Surgery or not

[Leeway]

I had PSA test in July of 8.4 had biopsy stated Gleason score of 3+3 received second PSA test 3 month later of 7.2. I have zero side effects and wondering do I really need to have surgery as my urologist' suggests or do I monitor every three months. 58 years old.

[SPEEDYX]

You have a chance for possible cure...I would definitely consider....check also with a MO.

[LearnAll]

I will leave you with a few facts to ponder:

(1) 3+3 is not even considered cancerous cells by a lot of oncologists.

(2) Once you lose your prostate, you will never get it back,

(3)In the world of prostate cancer, nothing changes overnight...there is enough time to research and get informed about right course of action.

(I will protect my dear prostate with my life ...until I can not)

[Mufj]

Depending on tumor loading AS may be an option. Monitoring psa and a confirmation biopsy might be in order. Did you rule out inflamation

G6 is considered indolent and by itself may not cause a problem. But if loading is high the something more serious may be there that biopsy missed(biopsy misses 30% of the time) especially with youre psa(assuming you ruled out inflamation)

Also get an mri if have not done so already

Consult with both RO and surgeon. Consider SE of tratments. Get multiple opinions

Lots of options available

Good luck and keep us abreast

[pjoshea13]

You have the good fortune of not belonging in the advanced PCa group.

With a GS=3+3 you should seriously consider Active Surveillance. Definitely not surgery at this point - or any other treatment.

Larry Klotz has written extensively on this:

pubmed.ncbi.nlm.nih.gov/?te...

-Patrick

[GP24]

I assume you had more than two positive biopsy cores. In this case, the guidelines recommend against active surveillance.

However, you can wait several months before deciding what to do.

[Hidden]

I would read some of the posts here from men and their wives who are experiencing PCa in its later stages, and ask yourself, do I want to risk it? There is more than one way to literally eliminate your cancer....it doesnt have to be surgery.

[dac500]

Your PSA is not increasing rapidly. If the cancer is confined within the prostate, you should take time to decide on a treatment. Nine years ago I was diagnosed with Gleason 3 + 3 prostate cancer. I had brachytherapy. Unfortunately, I had extra capsular recurrence four years later. I believe the biopsy missed a higher grade cancer very close to the capsule, which was not killed by brachytherapy.

So, please take your time. If possible, you should have MRI and other scanning.

[Leeway]

Unfortunately I cant have MRI, as I have pacemaker and have old lead from older pacemaker. thank you for all the response on this site great information.

[noahware]

I suggest you research the potential risk of 3 + 3 PC. Once upon a time it was normal to have RP w/ Gleason 6, but subsequent observations have found it to be pretty rare for true 3 + 3 to be highly aggressive and/or lethal.

In most cases where 3 + 3 recurred as highly aggressive and/or lethal it was found that the TRUE pathology was not that, and the biopsy failed to reveal what should have been a higher Gleason indicating more poorly-differentiated cancer. So be aware, that is a possibility: you may have a higher-grade cancer than the biopsy indicates.

If you do have a non-threatening PC and proceed with RP, of course you will be "cured" by the surgery, since the imagined threat will be gone! The question is, do you want to risk a "cure" when you might not actually NEED a cure? Many men do. They are relieved of the burden of thinking a cancer is growing within them.

That said, the idea of just "watching and waiting" with AS should not be a passive pursuit. One can be more "active" in "Active Surveillance" by making sure vitamin D levels are better than adequate, exercising, losing the spare tire, improving diet, etc.

[Tall_Allen]

You are posting on a site for advanced prostate cancer. You may get more relevant responses on this site:

healthunlocked.com/prostate...

You have what is called "low risk" prostate cancer. Especially considering your relatively young age, you should not have to endure the long-term side effects of any treatment if you don't have to. The top institutions preferentially recommend that low risk patients embrace active surveillance.

Before you do that, it's a good idea to get a second opinion on your biopsy slides from the top prostate pathologist in the field (no one questions him). It costs about $300 if your insurance doesn't cover it:

pathology.jhu.edu/departmen...

Active surveillance is more active than PSAs every 3 months or 6 months. Within a year, you should have an mpMRI-targeted biopsy at an institution with a really experienced radiologist. After this confirmation, there may be more MRIs and/or more biopsies depending on past results.

In the longest-running active surveillance trial in North America, over half of low risk patients have never needed treatment so far for 20 years.

I suggest you get on an active surveillance program at a center of excellence and not try a DIY approach.

[Tall_Allen]

I just read your comment that you cannot have an MRI (neither can I). There is another option that will probably be available to you within a year:

prnewswire.com/news-release...

[tango65]

Since you can not have an MRI you could request a micro ultrasound of the prostate which is useful to identify Gleason sum 7 or higher cancer.

pubmed.ncbi.nlm.nih.gov/301...

eu-focus.europeanurology.co...

There are several centers in the USA and Canada doing these procedures. These are some of them, it may be many others.

United States, Maryland

Johns Hopkins Brady Urological Institution

Baltimore, Maryland, United States, 21224

United States, Virginia

Urology of Virgina

Virginia Beach, Virginia, United States, 23452

Canada, Alberta

Prostate Cancer Centre

Calgary, Alberta, Canada, T2V 1P9

Canada, Ontario

Princess Margaret Cancer Centre

Toronto, Ontario, Canada, M5G 2M9

Canada, Quebec

Centre de Recherche sur le Cancer ("CRCEO")

Quebec City, Quebec, Canada, G1R 2J6

[j-o-h-n]

Lee be on your way............

(Stay vigilant)

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 10/23/2020 7:49 PM DST