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Active Surveillance for Gleason 3+4?

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User
Posted 28 Nov 2016 at 15:09

Hi Everyone

Fairly new on the site, but I already feel the love! It's an invaluable resource, support group rolled into one - so a big thanks for making it so.

Short history for me. I had two biopsies whilst living in USA in 2004 and 2006 - both benign. I have always had regular PSAs since then, and in September I had a full blood work ordered up due to an usual bout of extreme fatigue over a weekend. The results showed something was going on, and the one thing that really stood out was the PSA of 72. Naturally I was fast-tracked - 3 types of scans, and biopsy, which returned localised PCa Gleason 3+4 (5 of 14 cores). Prostate volume is 32 but no issues with waterworks.

Urogolist and surgeon both think the PSA may have been an anomaly so wanted to re-test. Just heard the result of PSA from Friday, it's now 3.4! Of course this is good news, because the surgeon said he preferred a PSA sub 10. I will have another PSA in two weeks.

I meet with the urologist tomorrow so I will discuss then. However if I hadn't had the infection - whatever it was - I would have kept up with my regular PSAs and if they kept with the almost flat line represented on the graph, I would probably not have had a biopsy. I know that AS is an option for Gleason 6 - is it an option for Gleason 7? Should I be looking at this as a lucky discovery :) and taking action, or should I think that it has taken 10 years to develop, let's wait and watch?

Thanks

Chris

 

User
Posted 28 Nov 2016 at 19:47

Chris

Thanks for the extra info. It's always the '4' that concerns me, but thats me. As the scans are clear it could be the percentage of PCa per core is low in which case they may consider AS as being a viable option to discuss.

Consider carefully and go for what suits you!.

Ray


User
Posted 28 Nov 2016 at 21:18
Hi Chris

We decided pre-biopsy anything above Gleason 6 I would not wait. See my profile. My logic was it isn't going away by itself. I am fit and healthy and any recovery would take longer the older I was. Your call obviously and when to make that call. They may currently be able to offer you nerve sparing . Mine was 4 + 3 so decided on NNS.

Obviously other options than surgrey.

Gordon

User
Posted 29 Nov 2016 at 00:03

Hi Chris,

Much depends on your attitude to risk, knowing that you have Prostate Cancer but not definitively that it is a 3+4. (We know that in a number of cases when removed Prostates are examined in the lab, that the Gleason has been upgraded when more extensively examined). You could seek assurance that the cancer is well contained but MRI scans don't always show this and PSA tests are not always a reliable indicator as some types of PCa produce higher levels of PSA than others. If you have the cancer treated now or soon, you have the best chance of it being curative, although this still might be possible for some time. However, even now there is no certainty that all the cancer can be removed or that treatment is needed, at least for the time being.

Decisions, decisions

Barry
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User
Posted 28 Nov 2016 at 17:21

Chris

Other than recently due to high PSA I see no DRE, Biopsy or Scans since 2006 so have you been on AS? AS could well have picked up the '4' rather than luck. There have been guys here on AS at 3+4 but they're they and you is you. Time to be guided by the experts?

Ray

Edited by member 28 Nov 2016 at 17:25  | Reason: Not specified

User
Posted 28 Nov 2016 at 17:31

Thanks Ray

Sorry - had the MRI, CT and bone scan in September/October - all negative. DRE from 2006, 2008 and in 2016 left side firmer and perhaps some irregularity. Not officially on AS, but I just made sure I had regular check-ups.

User
Posted 28 Nov 2016 at 19:47

Chris

Thanks for the extra info. It's always the '4' that concerns me, but thats me. As the scans are clear it could be the percentage of PCa per core is low in which case they may consider AS as being a viable option to discuss.

Consider carefully and go for what suits you!.

Ray


User
Posted 28 Nov 2016 at 21:18
Hi Chris

We decided pre-biopsy anything above Gleason 6 I would not wait. See my profile. My logic was it isn't going away by itself. I am fit and healthy and any recovery would take longer the older I was. Your call obviously and when to make that call. They may currently be able to offer you nerve sparing . Mine was 4 + 3 so decided on NNS.

Obviously other options than surgrey.

Gordon

User
Posted 29 Nov 2016 at 00:03

Hi Chris,

Much depends on your attitude to risk, knowing that you have Prostate Cancer but not definitively that it is a 3+4. (We know that in a number of cases when removed Prostates are examined in the lab, that the Gleason has been upgraded when more extensively examined). You could seek assurance that the cancer is well contained but MRI scans don't always show this and PSA tests are not always a reliable indicator as some types of PCa produce higher levels of PSA than others. If you have the cancer treated now or soon, you have the best chance of it being curative, although this still might be possible for some time. However, even now there is no certainty that all the cancer can be removed or that treatment is needed, at least for the time being.

Decisions, decisions

Barry
User
Posted 29 Nov 2016 at 08:40

Thanks all for your comments. After the meeting with the surgeon last week, I was leaning heavily towards the operation. Then seeing yesterday that the PSA had plummeted back to my normal range, it made me re-evaluate. But your comments are spot on with the realities of not really knowing the full extent of the cancer within the prostate, and increasing the chances of a good recovery from the op whilst fit and healthy. It's all a roll of the dice, but best to load the dice where possible!

I will discuss today with the oncologist.

Thanks again.

User
Posted 08 Dec 2016 at 22:45

Hi Chris

in a similar boat. I got diagnosed last month, 3+4, 6/20 samples, and advice from oncologist is to go for RP as I'm only 50, but no need to rush into surgery. PSA is still only 4.7 so option is having 12 weekly re-tests plus re-biopsy at 12 months. 

Re-test is next week, so we will see what that turns up.

 

User
Posted 08 Dec 2016 at 23:33

Hi MGR

It was a serious consideration for me but I have decided for the op in March. As I have posted elsewhere I wouldn't be here unless my PSA had peaked because of an infection. My current PSA of 3.4 is within the range, and I would not have been referred into the system, but the cancer is there. I have biopsy results from 10 years ago which show high grade PIN, so you could argue that it hasn't been aggressive over 10 years, but who is to say how that might change over the next year.

It's a tough decision but we all have to make them and live with them. Good luck with your decision.

Chris

 
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