Prostate cancer

[Barney71]

Age 44

Psa 5.4

Dre small hard spot on right

Transpirenial biopsy and Mri

Gleason 6

40 cores 1 core cancer right posterior 3.5% ( 1 of 10 cores)

Don't know what that means

My Mri before my biopsy was graded t1 as nothing could be seen then it was was looked at by the Mdt team and they upgraded it to t2 c as they say area on left side looked suspicious but my biopsy didn't pick anything up. They all decided with my psa and Gleason score being low grade I should go on active surveillance even though t2c says not advisable for active surveillance, because my biopsy does not match my Mri they advise this is the best option for now. My biopsy did pick up high grade pin in left side posterior.

If anybody can shred some light on this then I would be grateful as don't understand how they upgraded when biopsy said it was clear. Also my biopsy was saturation one 49 cores taken.

I am fit and healthy and no family history of this disease I have Bph and symptoms off that prompted me to go to docs then everything else followed. I have read up on Bph and it states this can raise psa levels as prostate enlarges and mine is 84 cc hence some water work probs, but got no symptoms now whatsoever no up through night normal flow etc. 

So with this feel probably best is for AS as all side effects of treatment are awful and unless necessary don't want to go down that route also saw an article about hifu still in early stages it says but no side effects etc so one to keep an eye on if need treatment in future.

[julianc]

Hi Barney 71,

Personally I would have the treatment. The side effects are manageable and you would have less worry and a higher chance of a complete cure the sooner it's done. Also at 44 you are younger and can recover well, and  will likely need treatment at some point in future anyway, imho it's not like you will stay on AS until you are 80. I was t3a and had RP at 49. My good pal was on AS, but ended up having treatment at same time as me,  and found it had crept up to t3a also. Good luck mate. J

[Barney71 in reply to julianc]

Hi thanks for your reply 

I will be checked every 3 months with dre and psa test and Mri then biopsy every 6 months so for now I think As is best for me but I do agree at some point weather it be 2 years or 10 years I will need treatment but the longer I hold off the more advanced treatment is becoming. The Polaris test is available privately but not on Nhs this will tell you if your cancer is aggressive it not Likely to cause any prob throughout life and different treatments with less side effects are dripping through bit by bit so I will go with what Mdt team advise for the moment, as I did question chance of it advancing and they have reassured with my regular testing treatment would be put in place way before it could advance and it would still be at curable stage. 

Did you have robotic surgery? If so if you don't mind me ask g did you suffer side effects and how long were you off work etc?

Cheers

Andy

[julianc in reply to Barney71]

Hi Andy, 

I had robotic 14 mtjs ago. 2 weeks off work. Still some incontinence and ED, but I am fine with that as it was locally advanced so more removed. ED  is addressable with cavijet injection for me. PSA undetectable. 

One thing i would do is really research and improve diet. Try the book Lifestyle After Cancer. Cheers J

[pjoshea13]

Hi Barney,

I would resist any urge to rush into treatment.  However, 25% of those on active surveillance in the U.S. do progress, & it's a shame that the 25% don't get advanced warning of increased risk, & the 75% have to live with the anxiety of perhaps being in the 25%.

Here in the U.S. there is the 4K Score test:

4kscore.opko.com

which is not covered by insurance at this point.  It uses: Total PSA, Free PSA, Intact PSA, and Human Kallikrein 2 (hK2) to arrive at a probability percentage for serious disease.

Some might be anxious in not getting a yes/no result.  In the following study, this is identified as a limitation:

"clinicians may be hesitant to make recommendations against active treatment on the basis of a statistical model."

This was from a European study that did not necessarily use the same algorithm as the 4K score:

"392 screened men participating in rounds 1 and 2 of the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer. Patients were diagnosed with PCa because of an elevated PSA ≥3.0 ng/ml and were treated with RP between 1994 and 2004."

"Using decision analytic methods, we showed that using the panel of four kallikrein markers in blood to make a decision about surgery would lead to clinically superior outcomes compared with current clinical practice. This panel could be used as a decision aid in men with low-risk disease, in whom treatment decisions are most difficult. Adding the kallikrein panel to the decision-making process may reduce the number of immediate radical treatments performed for low-risk disease, bearing in mind that delayed treatment is still an option under surveillance . This approach could save many men years of suffering from adverse effects of treatment, including incontinence and erectile dysfunction, and thus improve quality of life while advising few men with potentially aggressive cancers against immediate surgery."

ncbi.nlm.nih.gov/pmc/articl...

Perhaps such a test will become standard soon?

-Patrick

[maack1]

Based on your Gland Volume vs PSA level, the amount of PSA generated by the size of your gland is 3.07ng/ml, so that leaves just 2.33ng/ml of questionable concern. Looking at your single tissue sample from 40 samples taken and Gleason Score of 3+3/6, Active Surveillance is a reasonable option for now. However, when Active Surveillance is undertaken as the protocol, that really entails much more awareness than simply sitting around and waiting to “see what happens.” The considerations for both you and your treating physician are described in this paper tinyurl.com/3r7mm8m and feel free to print and take with you to a next appointment to discuss with that physician. As to your “staging,” the T1 was appropriate from initial thought as to “tumor confined to prostate and undetectable by a digital rectal exam (DRE)” but then the change to T2 does appear questionable and would rather have expected a change to only T1c following biopsy to coincide with the definition of T1c “Tumor is identified by needle biopsy as a follow-up to screening that detected elevated PSA results.” You also questioned what their “40 cores 1 core cancer right posterior 3.5% (1 of 10 cores)” meant, and I would expect they meant that of the 40 cores extracted, in a separate grouping of 10 core samples extracted they found only one of those 10 cores with evidence of prostate cancer activity and the core identified 3.5% activity. Hope the foregoing adequately addresses your concerns. Make it a point to thoroughly read the paper regarding Active Surveillance. Should you want to know more in the future regarding Robot assisted Laparoscopic Radical Prostatectomy (RaLRP), I can provide further information.

[Barney71 in reply to maack1]

Thanks for your reply my mri was t1 but my dre was t2 as could feel small hard spot but as I said upgraded to t2c but will look at mei scan when go in for my 3 month check which for my AS they are going to check psa and do dre every 3 months and mei prob every 3-6 months depending on results from psa and dre then biopsy after 12 months so will be checked regularly. Thanks again for all the info. Really do appreciate it.

Andrew

[Barney71 in reply to maack1]

I read somewhere for every 10cc of prostate size the psa is 1 ng? Or have I read that wrong.

[maack1 in reply to Barney71]

Wrong.

[Barney71 in reply to maack1]

Thanks for clearing that up for me.