Prostate Biopsy

[ironmanburg]

Hello everyone, I have had 2 biopsies in the last 2 years (the last one was in January 2023) with the latest one showing 1 out of 12 cores positive for Gleason 3+3 and another core suspicious for cancer. It was also noted on my last MRI that I had a bladder outlet obstruction. My PSA went as high as 13 then back down to 11 the last time it was checked in July. My question is should I be getting any more biopsies? The second one was supposed to be to confirm the cancer and it showed less cancer than the first. I've been on active surveillance for about 2.5 years. Thanks.

[Lizzo30]

Hello there Some consider gleeson 6 as more of a pre cancerous condition rather than cancer itself Have you made lifestyle diet changes for your PSA to come down ?

[ironmanburg in reply to Lizzo30]

Not really. I eat a vegan diet and train for endurance triathlons. Other than this and mild BPH I’m in excellent health.

[Lizzo30 in reply to ironmanburg]

Power to you for that ironmanburg My husband has always been a big milk consumer unlike me I have had soya milk for decades Recently though he has agreed to go onto soya milk

[Tall_Allen]

No need for more biopsies. I think you have a good handle now on what you're dealing with: minimal GS6, and elevated PSA due to bladder outlet obstruction. That tells you that you can continue with active surveillance. PSA will not be a useful signal for you, but mpMRI will be - maybe in 2 years - whatever the protocol is at the AS program you are enrolled with.

You may want to talk to a urologist about the bladder outlet obstruction - maybe HoLEP, Aquablation, Urolift, or some such therapy can fix that.

[ironmanburg in reply to Tall_Allen]

Thanks, Tall_Allen. I appreciate your insight.

[dac500]

Gleason 3 + 3 some people consider it as not even cancer. I was diagnosed with Gleason 3 + 3 in 2011. Guess what I am now battling metastatic prostate cancer, which is on the way to becoming castrate resistant. Be very vigilent.

[ironmanburg in reply to dac500]

Thank you.

[aceace12 in reply to dac500]

what has been you plan of action the last 12 years

[ironmanburg in reply to aceace12]

Two years. 4 mri’s, 2 biopsies, a 4k score test and multiple psa checks.

[dac500 in reply to aceace12]

I had brachytherapy in 2011, cyberknife in 2017, and on Lupron since 2018.

[LBRV711 in reply to dac500]

Hi dac500 - sorry to hear about your situation. I have five core samples with Gleason 6 and I am considering SBRT, but many on this site are wondering why I’m not staying with AS. I may, but very confused. I’m hoping for good a outcome for you. It’s amazing what they can do these days. All the best.

[ironmanburg in reply to LBRV711]

Thanks. You too.

[dac500 in reply to LBRV711]

When people hear Gleason 6 they immediately think of AS. But each case is different. You should do what is best for you according to your judgement and your doctor.

[ironmanburg in reply to dac500]

I will. Thanks.

[Daveofnj]

If you already have not, you should have your biopsy samples sent for genomic testing. This is very important. All Gleason 6s are not equally indolent.

[ironmanburg in reply to Daveofnj]

Ok thanks. I’ll have to research genomic testing.

[tcott54 in reply to ironmanburg]

I have had two tests. One through “Color” that tested for genetic mutations. It was free because I had been diagnosed with cancer. And the “Prolaris” test through Myriad that looked at the aggressiveness of the cancer. That was covered by my insurance because my UO recommended it.

[Garp41]

What was your 4K Score?

[ironmanburg]

36