Confused by 2nd Opinion From Johns Hopkins

[Abraxis49]

I will try to be as concise as possible. I just turned 70. In December of last year my primary care physician referred my to a urologist because of a 4.3 PSA. It was the first PSA in about 5 years, at which time my PSA was 2.0. I bought into the not necessary because of the possible over treatment..etc.

Urologist = dre was normal said to return in 3 months for PSA repeat. March, psa 4.47. Recommended prostate MRI. PRAD 4 lesion. Mri guided biopsy 6/1/19. result = cancer in 2 locations area 1) stage 2 (3+4) 25% volume. area 2) stage 1 (3+3)...I'm assuming) 25% volume. Uro recommended consulting with surgeon and RO, which I did.

I decided as a result of this group to get a 2nd opinion from Epstein at Johns Hopkins which I just received the results..... this is where I need help..I'm very confused.

JH results = area 1) stage 1 (3+3) with a volume of 60% area 2) stage 1 (3+3) volume 20%.

Does the higher volume trump the lower stage??? Seems like from what I've read, the threshold is 50%, therefore ruling out me being in the active surveillance category?? What is the influence/relationship re: treatment protocol with this new info??

I would greatly appreciate your thoughts!!!

[Gemlin_]

You have PSA < 10, ISUP grade 1, T1c, 2 positive cores --> Don't rule out AS.

The criteria most often published include: ISUP grade 1, < 2-3 positive cores with < 50% cancer involvement, a clinical T1c or T2a, a PSA < 10 ng/mL

You are absolutely in no hurry to decide!

Question to ask is the probability of undetected Gleason grade 4, is it high (the first pathologist opinion) ?

Other factors to consider (against AS) are:

- PSA density> 0.2

- Ratio f / tPSA <0.1

- Known mutation in BRCA2 gene

[Abraxis49 in reply to Gemlin_]

Thank you for your valuable input! My only concern is that the one core has 60% involvement which appears to be over the threshold of 50% for AS. Is the 60% really that significant in my case??

[Gemlin_ in reply to Abraxis49]

No, you are low risk. Even if you do nothing and forgot about PC the risk of dying from this disease would only be about 10%. With AS (and possible future treatment) it's something else than PC at the end.

[Abraxis49 in reply to Gemlin_]

Thanks for another confirmation!

[Hidden]

The JH downgrade is nice. They downgraded 2 of my cores 10% each. I'm not sure about the 60% as, I too, was told about the 50% involvement threshold. I'm guessing you haven't spoke with your uro yet? I don't think you need to rush into anything at this time.

[Abraxis49 in reply to Hidden]

Thanks for the feedback and taking the time to respond. Correct guess on the uro...i have an appointment first week of Nov. Trying to find some peace in the no rush

[Tall_Allen]

No. You are a perfect candidate for AS. Only Johns Hopkins (which has possibly the most stringent AS criteria) used to use that criterion, but even they no longer do. Here are their current criteria:

urology.jhu.edu/prostate/ac...

[Abraxis49 in reply to Tall_Allen]

Excellent!!! Thats the info i was looking for. Your knowledge and willingness to share that with this community is a real gift.

Much appreciated.

[Hidden in reply to Tall_Allen]

Thanks for the link. I've read this before and tried to apply it to me as my last bx had (4) 3+3 with the highest involvement originally at 30% dropped down to 20% by JH. My uros still say AS for this point in time.

[dadzone43]

Agree with others. AS is a safe option if you can tolerate safely watching.

[Abraxis49]

Thank you for your feedback