PCa Treatment undetermined

I was diagnosed with PCa in April of this year. My PSA was 5.83 prior to my TRUS biopsy. My Gleason score was 4+3=7. % positive cores 16% (2/12). I am currently on Active Surveillance. I chose AS because my biopsy remains were sent to Prolaris (Myriad Laboratories) for genetic testing. The results came back some what favorable in the non-aggressive range.

I visited my Urologist on 12-1-2016 for a re evaluation. I had a PSA test done prior to the visit, and my PSA had increased from 5.83 to 6.87. I was disappointed to say the least of the increase. The last PSA was taken 7 months ago. So that's an increase of 1.04. (not Good)

I discussed my options going forward and I have agreed to have a MRI-guided prostate biopsy After January 1 2017.

We did discuss another PSA test after 3 months, but I declined on that plan, My opinion, The MRI- guided biopsy would give me a better indication of my PCa, and let me make a sensible decision.

I will meet with my Urologist again after the results of the MRI- guided biopsy and discuss my treatment. Whether or not I stay on AS or go for treatment. . I am age 76, and healthy (at least I think so...)

Any thoughts or opinions concerning my decisions are welcomed....

8 Replies

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  • My humble opinion is that you are on the right track- the MRI -ultrasound fusion biopsy should target the index and sample the most likely aggressive tumors. Not necessary fool-proof, though - about 80% accuracy. Check your PSA doubling time - if < 9 months, cause for concern. If biopsy is substantiated that there is a Gleason 4 or 5 in the mix, at your age, you should consider targeted therapy for the prostate- which may likely minimize side effects and kill/control the likely tumor locations - through either cryotherapy, HIFU, or laser ablation (the first two are Medicare approved). Make sure you have no outside the prostate lesions through F18 sodium fluoride PET/CT scan- which will look over the entire body, not just prostate bed. Talk it over with your urologist, other prostate cancer specialists, and specialists providing specialized techniques. Even at 76, if you don't take care of, may risk metastatic cancer - leading to painful bone lesions later on - unless you plan to live only 5 more years.

  • Thank you evreca for the reply and advice. AS is not an option for me, since my visit to the Urologist. I plan to get a second opinion before I go for the MRI- Guided biopsy. The biopsy is not scheduled until after Jan. 1 so, I have time. I am not going to risk metastatic cancer , I plan for treatment, just not determined yet.

    Again, thanks!

    Roger

  • It sounds like you're taking the "active" part of "active surveillance" seriously - a good thing I think.

    The increase in PSA may be entirely insignificant. PSA is known to vary from day to day and can be affected by many kinds of stimulation from digital rectal exam to some athletics to infection, inflammation, or sex. But if it goes up again and again, that sounds like a growth of the cancer. I would NOT decline the PSA test that you were offered in 3 months. PSA testing is cheap, non-invasive, and gives you an ongoing measure of where things are going. If there is growth of the cancer, the PSA test will tell you how much growth and how quickly it's happening. So I think you should go for it and maybe stay on a 3 months schedule for a while. Do the MRI biopsy too, but don't decline the PSA test.

    As for treatment, I think most docs would recommend one or another form of radiation for a man your age. Radiation is easier to take and recover from than surgery. Some say surgery is better. Some say outcomes are the same (radiation worked well for me.) But whatever you do, the best favor you can do for yourself is to find the best doctor and hospital to perform the treatment. You want a real specialist, someone who treats a LOT of prostate cancer patients every year, has seen all the variations and complications, keeps up with PCa research, and impresses you as a serious and committed doctor.

    Best of luck.

    Alan

  • Thanks Allen, your comments and advice is most appreciated.

    What I meant by declining the PSA test.

    The Urologist first suggested having a PSA reading in another 3 months at my visit. He did not mention the MRI- guided biopsy. He then seen how concerned I was about the rise in my PSA. , then he suggested the MRI. I thought that was the way to go since my Prolaris score was found in the non aggressive range, and I felt like the Prolaris score and the Gleason 7, along with the rise in my PSA was somewhat condtradictory. And the MRI Guided biopsy would give me more substantial data on my PCa. Thanks again for your support and guidance.

    Roger

  • 4+3 is a rating that is somewhat out-of-date. The update to the Gleason system is the grade of the largest cancer lesion, and now the second part is the grade of the worst cancer lesion, even if it is less than 5%. It used to be the grade of the second largest cancer lesion. So under the revised system, the second number "cannot" be less that the first number. It would be graded as 4+4 I am fairly confident, using the system revised in 2014. Maybe I can find a URL.

    If you are at 16%, that seems low, but I mean "seems to me", for what that is worth. Not much.

    No longer does 3+4=4+3.

    see the last paragraph here

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

  • Here is a quote from that article:

    "That is, Gleason score = primary pattern + the highest pattern, in this scenario. For example, in a biopsy with Gleason patterns 3 (80%), 4 (15%), and 5 (5%), the Gleason score should be 3+5=8, rather than 3+4=7. "

  • martingugino,

    Thank you for the reply.

    Your information sounds reasonable, I would imagine you could get different scores depending on the Pathologist.

    What are your thoughts on a MRI-GUIDED Biopsy? I will be having one in January.

    Thanks,

    Roger

  • The PSA tests are not definitive and can reflect something other than prostate cancer. I agree with you on going to the biopsy.

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