48yr old had psa of 4.3 at annual check up referred to urologist one month later psa 9. Had ultrasound guided biopsy 1 of 12 cores, Gleason 6. Seen urologist, seperate surgeon, radiation oncologist all recommend treatment and not active surveillance. Anyone with a similar situation?
Forgot key factor blood relative (maternal uncle) was gleason 8 at age 50 with cancer already outside of prostate and is BRAC 2 positive. My mother had stage3b breast cancer 11 years ago
Forgot key factor blood relative (maternal uncle) was gleason 8 at age 50 with cancer already outside of prostate and is BRAC 2 positive. My mother had stage3b breast cancer 11 years ago.
Your sudden jump in PSA suggests prostatitis. Please explain why active surveillance, in their opinion, isn't perfect for you?
Initial pathology t1c psa9 but free PSA 8% having Psad o.44. Right lateral Apex was malignant. All three states given age best chance of dealing with treatment with family history of cancer.
In process of requesting second opinion/examine of biopsy sample through h.c John Hopkins, Dr Epstien.
Still on fence on genetic testing for BRAC
It's because of your age, that you should leap at the chance for AS. Studies show that younger men have nothing to lose and everything to gain:
prostatecancer.news/2017/08...
prostatecancer.news/2016/08...
Your other numbers - PSAD and free PSA and family history - only tell you you were right to have a biopsy. After the biopsy, they do not contribute to your risk of progression, which is "low."
Germline testing for BRCA may help give you peace of mind. While there is only a 0.2% chance you have that mutation, it is certainly an inexpensive option ($250) if you want to rule that out.
prostatecancer.news/2018/02...
There are more expensive genomic tests that can be done on the biopsy tissue (Decipher and Prolaris - Oncotype Dx was recently called into question), but those are reserved for men on the fence about AS due to equivocal risk factors (like some pattern 4).
I suggest you talk to those who run some of the top AS programs - like MSK, UCLA or UCSF.
Tall_Allen. Thanks.
I don't see where immediate action is required, but do keep a close watch on it. Fortunately there are lots of new treatments out there not available to me when I was your age.
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Concerns are low free PSA and family Hx. Suggest Color genomics for $250 to rule out low chance of BRCA and Prostate MRI if not already done.
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You dont mention anything about tumor loading.# of cores and %. G6 is generally considered indolent but if tumor loading is high then g7 may be present but not detected. The change in psa does suggest inflamation. So for now AS seem to be best action with mri, frequent psa test and follow up biopsy. Also get second and third opinion.
At youre age dont want to deal with SE of trearment but MUST be vigilant. Do research and get multiple opinions
Good luck
1 core at 10% of core right lateral apex.
With thzt dx you definitely dont want to rush to treatment. Get mri and confirmation biopsy. What you are looking for if any g7 or higher is present. If no continue monitoring with a profram of mri psa and biopsy. Treatment options improve every year. So delaying save from trearment SE and perhaps better treatment options. At youre age it is possible you may eventually need treatment. With youre dx delaying is not going to alter outcome So spend some time reasearching and getting more opinions. If you are in the Md area johns hopkins is top in the country.
Have a good day
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I was 46 when the PC appeared with Gleason 7. My urologist recommended me radical prostatectomy since the life expectancy is higher.
Did you follow that follow that recommendation and if so did you regret it?
Yes, I followed the recommendation. that was in December 2011. I had robotic surgery. I only spent one night in the hospital. some lymph nodes were removed and tested to see if the cancer was outside of the prostate. recovery is bearable if Kegel exercises and directions are followed.
My family history: three sister with breast cancer and my father with prostate cancer when 68 (treated with radiation) died at 92.
I would have the genetic test if there was a family history that indicated it could be useful, and if I could afford it (not everyone has the extra money sitting around, just a sad fact, especially right now). The answer will help you make an informed decision. Imagine if you had the mutation and didn't know, but also imagine if you didn't have it and that was something you didn't have to worry about (which is more likely).
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As several others have stated, a prostate MRI and/or a prostate microultrasound session would give you a much better feeling about selecting AS. Your Doc should be supportive of your doingat least one of these...if not, find another Doc!
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Studies have found that there is no definitive proof of Gleason 3+3 metastasizing. Perhaps it progresses at 1% per year...whatever that means ...what is important is to confirm to the greatest extent possible that there are no Gleason 4-5 cells residing in the prostate. Your family history would dictate being extra diligent about followup testing.....yet now very little risk in delaying treatment and possible/probable unwanted side effects/consequences of any of the treatments available. The key to any medical treatment/decision is having an accurate diagnosis.....to avoid over-treating, or under-treating. Experts are debating whether men should even be told that they have cancer when all that has been found are Gleason 3 cells!!!! Keepp us updated as you obtain further test results!
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Thanks all. This is just a real gut punch. With covid 19 and all I had started eating better. Returned to exercising 3 to 4 days a week. Lost 30 pounds in months. Feeling pretty good and then pow right to the gut you have cancer.
second and third opinions is the first thing i would do.... if what your saying is medically proven true ... i would never consider anything at your age but AS
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I'm 55 going on 12 years since all the Drs recommended treatment for my Gleason 6 PC. I had a PSA of 4 or so back then and now over 20. I've had so many biopsies but always G 6 just been found in more and more cores. You have to make your own decision but don't jump for the cure so fast.
My father died with a 20+ PSA but not of PC.
My current Dr says my high PSA might be what he calls "a red herring" He thinks I should get treatment in 2 more years because I can't keep having biopsy every 2 years. Mt prostate is like swiss cheese.
Good luck.
Sounds like you're in the Maryland area. If so my new Dr is Christian Paul Pavlovich at Hopkins. Maybe check him out. He's done a lot of surgeries and doesn't seem desperate to rush to treatment but if you do have surgery he should be a good choice.
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Sounds like active surveillance, unless the thought of any cancer terrifies you. Both a gleason 6 and having 1 out of 12 cores positive would seem to say it is not a big risk right now.
The key to active surveillance is to determine if it is slow or fast growing. Of course, you want the former. If it is slow growing, then you should relax a little. Talk to your doctor about the interval for checking and find what is ocmfortable for both of you. It's important to remember that you get to make the decisions, just make sure you are well informed. bring a partner or friend to the appointments as an advocate and scribe. This allows you to focus on listening to the doctor. The person with you can prompt you to ask questions that you have already decided on before each appointment.
We all hope it is slow growing but right now does not seem the time to take any radical measures. However, it is always up to you. Part of it is a healthcare decision, part is your peace of mind and part is a quality of life decision. One book that helped me wrap my head around this desease is amazon.com/Patrick-Walshs-S... Keep in mind that it is dated but written by one of the foremost experts in the field.
The reason I recommend this book is as a "primer" to give you the big picture. It's a starting point. There is a lot of good information out there on reputable websites for research but they can make your head spin. Whether or not you buy this book, learn what the pluses and minuses of every treatment are, in detail, before making any decisions.
Good luck.
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Good catch!
Thanks all. I have started reading DR Walsh's book I found the the 4th addition. Also upon following up with the radiation oncologist and surgeon, they both sent research studies supporting their positions. Ultimately it is my choice. So I am going to take the time to get educated. The links have helpful
Rising PSA - Scan or Biopsy
Forgoing Regular Prostate Biopsies
Days From Surgery and Having Doubts
Benefits of diet and fasting
Rising PSA after RP June 2018
