Some questions about prostate cancer

[BobDeVito]

Hi all,

My prostate cancer is not advanced. It's very early and right now we are doing active surveillance for it. My highest PSA in Feb 2016 was 7.7 with a Gleason score of 3+3=6. My two most recent PSAs were 5.0 and 5.4. I had stage 3a male breast cancer in 2012 and am just coming up on my 5 year mark with NED in June. With that in the back of my mind, I just hope I'm doing enough. The Urologist is my age and said he wouldn't do anything other then active surveillance at this point. Next MRI guided biopsy is in the July/August timeframe. Thoughts?

[Jvaughan0]

I think you need to get a second opinion and do your own research. New treatment options exist today that could ease your mind, but there are many schools of thought about what to do or not to do next. You have to reach your own conclusions before you commit to a conservative or aggressive approach.

[Darryl Partner]

Hi NOT to chase you away, but there is a group for newly diagnosed guys at healthunlocked.com/prostate...

[Darryl Partner]

Also, take a deep readthrough at malecare.org

[Hidden]

My suggestion is - see if your doctor thinks it would make sense, and your insurance will approve, a Bio-marker test (Decipher is the one I had done). The tests gauges what risk pool you are in given the tumor and your bio-marker makeup. There are two tests - one using your biopsy, and one using prostate specimen. Obviously you would have the biopsy test.

Good luck

[ctarleton]

You might also consider getting a test of your own inherited DNA, to see if you may carry some of the markers for Breast Cancer (e.g. BRCA), particularly if there may be a history of prostate or breast cancers or other cancers in family. Some men with Prostate Cancer develop tumors that might be treated later in other ways besides initial surgery/radiation, or Androgen Deprivation Therapy. The process usually involves either a simple saliva sample or blood sample, which is sent off to a specialty lab, where they test it and return a report of the status of 50-ish commonly inherited genetic markers that are associated with the development of common cancers. Some of those involve mistakes in genetic repair mechanisms, increasing the odds over time of some cancers to develop or grow in later life.

[AlanMeyer]

I don't know if your male breast cancer increases the risk of your prostate cancer. I don't know if anyone knows, but it might be worth doing some research about that.

There are published criteria for active surveillance based on observational evidence. I don't know the latest standards but I believe they used to be:

PSA < 7

No more than 2 cores positive for cancer in a 12 core biopsy.

No more than 5% (or was it 10%?) of each positive core containing cancer.

I think Dr. Jonathan Epstein at Johns Hopkins was the leader of the study that produced those guidelines.

Hope that helps.

Alan

[BobDeVito in reply to AlanMeyer]

Thanks Alan. I know a researcher at JH. Perhaps I'll have a chat with him.

Bob

[pjoshea13 in reply to AlanMeyer]

Alan,

BRCA1/2 mutations increase the risk for having both cancers.

(Incidentally, there was a paper in the past year on a man with BCa who had it metastisize to his prostate.)

-Patrick

[joeoconnell]

active surveillance would be my choice. i have known guys who have gotten anxious and felt like lets do something. do something has consequences

[S103462]

My thoughts would be inline with my story --> It's been 5 years now that I've been on active surveillance (AS) since being diagnosed in May 2012. 5 year into it, I'm good with that decision as part of my overall health plan.

Have had regular PSA/DREs since I was 40y/o (am 62y/o now). Over those years, PSA had risen to 4.0; then, was 5.7 in early 2012. Had biopsy; T1C, Gleason 6(3+3), 2nd opinion at Johns Hopkins confirmed results. Had bone/CT scan - negative for metastasis. Wanted time to research this topic.

Started PSAs/DREs every quarter; PSA remained in the 4.x range; repeated biopsy in May 2014; similar results. Had biopsy sent for Oncotype DX testing; Results were: Freedom from high grade disease (74%); Freedom from non-organ-confined disease (71%).

Decided to remain in AS. Went to PSA/DREs every 6 months. Just had a biopsy in October 2016 - no change; had another PSA/DRE in April - same results.

My plans are to stay with AS until some number changes. In the meantime, we continue regularly monitoring (6 month PSA/DREs) w/periodic biopsies; as slow-progressing as PC usually is, I'm in no hurry for radical treatment and all that goes along with that.

Also, will search out another (or different) DNA test soon, to justify (or not) whether AS continues to be a reasonable choice. Technology and medicine continue to improve - will continue to keep all options open.

[j-o-h-n]

Have you seen an oncologist?

Good Luck and Good Health.

j-o-h-n Thursday 05/04/2017 4:05 PM EST

[BobDeVito in reply to j-o-h-n]

Oh yes. I'm well connected in the cancer world. Love my doctors.