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What Treatment Should I Have for Gleaseon 3+4 after TURP

Posted 23 October 2017 13:35:19(UTC)

In March I had a TURP and the material removed was diagnosed and cancer was discovered, Gleason 3+4.  The consultant recommended doing nothing and have further 3 monthly PSA tests.  I had a PSA test in May and the reading was 0.56.  My August PSA was 0.81.  My GP said not to worry about the increase as the prostate can sometimes grow after a TURP.  I will be having another PSA on 10th November and then seeing the consultant a few days later.  I am fearing the worst and am thinking about what sort of treatment I should have.  At the moment I am leaning towards removal as I can't cope with the constant stress.  

Posted 23 October 2017 14:13:33(UTC)

Hello Shetland

I can understand your stress as some men just cannot cope with the thought of cancer inside them but really the decision has to be yours.
Your consultant has recommended doing nothing (Active Surveillance he presumably means) so you must be a good candidate for that.

As for treatments, well you probably already know about the Toolkit available through Publications.

You have to think long and hard about what you want and what you think you can actually live with post treatment.

Obviously not all men get all the nasty side effects but factor into your leanings that you may be one of those who suffer unwanted effects. All you can do is research all you can and make an informed choice that you can live with afterwards.

I hope others come along to advise you too

We can't control the winds - but we can adjust our sails
Posted 23 October 2017 14:54:13(UTC)
Hello Shetland

I can only echo what Johsan has said. As everyone is different no one ( not even the doctors it would seem) can tell you what to do. Do you know what your T stage is? Your PSA is very low so that should be a good thing.Did your case go to the multi disciplinary team for discussion?

My husband is 3+4 but PSA is 9.2 and stage T2c ( Tumour in both lobes of prostate)
The MDT advised surgery which to be honest we thought the best option also.

The consultant had to tell us about the other options but did say we could miss the window of opportunity if we did active surveillance. Wasn't an option for my husband due to the more aggressive 4 element to the Gleason score. If he was in his late 70's or 80's that would have been the better option. As he is 61 and in otherwise good health he wants to have a go at cure rather than living with it. Also we did note that they don't seem to do surgery after your early 70's so something to maybe think about if you later want it out.

As you are still young as far as this thing goes take your time to do your research and if you feel ok to keep it under surveillance then that's the right choice for you.

Best regards
Posted 23 October 2017 16:04:37(UTC)

I can understand why some men feel they want a diseased Prostate removed and hopefully with it all their PCa. But this does not necessarily mean the end of stress. There will be anxious moments around the time of the regular PSA test check ups and possible concerns about side effects that may or are being experienced just as having HT/RT RT or another treatment. Even with Active Surveillance there is the worry that at some point you might need radical treatment and would not wish to miss the window of opportunity for this. Some men, particularly those diagnosed early are cured following their first treatment whilst others sooner or later find they need further treatment as their cancer again requires intervention. This may seem harsh but you have to accept and be prepared for potential side effects and possible set backs whichever route you take.

I hope whatever you decide works well for you.

Posted 23 October 2017 21:03:21(UTC)

A psa of 0.8 seems very low, unless they removed almost all your prostate, and I'd guess that without the sample biopsy you would be considered clear.   The Gleason 3+4 probably means they're more interested in treatment than if it had been 3+3.  After more investigation such as template biopsy or MRI they might find it's very small although it can depend where it's located.  Each case is different.

It can also depend on your general health as the operation is considered major.

I've always said I wanted it out asap but mine was near the edge and a 4+3, later found to be 4+4.  Afterwards I was told it was a great choice.  Near the edge and 4+4 aren't good signs but it had a negative margin which is good.

You might be some way from needing treatment which could increase your treatment options, but I know what you mean about wanting to be clear of it.

Keep us in touch



Posted 24 October 2017 18:17:25(UTC)

Shetland, I wonder if your anxiety is partly because you are comparing your PSA with that of men who have no prostate? This is like comparing apples with pears.

When you had the TURP they basically took the centre of your prostate and bored a hole - a bit like an apple corer. You still have a healthy prostate which will produce PSA like it always did, it just has its middle missing. My recollection of your previous posts was that the urologist was confident that they had got all the cancer with the TURP because it was a very small % tumour? If that is correct and your consultant is happy with your PSA you could ask at what level would s/he start to be concerned - 2? 3?

Don't rush into unnecessary radical treatment just because you find the testing regime stressful - as Barry says, you are going to have to live with that stress for the rest of your life anyway.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Posted 26 October 2017 21:29:32(UTC)

Shetland, everything Lyn has said is good advice.

After my HoLEP (a TURP by any other name but with bells and whistles) two years ago, a Gleason 6 (3+3) was discovered in the recovered prostate tissue and following the procedure my PSA readings fell as low as .3 and slowly climbed to 1.0 where it has remained for a year.

AS is my chosen path with regular PSA tests to monitor any progression if any and there may be a chance that the HoLEP got all the PCa, as could be the case with your PCa following the TURP but with the remaining prostate tissue plus any regrowth having the potential to develop a new PCa, I shall remain vigilant until I pop my clogs from something else.

All the best.

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