Considering Active Surveillance with GL7 - help with MRI/biopsy interpretation - Scans (CT / MRI / Bone scan),active surveillance,surgery or active surveillance,Biopsy

My diagnosis was G 6 nothing visible on the MRI and only 2 cores with cancer cells 1% and 5%.

I was offered AS, but chose the op.

One constant said I was being over treated, the other suggested getting on with the op.

After the op the pathology was upgraded to G 7 (3+4) with a minimum positive margin less than .1 mm.( not of clinical concern)

Had I left it longer would it have been advanced?

No one now thinks I was over treated.

Good luck

Nigel

I am a keen advocate of AS but this link is not relevant as PNI takes a patient out of the low risk localised group as defined and into medium to high risk depending on G and %

Welcome to forum.

Please read my profile.

Any questions pm or post.

My humble opinion, further to Lyns post. AS not applicable to Grade 4 . Things are not going to improve. At 61 and assumed good health you are just delaying decision ? Yes it's tough, however currently you have time to review all options. To put in perspective. . My brother just dx PSA 3.57 and aged 69. He is Gleason 7. Single lesion it 'appears' ie still intermediate risk yet slightly less than my dx 2 years ago. He is opting for RT (He lives in Australia )

We discussed at length , last few weeks. AS was not advised by his consultant and he decided on 45 sessions of RT. Probably starting March. I had da vinci in UK/ NHS.

The key issue is everyone is different, and disease progression unknown . Statistics. Suggest .. Once removed the staging is upgraded in 60 % of cases. I'm sure someone will concur. I don't regret my decision and occasionally feel did I leave it too late. I hope this helps. Do take your time. All the best

Edited by member 16 Jan 2017 at 22:23  | Reason: Not specified

Probably worth a read of the NICE guideline

Active surveillance
1.3.11 Consider active surveillance (in line with recommendation 1.3.8) for men with intermediate-risk localised prostate cancer who do not wish to have immediate radical prostatectomy or radical radiotherapy. [new 2014]

Full link here
https://www.nice.org.uk/guidance/cg175/chapter/1-Recommendations#localised-and-locally-advanced-prostate-cancer-2

Good luck with your decision

Hi Janet,

I am 66 and was diagnosed in June last year with 5 out of 19 cores positive in 3 different sites, and a Gleason of 3+4 with the super duper MRI scan only finding 2 of those sites. The consultant, who is a surgeon, recommended robotic removal but referred me to an oncologist so as to discuss the other options more impartially. The oncologist went through all the options but came down strongly in favour of removal so that's what I opted for with no regrets so far. It may be worth trying to get another opinion. Good luck

David

Hi Janet,

A summary of my cancer experience might help you (or might not!).

Diagnosed with prostate cancer 4th Nov 2016 (I was 54 then, I am 55 now). Biopsy and PSA test results:-

PSA July 2016 - 7, PSA Oct 2016 - 7

MRI scan Oct 2016 - clear

STAGE: T1c
GLEASON: 3+4=7
12 samples taken
Left 6/6 max involvement 40%
Right 3/6 max involvement 50%

My MRI showed nothing at all. I believe it was just a standard MRI. When I saw the oncologist she said the standard MRI was next to useless and she didn't know why they bothered with them as they just muddied the waters when it came to results. It sounds like your OH had a better scan than mine though.

I had Robotic surgery on 7th December and had my appointment to discuss post-op results yesterday:-

Gleason 3+4=7 (No change)

PSA = undetectable

The surgeon said that they believe they have got all the cancer. There was a slight downer in that the cancer had breached the prostate capsule, but was within the surgical margin. This gives me a slightly higher chance of re-occurrence.

In my experience MRI is not a very reliable guide as to what is going on in the prostate as I had extensive cancer and penetration of the prostate capsule and nothing showed on the scan. However  it looks like your OH has had a different scan to me so my experience might not be relevant. 

Cheers

Mark

Hi Janet

The benefit of the mpMRI, which you indicated your OH had, is that it can save the need for a biopsy. So regardless of which MRI your OH had, the biopsy has indicated the presence of PCa, so you have to focus on that. As mentioned I have a similar diagnosis to your OH, but AS was not recommended by either of the consultants.

There have been some good posts recently by members who chose brachytherapy with reports post procedure. Definitely worth reading those if your OH is considering that, and coming up with questions for your appointment.

Good luck next week.

Chris

Yes, thanks to Lynn and Gordon for highlighting the significance of PNI. Will certainly be raising this at the consultation next week. Have trawled a bit for info, and only meta analysis I've found concluded that PNI wasn't associated with worse prostatectomy findings "and should not influence the decision to pursue AS" - https://www.ncbi.nlm.nih.gov/pubmed/24976227, however this was for men qualifying as low-risk under revised Epstein criteria (which OH isn't as far as I understand). Haven't found anything relevant to his staging, so it's hard to assess the significance. At some point I realise I have to stop consuming the internet.... 

Brachytherapy was originally suggested as one of the alternatives, but then withdrawn when it appeared from MRI that his prostate volume is on the large side (69cc). Although the ultrasound indicated a much smaller volume. Nothing seems definitive - it feels like going on a treasure hunt while blindfolded and with earplugs in! 

Janet