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Gleason 6, PSA low but biopsy sectors increased

cbreston profile image
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Darryl, thanks for bootstrapping the group. Going through this with my father 20 years ago, there was fantastic listserv that unfortunately no longer exists. I'm 59, hoping this medium fills the gap and can age with me.

Given family history, I monitored my PSA, which gradually increased (log scale) from 1.0 to 3.1 over 14 years. But a one-year jump from 2.3 to 3.1 met the criteria for a biopsy, which found Gleason 3+3 in 2 of 12 regions, left and right, "involving 10%..." and "discontinuously involving 50% of the specimen," respectively. Urologist considers DRE palpable on a 25cc prostate, though primary physician didn't feel anything. A year later, PSA is down to 2.3, and I have 3+3 in each of 4 of 12 regions at "2%, 4%, 2%, and 4% of total biopsy lengths" as evaluated by an entirely different pathology lab. Urologist recommends brachytherapy based on increased number of positive biopsy regions as "growth". Oddly, radiation oncologist, if forced to choose, recommends further Active Surveillance (AS). I'll be getting MRI and both germline and Decipher biopsy genotyping.

Absent any troubling results on MRI and genetics, I'm inclined toward waiting another year, doing a biopsy, and ensuring it goes to that second lab for consistency of observation approach. It's not clear to me that the path results are using comparable methods, or that biopsy region increase from 2 to 4 is likely to be anything more than sampling variation.

Any thoughts from the group?

Any other information I should include with my history?

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Danish-patient profile image
Danish-patientModerator

I fully understand your worries related to active surveillance. Your PSA levels seems to be very low, even for a person with no PCa. On the other hand, surgery could remove the fear, as it ought to be possible to cure the disease in your situation.My case there was very different - PSA was 17-20 and Gleason 8, so I had no doubts that surgery was necessary and urgently needed. It didn’t cure me, so I have had more or less all available treatments during the following 14 years.

Stevecavill profile image
Stevecavill in reply to Danish-patient

Yes, always use the same lab! Active surveillance is sadly underrated. If you want to look into AS in more detail I can recommend look into the work by Laurence Klotz, who is a world leader in the field. He’s in Canada. You will find him in PCRI, and Urotoday among others.

cbreston profile image
cbreston in reply to Stevecavill

Thanks to both of you.

Danish, I'm not of the "removing fear" style of thinking, so this conversation is moving me more toward continuing AS. Lesson learned on mixing labs. Wish I'd known that in advance. Even if the two labs' standards for assessing 3+3 were exactly the same (which it's pretty clearly not), binomial significance is under 80%, if I'm doing my stats right. Barring something problematic in MRI or genotyping, I don't see the case for therapy yet.

Steve, is there any specific work of Dr Klotz that I should look at? I see his recent work on urinary RNA, but nothing he's measured yet would seem to add predictive value to my biopsies.

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