Recently diagnosed

[Samps]

Hello everyone, I'm 60, diagnosed Gleason 6 (3+3), biopsy 8 cores out of 22, no spread, pet scan negative.My doc recommends active surveillance as he consider Gleason 6 lower risk. I'm bit depressed! I'd really appreciate your humble advice and insights. Wishing you all the best. Good health and wellness.

[NanoMRI]

My first pathology Gleason opinion was 3+3. mpMRI suggest more threatening cancer. 2nd and 3rd pathology opinions 3+4. After RP, 4+3 confirmed by 2nd opinion. And, it turned out, mine indeed had gotten out. All the best!

[WhatHump in reply to NanoMRI]

Yes. That’s the problem with biopsies. They only sample a tiny percentage of the gland. Stay on top of this. It will give you peace of mind, and a better outcome should things change.

[NanoMRI in reply to WhatHump]

Exactly! Fortunately I did not take a bite of the AS apple - as at the time of my 3+3 Dx my cancer was already on its way to my para-aortic lymph nodes, if not already there. IDK why some folks without personal experience speak as condescendingly, arrogantly as they do.

[Tall_Allen]

Congratulations on being able to be on active surveillance! IDK why you posted in an "advanced prostate cancer" forum. You might find more men in your situation here:

healthunlocked.com/prostate...

[gsun in reply to Tall_Allen]

Yes you might get better information on that forum.

[Ashski in reply to Tall_Allen]

From what I can see on the Active Surveillance forum there is hardly any activity..

There are a few posts here in this thread already that describe their Gleason 6 progressing.

[Tall_Allen in reply to Ashski]

I did not link to the active surveillance forum, I linked to the "network" forum.

[Ashski in reply to Tall_Allen]

Right. Yes more varied stuff there I see.

[jet75028]

Hi,

6 years ago I was diagnosed with Gleason 6 and was undergoing active surveillance. Recently the last biopsy showed cancer moving into smooth muscle of urethra and now need prostatectomy. Just stay on top of your surveillance never know.

[CRPCMan]

Don't let them scare you. Go to a doctor that acknowledges that a 3+3 in not considered Cancer.

[j-o-h-n]

If you wish to post here or anywhere else on H.U. you should update your bio...All your information is voluntary but it helps us to help you and helps us too.

Good Luck, Good Health and Good Humor.

j-o-h-n

[addicted2cycling]

I imagine that you are aware that your listed ethnicity "Black / African / Caribbean" places you in a higher risk category. Please remain very vigilant r.e. your PCa condition even with a GL6 diagnosis.

prostatematters.co.uk/the-r....

Good luck and keep posting.

[Conlig1940]

Read Dr. Patrick Walsh's book " Guide to Surviving Prostate Cancer " -- The section on active surveillance . Also read the U.K. 15 year Prostate Cancer Protec T trial results .

And remember ACTIVE SURVEILLANCE means " ACTIVE " -- Regular PSA , an MRI and a Biopsy depending on any negative trend .

[Ashski in reply to Conlig1940]

Thanks for those references.

I did a quick AI review of the UK trial:

“The UK's 15-year Prostate Cancer ProtecT trial results provide valuable insights into prostate cancer active surveillance. At the 10-year median follow-up, the study found that prostate-cancer-specific mortality was low, with no significant difference among treatments, including active monitoring, surgery, and radiotherapy ¹ ².

Key Findings:

•⁠ ⁠Low Prostate-Cancer-Specific Mortality: Only 17 prostate-cancer-specific deaths were reported overall, with 8 in the active-monitoring group, 5 in the surgery group, and 4 in the radiotherapy group ².

•⁠ ⁠Disease Progression: Higher rates of disease progression were seen in the active-monitoring group (22.9 events per 1000 person-years) compared to surgery (8.9 events per 1000 person-years) and radiotherapy (9.0 events per 1000 person-years) ².

•⁠ ⁠Metastases: Metastases developed in more men in the active-monitoring group (6.3 events per 1000 person-years) than in the surgery group (2.4 per 1000 person-years) or radiotherapy group (3.0 per 1000 person-years) ².

•⁠ ⁠Quality of Life: The study also reported on quality of life outcomes, finding that men in the active-monitoring group reported better sexual and urinary function compared to those in the surgery and radiotherapy groups ².

Active Surveillance Insights:

The ProtecT trial suggests that active surveillance can be a viable option for men with localized prostate cancer, allowing for delayed or avoided radical treatment ¹ ². However, regular monitoring is crucial to detect any signs of disease progression.

•⁠ ⁠The ProtecT trial had 1,643 participants, divided into active monitoring (545), surgery (553), and radiotherapy (545).

•⁠ ⁠Disease progression was defined as increased PSA levels, clinical progression, or transition to radical treatment.”

So it seems the conclusion is this trial is telling me that 22.9% of active surveillance participants experienced “disease progression”. As defined above.

[Ashski in reply to Ashski]

Question: What percentage was Gleason 6 in trial?

“The ProtecT trial break down the participants based on their Gleason scores, but not explicitly within the active surveillance group. However, we do know that about 77% of the participants had a Gleason score of 6, indicating mostly low-risk prostate cancer ¹.

The trial primarily focused on comparing treatment approaches for prostate cancer, including active surveillance, surgery, and radiotherapy. The active surveillance group relied heavily on serial prostate-specific antigen (PSA) testing to monitor cancer progression ¹.

While the trial didn't provide specific breakdowns of the active surveillance group by starting Gleason scores or PSA scores, it did offer valuable insights into the long-term outcomes of these treatment approaches. For instance, the 15-year follow-up showed similar prostate cancer-specific mortality rates across all groups, ranging from 2.2% to 3.1% ².”

[Ashski]

I am on active surveillance, 3.5yrs after first biopsy 3+3 Gleeson opinion. I’m 59.5yrs old now.

Since official diagnosis the PSA has fluctuated around the 3.0 level, plus or minus 0.3.

I’ve had two biopsies & two MRIs. The last biopsy in late 2022 had 9 of 21 cores positive. About the same as the first biopsy. So it’s high volume but low grade. Second MRI was a couple of months ago & showed no imagery change. The same radiologist did both MRI reports. My urologist wanted that.

My 87yr old father had his prostate out when he was 62. He waited a few years, his PSA kept rising. Unfortunately I don’t know what his Gleeson score was when first diagnosed.. His PSA does still rise and he has hormone injections every 12-18 months to bring it down. He’s has incontinence issues ongoing which coincided with the start of hormone treatment after 3yrs post op of no issues.

My first urologist advised to take it out, especially because I was young at 56yrs. A second opinion said I was a reasonably good candidate for active surveillance.

Urologist has me doing two more 6 monthly timed PSA tests before mid year 2025 another biopsy to occur.

Am I just kicking the can down the road and taking too big a risk. Given family history & high volume biopsy I get the feeling I am.

I’m reasonably active, play soccer a couple of times a week, not overweight but not a great diet. I don’t lose sleep over my PC, probably because too many other things do that for me already.

[Conlig1940 in reply to Ashski]

It's a personal lifestyle and age issue . I have an associate on AS for 6 years - he just turned 60 in June and is reviewing his options while he is still young and fit, like you . There are many focal therapy options out there for Gleason 6 , 3+4= 7 and selective 4 + 3 = 7 .

NanoKnife is gaining international recoginisation , and showing great results . The USA lags the world acccepting this Focal Therapy . I have several friends who went this route and to date are very pleased with the result . The 1st went to a private clinic in Germany *** , the others had the procedure in Toronto, Canada where there are several locations .

Additional Monotherapy Treatments , to avoid hormone therapy in particular , is popular for SBRT and HDR Brachtherapy . Both are short term treatments with excellent results .

*** Google: Niagara Now - William Thomas NanoKnife in Germany . Niagara Now is a local area newspaper . Wm. Thomas is an author of numerous books .