risks of Gleason 3+4

So if you are offered AS by your clinicians, go for it as long as they think you can get away with it.

Cheers, John.

The only experience of this I have is that I was offered AS if I had a template biopsy.  Mine was said to be 4+3 based on finding 5% on one pin and my psa was 9.9.   It seemed like putting off the inevitable.

Your psa rose 0.4 in the first 18 months,  1.8 in the next 18 months.   Although that's a rough guess without having real dates.

 It can't be certain, but in 2021 using simple graphs it could be 7.

Some doctors say beware over treatment, perhaps you could let it go a bit longer as that 7 might be less if the next psa test is not the expected rate.

I chose surgery and the surgeon said the MRI showed the lesion was close to the edge, 13mm in the apex.  In the apex seemed reasonable at was away from the bladder which you might hope is not affected.   13mm seemed fairly large although apparently it's middling.   You might ask what the MRI shows about size and location as that might give you a bit more confidence in a decision.

With all this you can only make assumptions and probabilities.  That's where the anxiety factor comes in.

I'm just a patient who thinks about it too much.  All the best.

Best wishes,

Chris

Thanks for the thoughts and experiences. I guess I feel I need time to breathe and just get myself calm and consider things before I embark upon anything and it does seem with my PSA at 4.1 and T2 (a or b still checking that !) and though Gleason 3+4 I have a little time to rest and take it all in without any immediate extra risk. I guess I would like more info in position and sizes and then the possibilities of say HIFU if it does upgrade or PSA rises.

Of course managing anxiety is an issue but I have had some experience in that with other ongoing health issues so maybe that’s less problematic for the moment unless things change quickly.

My only extra worry is I had no CT scan and as I live with ongoing muscular skeletal pains from my childhood so what is normal for me may mask bone spread mets. So despite being told the PSA and profile shows no likelihood of mets - that is my main late night OCD thought!

Edited by member 25 Jan 2020 at 13:59  | Reason: Not specified

It can also depend on who you're asking.  Surgeons tend to favour surgery etc.  

When I was diagnosed it was by a Urologist who didn't do prostate cancer operations.  He seemed a bit vague about the location of my lesion saying it was near the edge but there are areas of the prostate they couldn't see easily so recommended a template biopsy if I had AS.  It was classed as T2a possibly T3, but was later T2a.

When I chose surgery and met the surgeon he was very matter of fact saying it was 13mm and located in the apex drawing a diagram and showing what he'd do.   I don't know why the urologist didn't do that.

Also as Johntheprint says above brachytherapy is something to be looked at.   I didn't have any choice in my opinion with a 4+3 close to the edge.  I was always worried about stray cells.

I'm also interested in what Lyn said about it not becoming more aggressive as mine was fully diagnosed in the lab and came out 4+4, so the single pin on the biopsy was wrong no surprise.   I've always thought it would develop to 5+5 if left.   I'd also like to know if mets are the same grade as the core lesion if they don't develop. Can you have a 3+3 met etc.

As a final point you said you worried about not differentiating between met bone pain and your other pains.  We all have that problem.  I got a massive hip pain during diagnosis and was convinced it had spread.  It improved but still niggles, arthritus they say.  They also said everyone thinks every pain is related so it's psychological to a degree.   Also as far as I know, and someone may correct me, mets only get painful when they're well hold and you'd be a T4.

Edited by member 26 Jan 2020 at 13:15  | Reason: Not specified

I am T2a and was offered External Beam RT or RP. Gleason 3+4 with 10% of the biopsy cells sampled graded 4. I opted for surgery and had it yesterday. I’m 55 in March.

I wasn’t offered AS but if I had I would still have opted for treatment.

Edited by member 26 Jan 2020 at 23:06  | Reason: Not specified

Darren, hope the recovery goes well and TechGuy, also seems you are happy with the choice. I guess i have a slight issue in as far as i think the impact of just the surgery and anesthesia alone would be quite dramatic with me. I am not saying i wouldn't take the risk, but it would probably take me 3-6 months to recover compared to 2-3 weeks for an average person.

I guess given my age and current level of Ca I would like to know what else might work. What treatments other than hormones and radiotherapy have a good outcome which can be done on spinal block and not GA, such as Proton Beam and HIFU (though i think HIFU requires a GA but not sure).

Nomis

yes very happy indeed. No pad needed and not leaked for about a week now. I still wear a pad when out just for reassurance but no issues. No ED issues at all which I am amazed with. Same dimensions and quality erections that I had pre op. 

Yeah GA impact a consideration. The epidural reduced the amount of post op drugs needed. I was wide awake pretty quick post op. Took a minute or two after opening my eyes to string the words together to ask about margins. I felt like a windows 98 first edition machine booting up. I spent quite a bit of pre-op time getting my BMI from 29 to 25 plus a lot of strength and cardio training. My view was to get as match fit as possible for the surgery. Absolutely no regrets of anything. First PSA bloods next week so a little on edge about that but it will be what it will be I guess.

yes HIFU is done under GA. proton beam not needed but costs can be very high. I was very tempted down this path but my understanding of the cell pathology told me it would just be a matter of time until other rumours popped up so RP logical in that sense. Still a metastatic disease so possibly of distant seeds but getting shot of main issue seems a fair strategy. If only at minimum to buy time where I view immunotherapy being more evolved in years to come.

TG

Seems the GA vs local is a developing area or maybe just centre and or cost dependent when it comes to some non conventional survey or other treatments such as HIFU. 

A comparatively small number of cases using HIFU have been done using a spinal block or epidural where appropriate. I believe those administering the treatment prefer a patient to be anesthetized because it is important that the man does not move and for the patient, the position he is placed in is very unnatural for this procedure.

Edited by member 28 Jan 2020 at 13:03  | Reason: Not specified