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Prostate Cancer Network
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Grade 1 gleason 3+3

New to here just been diagnosed grade 1 gleason 3+3 waiting for mri scan in 2 weeks to ee whats going on, I am 60 years old and still in shock, what's the best way forward from here don't fancy removal of the r prostate.

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As a first step, pay $275 to have your biopsy slides read by Epstein at Johns Hopkins:

pathology.jhu.edu/departmen...

If confirmed, the first option you should consider is active surveillance. Over half of men with low risk PC like yours have stayed on AS for over 20 years, so far. Some kinds of PC never progress.

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Accessing that URL over SSL (https) is causing JH's web servers to pitch a fit about mixed content (stuff being served up over https and http at the same time). The end result is a poorly rendered web page. For better results, try it over http for now:

pathology.jhu.edu/departmen...

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Bigall,

First thing you should do is relax and chill.

A grade 1, 3+3 is hardly anything.

So, I gather you have had a biopsy? How many cores were positive?

The important thing is to not rush into any treatment, especially surgery. Before you do anything learn about your options. It is very likely that you could do Active Surviellance. This means keeping an eye on it without radiation, surgery etc. Talk to your doctor about it and without fail, GET A SECOND OPINION.

Others here will offer more advice. Pay attention and learn before doing anything

The worst thing you could do is rush into treatment without fully understanding what you are getting into.

All the best

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There was ten take only one came back abnormal thanks for the advice psa level 18 tho strange to be that high for grade 1

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Good luck with whatever you decide.

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Wait. Read, research, listen, seek second opinions from radiation and medical oncologists, have all your test and MRI results evaluated by a second expert. You are not in a high risk situation. Wait some more. You will have to wade through some bogus advice along with the good but remember it is your life and your body. Knowing that you have done the best for yourself by making a rational, informed decision about your treatment will make this ordeal much easier to bear. Good Luck!

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All good advice. Especially about getting additional opinions and having slides read by another pathologist (or 2). The reading of slides can be as much an art as a science. Getting additional opinions will help you feel more secure.

You did not indicate your PSA and PSA history. The doubling time and rate of increase of PSA is as valuable if not more so than the PSA itself.

And do not rush into anything. You have time to research. Read ask questions understand.

Active surveillance may be a good option. I faces the same situation 10 years ago. Got the same good advice and for me chose Active Surveillance.

Each of us have different attitudes, concerns, life situation and beliefs. The decision is as much emotional and personal to you as it is technical. Learn and talk to those close to you. Sounds like time is on your side.

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Thank you for the advice my psa level was 18 strange to be that high for grade 1

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Bigall

The high psa might be from something else. Some physical activity and infections can raise it.

All the best

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I agree, it does seem high. As mentioned several factors could affect it such as exercise (workout, bike riding, sex) an infection etc. anything that can irritate the prostate. I have known of cases where the blood draw was done after the DRE giving a false high reading. Do you have a history of your PSAs? If so what has it been?

Also keep in mind that a biopsy is usually 12 very very very small samples from different areas of the prostate. It is entirely possible that the samples did not reach the larger tumor.

All AS studies I have looked at including the one I entered have, among the criteria list, a PSA < 10. Hopefully you have a history of PSAs. If so what has been the doubling time? If I were you I would want to repeat the PSA the sooner the better. While the PSA is of concern, I would want to be sure it is not an outlier.

Also be sure the PSA was measured using the same assay method. One would think PSA is PSA no matter what method to measure it is used. I have found that is not always the case.

In my case my entry PSA ten years ago was 3.0. It has since doubled to 6.0 in 10 years though they changed assay methods along the way which muddies the waters.

Given your PSA I would have some concern at this point and be following up. And as everyone has said, educate yourself.

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Shoot. Just chill out and enjoy your 35 more years of being a PITA.... We all are PITA's

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 06/12/2019 11:42 AM DST

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I will echo some of the above advice. You should have requested a 3T MRI before the biopsy. A blind biopsy is not real useful but follow up MRI is second best. I would have it before you get a second read of your biopsy since it may show something that will cause a second biopsy. If not the second read is very good advice. Insurance should cover but lots of th very reputable large programs don’t charge much for a second read. With both of these you have good information to consider options.

I agree you are not in a rush but all options including active surveillance are not without some stress. I took six months to decide on treatment with a GS 3+4 and one well defined lesion confined to the gland. I liked the book “ invasion of the prostate snatchers”, but I read several books. If a publication is more than 5 years old, don’t buy it. Clearly the one sited is aimed at over treatment but helpful in looking at options. Second and even third opinions are really important and they can wear you out. Read, keep working out and take comfort that there are lots of men like you doing the same thing you are.

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"Blind biopsy" (a biased term IMO) worked for me.

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If thats all...active surviellance ....and enjoy life...that it

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Tall Allen is right. Your Gleason does not show aggressive cancer. Active surveillance including monitoring your PSA every 6 months and an annual biopsy would be my recommendation.

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