is your age?  Has your PSA been stable?  PSA velocity can be as important as the absolute value.  Are you in a formal AS protocol?  

[Dr_WHO]

Please be careful just relying on PSA.  I am almost two weeks post op. From stage 4 cancer.  My PSA was 4.3 when they determined I had cancer.  Some forms of prostate cancer do not raise your PSA.

[Attitude67]

You have not provided a lot of information about yourself however it's my belief that once PCa is discovered you need to seek treatment because prostate cancer grows as a result of prostate cells failing to die. Normally Aptosis or programmed cell death disposes of old cells but when Aptosis fails cancer cells grow and a growthsurge could occur at anytime. Right now is the best time to seek treatment with curative intent. If you qualify the least invasive treatment is a form of ultrasound. Keck School of Medicine at USC is the first academic medical center in the nation to utilize the FDA-cleared high intensity focused ultrasound (HIFU) surgical ablation system to target and destroy prostate cancer. The energy-based focal ablative technology allows physicians to introduce the HIFU probe into the rectum while the patient is under general anesthetic and aim the ultrasound beam at the prostate, specifically targeting the cancer lesions. It is a NSP (nerve sparing procedure) with very few risks, almost no pain, and it causes no urinary problems. It is provided on an outpatient basis with no down time and is extremely effective. It is even better if you undergo a little ADT to consolidate the growths you already have and can free you of many future worries.

[S103462]

Similar story as yours – I was diagnosed 4 years ago (at 56y) with similar numbers as you have. Had a 2nd opinion -- same diagnosis. In reading various blogs, it’s really a personal call. Some people hear “cancer” and they’re totally devastated and want everything cut out immediately. Others take a more measured, calculated approach – so much depends on the data, one’s age, one’s life view.  It’s not a one-size-fits-all call.

In my case, I decided on Active Surveillance. 

Initially, went back every 3 months for PSAs & DREs. No issues. At the 2-year point, had another biopsy -- no change. Also, had a genetic test done to determine the aggressiveness of the cancer. (myprostatecancertreatment.o... Those tests showed a non-aggressive situation. 

Then, started every 4 months for PSAs & DREs. Will be going for another biopsy this month. If everything goes as hoped/expected, will then go to 6-month intervals between PSAs and DREs and another biopsy at some point. Desire is to hold off any aggressive treatment until it's determined to be necessary.

For me, like any other health-related call, it’s an acceptable risk when comparing all the upsides & downsides of the options. For you, it’s your call.

[JoelT]

Sounds to me like you have made an excellent choice.  All prostate cancer treatments are guaranteed to provide you with some level of negative side effects, some which could change your life.  Just remember, to stay on top of your PSA tests and discuss with a doctor you has experience with AS what other things you will need to watch.As Darryl suggested move over to the other Malecare group which will have many more men in your situation.

Joel

[Stevedl]

Along with your post, I read the great replies. With my family history of enlarged prostate (Uncle, brother, cousins) and actual cancer (Dad and two Uncles, including one with prostate that spread), having the surgery was an easy decision. Also, my Mom and sister had cancer. I also discussed it with two other Doctors and two Paramedics. For me, being cancer free was most important. However, the side effects have been somewhat frustrating; over time things have improved.

[20PeteG16]

Boxmk,

 You sound like you are getting adequate testing. As mentioned in some of the responses, Family History and second readings by pathologist should be included. Active Surveillance is considered a treatment and your involvement important to your outcome. AS is not for everyone.

 With a Gleason 4+4, staged T3, PSA only 7.5 at age 57, I chose cryosurgery vice my only other choice at the time in my location radiation and ADT 90 miles away. I got several other opinions! I had a remission in 2011, cancer showed up in three lymph modes and went on ADT for 9 months, but only AS since. Working for me, fully functional now 8 years later.

PeteG

[Spitzz]

Active surveillance is ok, 6 month PSAs should be ok, don't go longer than that..

Have a game plan in advance in case it gets away from you.

BEST OF LUCK