Choose between Active Surveillance and Treatment

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User

Posted 03 Jun 2019 at 23:47

I have just been diagnosed following a biopsy of 40 core samples , with prostate cancer Gleason 3+4 =7 , localised. I have seen two consultants privately, one who advocates active surveillance only , and the other , though not opposed to a period of active surveillance,prefers the radical prostatectomy route. Published information seems ambiguous as to whether diagnosis of the ‘low7’ Gleason grade specifically requires the treatment route , and I would like to know the statistical risk of A S.

the active surveillance route .

User

Posted 04 Jun 2019 at 06:50

How old are you, Patrick? AS can be suitable for older men for whom the slow spread of the disease is unlikely to cause issues during their expected lifetime, but for a younger man, treatment is generally considered necessary for G3+4 cancer.

Best wishes,

Chris

User

Posted 04 Jun 2019 at 07:09

AS may also be suitable for a limited period of time for a young man who wishes to complete his family, store sperm, etc. The key being 'for a limited time', accepting that radical treatment will be needed at some point.

You don't say whether you have also seen an oncologist. If you are suitable for AS and surgery you may also be suitable for radiotherapy and specifically, brachytherapy which has almost the identical success rate but rather more bearable side effects (usually).

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

User

Posted 04 Jun 2019 at 07:36

My friend, G 3+4=7 has been on AS for five years. He has seen five different consultants all over the world. Two suggested AS, two suggested surgery, and one RT in the first instance.

He has had a normal, (and apparently very active sex) life over that time. He is a man of means who can afford all manner of innovative tests and annual MRI scans and specialist consultations. He is in his early seventies. Although he has had a recent rise in PSA, he is going with AS again, subject to more tests, scan(s) and another template biopsy shortly. As I said to him: “If you’d been on the NHS they’d have ripped it out years ago!”

So my suggestion to you, is to obtain as many opinions as you can from clinicians, and to remain on AS for as long as they think you can get away with it. This is increasingly the thinking with ‘low risk’ cancer, but G 3+3=6 would have been better. You have to play the cards you are dealt.

Best of luck.

cheers, John.

User

Posted 04 Jun 2019 at 07:49

If you choose to stay on AS, there is increasing evidence of the value of exercise in slowing the growth of the cancer, allowing those who exercise to remain on AS significantly longer before intervention is required than those who don't.

User

Posted 04 Jun 2019 at 07:51

Patrick, I was G3+4 aged 54 at dx. I was advised AS definitely not advisable because MRI and biopsy showed the tumor was close to the edge T2c. The post op pathology showed it had spread outside the prostate T3a (extracapsular extension). So definitely the right decision for my case.
I would ask what the exact DX is, but would think they would have told you if yours was similar.
Good luck whichever way you go.

Cheers
Bill

User

Posted 04 Jun 2019 at 07:59

Thanks Chris - I’m 63 . There seems to be some ambiguity in the terminology used in all the information I have read - it’s not clear whether I’m low or medium risk .

User

Posted 04 Jun 2019 at 08:28

If one has said you are suitable for AS and the other is ambivalent then you are presumably low risk. It isn't as straightforward as G6 is low, G7 is intermediate ... PSA score, prevalence of 4, tertiary Gleason, % of cores affected, % of each core affected, position of the tumour, all affect risk.

Someone with a G7 (3+4) but all cores positive and signs of tumour in the transitional or central zones or with elements of mucinous carcinoma would be advised to have treatment sooner rather than later. A G7 (3+4) of very low volume in the peripheral zone might be treated as if it was a G6.

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

User

Posted 04 Jun 2019 at 09:00

Thankyou very much .

User

Posted 04 Jun 2019 at 09:34

If you've not already done so, Patrick, I'd suggest that you request a consultation with an oncologist. Urologists do surgery, oncologists do non-surgical treatment such as brachytherapy and radiotherapy, and each has a perfectly natural tendency to suggest their own field of expertise as the best way forward!

I was in a fairly similar position to you. At age 55 in May 2018 I too was diagnosed with G3+4 cancer, but in my case the fact it was coupled with a relatively high PSA reading of 32 meant that both my urologist and oncologist felt that hormone therapy followed by radiotherapy would be the best way forward for me. I started on HT last August, had my RT in Feb and Mar this year, and things are looking pretty good thus far. I had relatively few side-effects from either the HT or RT and, although I'll be on the HT drugs for another 14 months or so, that's something I can live with. Personally, I don't think I could live with the knowledge that I had cancer inside me - one thing that's for sure is that it's not going to go away if you ignore it - but we all have a different perspective on these matters.

We are a very supportive community here which has helped me enormously on my journey through the treatment of this disease. You've come to the right place for support. If you have any medical questions, you can ring the PCUK nurses on the Freephone number at the top of the screen. They are very knowledgeable and helpful.

Very best wishes,

Chris

Edited by member 04 Jun 2019 at 09:40 | Reason: Not specified

User

Posted 04 Jun 2019 at 10:14

Hi Patrick,

I had PSA 2.19 and gleason 3+4 =7 and the first specialist i saw advised radical removal of my prostate as he said at the time was the best way to go at the Lister Hospital and he was the surgeon to do it, but i asked for a second opinion with a Brachytherapy specialist that was at the hospital at the same time and he said with my diagnosis there was no reason why brachytherapy should not be an option and it was only because of a friend that had had the same procedure with good results.I had brachytherapy in September 2016 and had little or no problems post opp and in January 2018 my Psa is down to 0.22 with test extended to 12 months.

If you click on my avatar you can see my journey so far.I was 70 when i had the operation.

Good luck John.

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