Decision Time (again)

[adventure4me]

Time to decide (again) how to proceed.

2/2023, MRI showed 1 large (2.4cm) lesion pirads 5. Gleason 6 in 8 of 12 systemic cores and 4 of 4 targeted cores. Began active surveillance.

10/2023 New status: MRI showed lesion #1 same as previous. Also new lesion #2 0.8mm pirads 4-5. Biopsy with bilateral gleason 3+4 in 5 of 12 systemic cores, 1 of these gleason 6 (5% of core), 4 of these cores gleason 7 3+4. 20/20/20/60% of the cores, all having 5% pattern 4. Lesion 1 targeted cores 4 of 6 gleason 7 3+4, 60/70/80/90% of cores, all 5% pattern 4. Lesion #2, 2 of 2 cores atypical cells, no gleason score.

Other info: long-standing urinary issues, AUA score 20-25. Decipher 0.18. PSA steady 6. Age 58, otherwise healthy.

Asking the group for advice, thoughts, counterpoints, etc to help me make a decision from a broad perspective from the community. My personal immediate thoughts are from my own thought channel, I really appreciate others’ observations, thoughts, advice, counterpoints, etc… to help make the best decision for me.

TIA!!!

(see my profile for more history details)

[Tall_Allen]

We had a similar diagnosis. I think I had 9/17 cores positive for Gleason 6. This was before most of the long-term data on AS was available, before Decipher, before mpMRI, and before 5% pattern 4 was reported as 3+4. I decided on SBRT. It's hard to know if my decision would have been different with hindsight.

[adventure4me in reply to Tall_Allen]

Sounds like your outcome is favorable which is great to hear. Thank you for taking time to reply. 🙂

[Kauaiboy]

My clinical diagnosis was less invasive than you present -2 cores, 3+4, 5%: PT1a. For various reasons I elected to have RALP 4 years ago at age 63. The pathology showed a more advanced disease with EPE, more areas, and a pT3c classification. Biopsies and MRIs are not 100% definitive. I’m 67 and have had no recurrence. I’m thankful I did this as the “horse was about to leave the barn”. The decision on whether, or when and which technique to employ, is very personal. I was in my late 50s when diagnosed and watched it go from 3+3 to 3+4 and then got a surprise kidney cancer while in AS. So out came the kidney, then 9 months later the prostate. Despite a recent diagnosis of a rare but very treatable blood cancer, I don’t worry about the prostate or kidney cancers anymore. I attribute that to having gone through treatment. Compared to the years while I was on AS, I only think about cancer now on the day I have blood drawn. Memento Mori - remember to live!

[adventure4me in reply to Kauaiboy]

Thank you for sharing, some similar characteristics. Great point that the imaging and biopsies are imperfect, especially given my widespread progression (or sampling differences?) in only 8 months with gleason 6 and low decipher. Boy you have a handful getting hit by multiple issues, sounds like you're addressing them well! Enjoy life indeed, I keep reminding myself the same. Thanks again. 🙂

[FMOH_N]

Why wait? you need to deal with it. so it is better to do it now. In about 30% of cases the cancer is unfortunately upgraded. My recommendation: take action NOW

(same respond to you in Inspire.com)