What to do??

[Chuck67]

So I have been on active surveillance for approx 2 years after a biopsy gave me a Gleason score of G6 (3+3). Two weeks ago I had another biopsy - 4 samples taken at the site where the cancer was found last time and from my MRI scan taken in March (before everything went crazy and locked down for the Coronavirus) and some other more random samples. Results have just been phoned through.....Gleason 7 (3+4). A step up the ladder!! Although because of Christmas and New year, I won't get to see a consultant until next week, the person who called me, technician/consultant I think, said that all options were mine but the main consultant would guide me through their preference. That said, the options she put to me were more active surveillance, Radiotherapy or Surgery. What do you guys think??

[Justfor_]

I would combined the two:

1) MP MRI PIRADS 3 or less, AS. Higher, (4 or more) action within 6 months.

2) PSADT one year or longer, AS. Shorter action as previously.

If 1) and 2) do not coincide towards the same route you are in an ambiguous state.

At your age, surgery is the preferable action to take if /when needed.

[Magnus1964]

After reading your profile,you are in a quandary. With you family history you should be very vigilant. Your PSA is not out of sight. But don't wait too long act. It's a hard choice given your age.

[Tall_Allen]

It depends what percent of the GS 3+4 was pattern 4. If it was <10%, you are fine staying on AS; if it was 40%, you should consider treatment instead.(note: this is different from asking what percent of the core had cancer in it). Not every pathologist reports the percent pattern 4 (although they should), so you may have to ask for it. If the percent pattern 4 is, say 10%-30%, you may want to ask for a Decipher or Prolaris test to see if your cancer has the genomic signature of a more virulent type. For a guy as young as you, AS is, of course, the preferred option.

Also, there is no rush to make up your mind. You can easily take several months to learn about your options. At your age, the treatments with the fewest lasting side effects, like SBRT, are of course preferred to surgery.

[Chuck67 in reply to Tall_Allen]

Just so that you know I, at least, follow what you say. It has taken a while to get the information but my % Gleason Pattern 4 was <10%. Also of note was the following: Intra-ductal Carcinoma noted in block 3A

Of the 4 cores - approximate % Tumour in total tissue - 60%

Perinurial Invasion Identified: Yes

Extraprostatic Invasion: No

I have a meeting on Saturday to hear my options. Your opinion would be greatly valued.

[Tall_Allen in reply to Chuck67]

The % pattern 4 is good, and with your low grade PC, the IDC-P is probably not an issue. However the PNI may increase risk enough so that AS is no longer a good option:

prostatecancer.news/2018/03...

[Chuck67 in reply to Tall_Allen]

Thanks Tall_Allen, as always you are a credit to this forum. Keep going...please!! Thanks again.

[CorreaGlabra]

One thing that you can perhaps also do is get a 2nd opinion on the biopsy result.

[Chuck67]

Thanks Guys....it is always reassuring to know that there is this forum to go to when you feel overwhelmed and out of your depth and that there are other guys out there in exactly the same position as you. The advice you give on a daily basis is invaluable, especially Tall_Allen but thanks again to everyone. I appreciate it more Than I can say.

I will ask about the percentage (Tall_Allen) and follow yours and my Consultants advice. My gut feeling is SBRT if I have to. I would hope that this could be a treatment that could end my PC??

[rscic]

I had my Gleason 3+4 (85% =3, 15% = 4) taken out in May of 2019. At Pathology 20% of the gland contained cancer and I had microscopic EPE & microscopic positive surgical margins. No tumor in the seminal vesicles. No evidence of visible metastasis. I opted for adjuvant RT beginning 90 days after surgery due to the EPE & Positive Surgical Margins (this is somewhat controversial with some agreeing with Adjuvant treatment and others saying to wait until PSA goes up & then begin Salvage RT). I am hopeful it was all killed.

Just my experience with Gleason 3 + 4 cancer. My tumor was in 20% of the gland .... yours may be less (or more) ..... a comparison MRI might be useful.

Good Luck,

Rick

[doc1947g]

You are in the Favorable Intermediate Risk with a G(3+4=7) Grade 2.

I am in the Ufavorable Intermediate Risk with a G(4+3=7) Grade 3.

For you the NCCN recommand:

1st

Active Surveillance

PSA every 6 months

DRE every 12 months

Prostate Biopsies every 12 months.

mpMRI every 12 months.

2nd

EBRT or Brachytherapy alone.

3rd

Prostatectomy with or without PLND(Pelvic Lymph Nodes Disection.

Here is a link to a very good document from NCCN:

nccn.org/patients/guideline...

I had 6 cores out of 12 positive on the right side at 85% G4, then on a special pre-RT Scan they found multiple tumors on both sides. 73 y.o. with Lymphoma LNH and many acute chronic diseases.

I have been on Lupron Depot 22.5mg/12weeks X2 from May 2020 to Nov 2020 and on

VMAT-RT 3Gy X 20Fx in June 2020 and my

PSA = 0.03µg/L and my

Testosterone = <0.2nmol/L or <0.0577µg/L or <57.684ng/L or <5.7684 ng/dL

[aceace12]

i would not get options from anyone but a doctor