Gleason 6 and being advised to have radical treatment

User

Posted 04 Jan 2021 at 14:09

Hi,

I was diagnosed with low grade prostate cancer three and a half years ago and have been on active surveillance since. I had a TRUS biopsy at the time of diagnosis and another a years later - both confirmed the Gleason 6 grade and T1-T2a staging. An MRI didn't find anything significant.

Since diagnosis my PSA has been creeping up 3-4.5-5.2-5.7 and an MRI was arranged. The MRI came back with a 10mm PIRADS 4 lesion and another TRUS biopsy was arranged. This biopsy came back Gleason 6 and actually only found something in 1 out of the 15 cores that were taken (the standard 12 plus 3 targeting the area of the lesion) which was less than the original biopsies. The doctor that was doing the biopsy did explain that it would be difficult to target the area of the lesion accurately using ultrasound, but the results made me think that I'd be OK to continue with active surveillance.

However, just before Christmas, the urology consultant contacted me to tell me that the MDT had concluded that radical treatment was required. Although the biopsy result of Gleason 6 indicated low risk, the fact that the biopsy results seemed inconsistent and the MRI result suggested something significant meant that the cancer was really 'high risk'. To be honest, a poor phone connection (it was a telephone appointment), and the shock of being told treatment was required meant that I didn't really understand what I was being told.

I'm going to contact the single point of contact nurses this week, but my question is has anyone else been in the position of being told a Gleason 6 cancer needs radical treatment?

Bruce

User

Posted 04 Jan 2021 at 14:37

Hi Bruce,

I'm the same age as you and have been uder AS for over 4.5 years, PSA level was 4.5 at first sample and registered 9 at the highest but I had had sex the day before the appointment and that would have pushed it up, I was averaging around the 6-7 mark most times. During the 4.5 years I have had 3 Transrectal Biopsies the first being 10 samples then one year later a 20 sample then 4 month ago another MRI and 20 sample. I was told I was now at Gleeson 7, cancer non aggressive and still contained but I was recommended that it was time for medical intervention. I have decided to go down the route of radiotherapy and will have proton beam therapy (7 Sessions) and I have already had the SpaceOar done. Maybe like yourself I found it really difficult to make a decision as to what route to take but I would say read as much as possible on here and try and get a face to face with a consultant. My urologist has been fantastic and he then referred me to an oncologist who I could not fault and originally I was going for something called Stereo tactic Radiotherapy.

We are all different I know but on something as serious as this I beleive you need to meet the people who are giving the advice.

Good Luck, I consider that I am very lucky as this should be curable

All the best

User

Posted 04 Jan 2021 at 19:53

Mine was G3+3 and T2B at diagnosis (MRI and TRUS), I was offered AS or Radical treatment, my Urologist advised radical treatment due to the proximity (Near edge).

After prostatectomy it was upgraded to G3+3 T3A.

User

Posted 05 Jan 2021 at 02:08

It’s unfortunate you didn’t have a transperineal or target biopsy in the first place, like I did, where they took 42 samples.

You would have had a much clearer picture of the extent of your cancer, and not had to endure two subsequent TRUS biopsies.

It’s disgraceful that you had the discourse about your cancer with the consultant over the phone (blame everything on the plague).

Others will be here to answer your question, but I wish you the best of luck.

Cheers, John.

User

Posted 05 Jan 2021 at 09:53

It's the fact that your PSA is steadily increasing that's the danger signal. If I were you I'd follow the recommendations of the MDT and get it sorted.

Best wishes,

Chris

User

Posted 05 Jan 2021 at 20:36

As Jonathan has said, it may well be that in your case it is the position of the tumour that has led the MDT to recommend radical treatment. You may feel that the advice of the specialist team is worth taking.

Barry

User

Posted 05 Jan 2021 at 21:06

Mine was 3+3 and I went on AS, however when my PSA reached 10. something I was told it was time for action. I went for LDR Brachytherapy. The trigger point for me was a couple of quick PSA rises and exceeding a PSA of 10. As Barry said, sometimes you have to accept the advice of the experts.

John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2

Jan '20 PSA 0.3 July '20 0.1 Jan. 21 < 0.1 Dec 21 <0.01 June '22 <0.01 April '23 <0.01

User

Posted 06 Jan 2021 at 16:45

Thanks guys.

I spoke to the nurse today and she told me the recommendation was based on the MRI results. I didn’t say this to her, but I did wonder what the point (ouch) of the three biopsies was, and whether a non-multiparametric MRI is all that useful for prostate diagnosis. However, I do agree that you have to trust the medical team - they are doing the best they can with what they have. I’ve also been feeling different recently - it’s getting harder to pee even with the tamsulosin, so I’ve decided to settle myself into the idea that I need treatment.

I’ve got a telephone meeting with a surgeon next week and a face to face with an oncologist at the end of the month, so the next thing is to decide what treatment I want. Wish me luck!

Bruce

User

Posted 06 Jan 2021 at 16:55

Good luck Bruce

From what you have said I would imagine you should have a good choice of treatments

I was Gleason 3+4 and T2a at the time I elected to have treatment. For me it was either RT or surgery ( see my profile) and was a relatively easy decision

That was over 9 months ago now and been very happy (so far) with the outcome

Notification

Join the online community now.