I`m new here. Be nice ;-)

[Deere]

Hello! I`m 62 years old. Diagnosed October 2018 by blind biopsy and Gleason score of 3+3=6 1 out of 12 cores. Currently on self directed Active Surveillance. Vegan diet with supplements since October 2018. I`m waiting on a 2nd opinion of my slides from Dr Epstein at Johns Hopkins. Also seeking a Active Surveillance friendly urologist in Arkansas. PSA in October 2018 6.44 - PSA in February 2019 6.61.

[Tall_Allen]

AS sounds like a great idea for you, but you should have a confirmatory mpMRI-targeted biopsy within a year.

[Deere in reply to Tall_Allen]

Thanks! I have a complication with the MP MRI. I have steel shrapnel in my right calf. I have not nailed down a strait answer about the risk involved with the steel being near the arteries and nerves. Waiting on an opinion on the 3TMRI from Dr Busch in Chattanooga.

[Tall_Allen in reply to Deere]

No worries- you can get an even more thorough biopsy without an MRI - transperineal template mapping.

[Atlantic77]

Check out Dr Klotzs on the internet, he is a pioneer in the modality of AS and thanks to him many men avoid unnecessary invasive treatment and the associated adverse side effects.. It sounds like you have a very low risk prostate cancer and if confirmed to be Gleason 3 + 3 = 6 on only 1 core out if 12 then there is more and more research coming out that soon it may not even be regarded as a cancer. The other measurement to be considered would be the tumour volume (PSA score divided by prostate volume), if this is 0.15 or lower then you are in the very low risk range. So AS would appear to be very appropriate for you.

[OldTiredSailor in reply to Atlantic77]

BUT - prostate and tumor volume are easily misunderstood using either MRI or TRUS data. Both 3T mpMRI (with contrast) and 12-core TRUs biopsy reported my prostate to be 18cc and the G7 tumor to be 0.32cc. With a PSA of 10.2 that yielded a very high PSA density measure.

The pathologist measure the actual prostate and tumor, post RP, and found a 37cc prostate and 7cc tumor. Big Difference and it completely changed the meaning of the PSA density.

[Deere in reply to OldTiredSailor]

I have had no imaging other than the ultrasound probe that measured TRUS volume at 75.60. Does that sound right? Thank you!

[Atlantic77 in reply to OldTiredSailor]

Yes that is quite a turnaround of measurements, I wonder what sort of a time span had passed between mpMRI, biopsy and RP - presuming of course that both tumour and prostate volume evolved during this time.

[Atlantic77 in reply to Atlantic77]

Also PSA readings are very unreliable for precise measurements, at best they give an indication of overactivity or stimulation in the prostate but that could be due to many factors.

[OldTiredSailor in reply to Atlantic77]

Four weeks but no change in PSA

[Deere in reply to Atlantic77]

Thank you! PSA score divided by prostate volume - 6.44/75.6=0.08

[Atlantic77 in reply to Deere]

That measurement of 8% tumour volume along with the rest of your measurements puts your tumour in the very low risk range.

I am in a similar position to yourself with Gleason 6 but with a tumour volume of 21% and I am in the low risk range and on AS.

[gamma909]

One additional consideration is to get a genomic test. My med onc was able to request this. It's another way, in addition to prior replies, to confirm that AS is a good approach. I've found that getting as much data as you is quite helpful given the complexity of PCa. Good luck and good health.

[Deere in reply to gamma909]

Thank you! I had the Polaris test. Molecular score was 4.8 "DSM 4.8 risk exceeds threshold for active surveillance" was stated. That made my uro smile. Polaris considers anything over 3.2 out of the AS range. I`m not sure how much to trust this 1.6 difference when considering treatment options.

[gamma909 in reply to Deere]

I would take this as one more piece of information you can use to make a treatment decision. Genomic tests are based on correlations along with the quantity of results they collect over time - any one individual's (i.e, yours) experience can vary when it comes to accurate prognosis. In my case, I was 3+4 and genomic test put me into an "unfavorable" category so I ended up ruling out AS after mpMRI and meetings with 4 doctors.

[Deere in reply to gamma909]

That`s good info! Thank you so much!

[Hidden]

First, that is great news for you. As others have pointed out, CaP is complex with the emphasis on _Active_ with active surveillance. Look at the Lewanda video, maybe more than once to get the most current recommendations [youtube.com/watch?v=WmWsi_B...(Not working as expected?)]. One of the things he pointed out was the scientific data on POMI-T supplements for lowering PSA. You might want to add that to your other lifestyle changes. You will find that most participants in this forum ARE nice. The 3T magnet will be even more dangerous for that shrapnel if the shrapnel is ferrous. Welcome.

[Deere in reply to Hidden]

Thank you! I`ll watch that video. I do take POMI-T. Nice to be in a group of nice folks! Not all forums are like that. The shrapnel is from a gunshot wound that passed thru my truck door, thru my right calf and exited thru the firewall of the truck. The bullet passed thru the calf leaving some large shrapnel very close to arteries and the peroneal nerve. 30 year old wound with lots of scare tissue. What would be your choice of imaging if you could not have the 3T? Thanks for the welcome!

[redsox1967 in reply to Deere]

Pomi T research is real and has been confirmed. I take it as well along with Tumeric (doctors best) and saw Palmeto sleep is very important. Read Why we sleep (walker) T cells don’t activate till after 7 hours of sleep

[redsox1967]

It’s great news with a PSA of 6. Changing what you put into your diet makes a HUGE difference . My short story is a diet low in fat 20% calories from fat and sugar has prevented me for having radiation. I found an MD in NYC who was a radiologist by training and has looked for alternative methods. Reduce fat, calories and sugar and you are on the right road for reducing risk. It’s a large life change but very worth it. Lugo has a book that has been helpful. I know someone who has been 8 years on active surveillance in Rhode Island. It works! Be well.

[Deere in reply to redsox1967]

Thank you! I am on the right road for sure. Major diet changes. Glad you were able to avoid radiation! That`s my goal too!

[redsox1967 in reply to Deere]

I’m also trying to be regular with a PEMF machine. The theory is inflammation you can find research articles NIH on it. It’s interesting and useful for our condition. Tumeric makes sense. My GF is a registered dietitian and nutrion action lists Doctors Best as one that has excellent efficacy

[tucker_man]

I have a different take than prior posters and I was in a similar situation as you. Epstein confirmed the Gleason 6 that my urology center diagnosed but an OncotypeDX (genomic) bumped my NCCN risk from low to intermediate favorable. Only one core and it was 60%. Still, at age 58, my opinion is it is not IF, but WHEN I would need to start treatment and I'm starting radiation treatment next month. Chance of side effects are low and I'm young enough to recover well. PSA was steadily increasing and last time was almost 8. As far as I'm concerned, the longer the cancer is present, the more chance some could leave the prostate and lay "dormant" elsewhere--I can't otherwise explain the amount of recurrence that happens when a patient has had radical prostatectomy on fully encapsulated PCa. I don't think the body just manufactures new prostate cells that turn cancerous. Anyway, that's just how I looked at it and while RT might not be the perfect solution, I felt it was better than just waiting. I second the advice to get your biopsy genomic tested to make sure you're really a very low/low risk.

[Deere]

I`m waiting on Epstein to confirm my G-6. I had the Polaris genomic test. Score was 4.8 and stated "NCCN risk; very low/low. Thank you! Best wishes with your treatment!

[RonnyBaby]

Sorry but I can't resist it !

I'm taking my ugly pill !

(sometimes it seems that things are 2 serious around here - LOL)

Take care - keep up the good work - we do wish you the best ....