Active surveillance or treatment?

My Gleason score 4+3 =7 . PSA 5.83. Biopsy showed 16% (2/12) positive Cores AUA risk intermediate. Clinical T stage T1c. MRI showed cancer contained in prostste. Polaris score in less aggressive range. I am 75 years of age. Appreciate comments on active surveillance or treatment?? I am anxious that prostate cancer is is my body.

16 Replies

  • Hello. Like you I am 75. A random PSA test in July 2015 (I was 74 then) gave a PSA of 5 (not particularly high). Rectum exam showed a small lump on my prostate and showed a Gleason of 5+3 = 8. MRI, CT and bone scans were clear. T2; N0; M0.

    No leakage from prostate at all. I was offered a radical prostatectomy by Da Vinci robot controlled keyhole surgery. Had that on 24th Nov 2015, absolutely painless operation, bag for a week and then pads for around 6 weeks. PSA was 0.01 at 6 weeks and again at 3 months. Next PSA due in August with no clinic appointment, just a phone call to me to say what count is.

    Do what you and the Urologist says. We are all different. OK I have erectile dis-function, no 'hard member' and no ejaculate. BUT that is a small price to pay to be clear.

  • Yes, We are all different. Including our health providers. I was told by my Urologist, I was not a candidate for surgery. Recommends active surveillance.

  • What an incredible coincidence. I am 71 and I have experienced exactly the same. Having been warned in great detail of the possible side effects of the op. I accepted it and was glad to be clear. Todays technology is amazing not like in the days of my dad when the disease took his life at 65. My advice to everyone make sure you get all the information if in doubt contact or speak to a specialist nurse. Don't sit and worry yourselves. There are loads of us with simular experiences keep chatting.

  • Hi Roger,

    I believe that in GS=3+3 cases, there is a 25% chance of progression during active surveillance. For GS=4+3, I would think the risk is much higher.

    It seems to me that active surveillance [AS] is designed to protect the majority of U.S. cases (i.e. the large number of over-diagnosed cases) that will not progress. For the others, necessary treatment is delayed. AS has to be anxiety-inducing for everyone who opts for it.

    The 4K Score test (not covered by insurance) would help many decide whether to remain in AS (with far less anxiety), or to opt for treatment. See links below.





  • pjoshea13,

    I had my pathology remains from my biopsy sent to Prolaris. My score came back 2.6 which is in the less aggressive range. It also give a 10 year specific mortality rate. Mine was 3%, meaning I had a 3% chance of dying in 10 years. My MRI showed no cancer had left the Prostate. being 75 years of age this is not bad statistics. However, Just knowing the cancer is in my body gives me daily anxiety and worries. I will meet with my Urologist in July to determine TREATMENT OR AC

    Thanks for the info and reply.

  • Roger,

    I just checked the Social Security Period Life Table, 2013 [1], & it looks as though the 10-year probability of dying (for a 75 year old male) is 45%. Hopefully, you will be in the surviving 55%, but I think this gives some perspective to the 3% excess risk.

    To get rid of anxiety, you should become active in educating yourself on things that might improve your odds. For example, many people with PCa use Metformin. Even Dr. Myers now promotes it. Vitamin D, resveratrol, etc, are other things he recommends. But he is cautious & ignores studies that others find compelling.

    I am currently attempting to get through the alphabet of foods & supplements that can affect PCa. I use only papers available on PubMed & I'm posting my findings here. My feeling is that an understanding of how a supplement may help, improves confidence in survival. Daily anxiety becomes a thing of the past. It's been a long time since I've had those dark 3 am thoughts.

    Best, -Patrick


  • Patrick, That just reiterates males 70-75 years old will die with something else instead of PCa.

    I take a supplement called IP-6 & Inositol. Claims it supports natural killer-cell activity. Supports immune system. If my prolaris score had been in the aggressive range, no doubt I would look at treatment. then again I am putting a lot of faith in genetic testing.

    Have you had a biopsy? Or trestment? Thank you for the reply and advice, I truly appreciate it.


  • Hi roger,

    Just my suggestions after a similar run,

    A. Get a couple of other independent, unbiased opinions from experienced urologists, not the ones where patients are pushed to robotics

    B. Ask your doctor if taking an anti-biotic for two weeks to clear off any infection in the prostate is advisable...not much to lose there

    C. Get a bone scan to ensure no cancer outside the prostate

    D. Wait 3/4 months and get another biopsy at a different place which has a first rate path lab....errors in the reading of path slides is rather common.

    E. Then decide...waiting a few months does no harm at all, may actually surprise you for the better.

    F. Stay calm, exercise and enjoy every day.

    G. My best wishes!

  • Hi axb,Thanks for the advice.

    It sounds like a good game plan. Drcember, another PSA. Then spring another biopsy. If I choose AS.


  • Hi Roger,

    Just another thought....which I have found to be extremely helpful for a few hundred dollars and w/o having to travel, etc.

    check out the site:

    pick cancer, and then complete the info., upload your results and images and submit for a completely independent Opinion from one of their expert Doctors.

    Can't lose, something to gain perhaps!


    you can securely send (share feature) this info. to any physician anywhere of your choice do not have to use their Physicians....and that sharing is free!

    Best of luck my Friend!

    If you are in the Los Angeles area, do check our Dr. Reiter at UCLA or Dr. Ng (?) at Cedars....and others at COH and USC.

  • This paper provides an explanation if considering Active Surveillance. You will note that with your Gleason Score of 4+3/7, you are not an appropriate candidate:

  • I did read the article, I am new to prostate cancer and found the article interesting. Although lots of medical lingo that is over my head. You say I am not an appropriate candidate for AS... I will be 76 yeas old next month and the Prolaris score from Myriad shows that my cancer is in the less aggressive range. with a 10 year mortality rate of 3%. My Urologist recommends I go AS . My cancer has not left the prostate. I respect the writing, but I have read and been told numerous times, that AS is the best for me. I would appreciate if you would elaborate on my reply.


  • Sorry, cannot get the link to work ?

  • Axd,Thanks for the info. I will certainly check it out. Any thing that helps or learn about the horrible disease is great! I thank you!

  • My husband was a 4+3 with a psa close to yours at the age of I think 54 in 2003. He had radical prostatectomy, radiation twice, liquid radiation and triple blockade hormone therapy now. He wishes he wouldn't have had the RP. He thinks he should have had hormone replacement. They told him they weren't sure if it escaped the prostate but it did. He is in prostate cancer remission.

    My best wishes for you,


  • Darryl having major user issues. Can't open messages notifications etc.

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