Hello,
a 67 years old friend of mine has slightly rising PSA, so he went on prostate MRI and the result was unclear. Then he went to biopsy.
This week he got these results:
cT1c, PSA 5.4, PSA density: 0.11,
biopsy: acinar adenocarcinoma, GS6(3+3), 4 positive cores out of 15 taken: 1 core in the left lobe, 3 cores in the right lobe.
No urinary problems, healthy and active.
I think the urologist would like to cut it out (surgery).
What would you recommend for him?
He sounds like the poster child for active surveillance (AS). There is no need for radiation or prostatectomy. About two-thirds of men with his diagnosis have no progression after 20 years of AS (so far).
Thank you!
TA is absolutely right! There are Active Surveillance Support Groups he can join.
Get a Dechiper Test done to be extra sure
Don't cut it out! He will regret it. Get a second opinion from a MO and a RO.
I recommend second pathology opinion, genomic testing of biopsy samples, and some assurance the biopsy samples actually hit the worst bits of the tumor.
My first G score (their opinions) was 3+3. Second and third 3+4. Final, after surgery, 4+3.
ONLY my GL10 opinion as I approach the 10 year mark and currently doing Watchful Waiting for 3 GL6 cores recently found in my remaining LEFT HALF of prostate, I am in agreement with T_A for a strict protocol of AS. I would do it if in your friend's position.
p.s. - The ONLY BIOPSY that I endorse is a Saturation Transperineal 3 Dimension Prostate MAPPING Biopsy because it can review 90+% of the prostate and is clearer than any scan available.
Watch youtube videos posted by PCRI.org. Dr. Scholz and Alex do a good job explaining current options
Tall_ Allen is very knowledgeable. He is a fantastic resource.
Do your own due diligence of course but with a 3+3 diagnosis, I also highly recommend Active Surveillance.
I, originally diagnosed with a 3+4 Gleason (in one sample, and a 3+3 in another), a 150 ml sized prostate, at the age of 71, in early 2021, after consults at Mayo Clinic (s), UCLA, OHS, and sit-downs with different treatment centers that offered everything from radiation via different systems, various ablation methods, etc, I opted to stay on AS until the time my BPH became too problematic.
I believe the size of my session(s) were smaller than your friend's and were found in only 2 of 12 or more core samples in 2 MRI guided biopsies.
In the first 3 months of my due diligence, (beginning in May 1971), I secured a second opinion with Mayo Scottsdale, who secured samples from my biopsy and of course all my other relevant records. They graded my cancer cells as 3+3 from each sample.
Mayo Rochester accepted me into their Focal Laser Ablation trial and with them I had 3 MRIs, an MRI guided biopsy. (Mayo is amazing by the way). They kept me in their trial but continued to recommend active surveillance. in 1973, their biopsy yielded a 3+3/ 3+3 the lesions, in the same spot, same dimensions. Subsequent to the biopsy came PSAs every 3 months and an MRI every six months.
Based on my experience and due diligence, my thoughts are that your friend should continue to look for the treatment option that might best suit his sensibilities and instinct and in the process choose on a good doctor or doctors to monitor him while he remains on active surveillance.
I was told that I, in my circumstances, healthy in all other organs and ways, that I was very unlikely to die from prostate cancer. I was told that I would die with it but not from it.
I recommend you stay connected here as you proceed.
I'll post the rest of my story regarding focal laser ablation in a few weeks.
Newly Diagnosed 
prostate cancer 3+4
newly diagnosed
New biopsy: now G4+3
