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Cancer spread with steady PSA?

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User
Posted 17 Mar 2021 at 12:56

Am 62 and was diagnosed in November 2020 following a biopsy in September. 3 of 33 cores showed cancer with Gleason scores of 3+4=7 and two of 3+3=6.

Had a PSA of 6 and, after careful consideration, opted for Active Surveillance. My PSA last week was 5.3 so it seems to be good, but I am concerned whether the cancer can spread even though the PSA score remains steady (I know that it is early days yet). I am feeling OK.

Any thoughts/advice?

Thanks

 

User
Posted 17 Mar 2021 at 13:54

My main concern would be the staging you are given. Have you had a recent MRI and do you know the staging?

 

User
Posted 17 Mar 2021 at 14:13
Echo that AS needs regular MRI as well as PSA checks
User
Posted 17 Mar 2021 at 15:29
The T2c would usually rule out AS but as you only had 3 positive cores, I assume that this was one small core on one side and 2 small cores on the other. I also assume that your biopsy found adenocarcinoma rather than one of the rarer types as, if it was a rare prostate cancer, AS would have been ruled out I think. We regularly say that every man's cancer is different but years & years of data shows that adenocarcinoma is usually very predictable - as the cancer becomes more active, the PSA rises. A stable PSA usually reassures that the cancer is not active. The annual MRI and DRE are an essential part of confirming this though; don't be persuaded to delay those later this year.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 17 Mar 2021 at 13:54

My main concern would be the staging you are given. Have you had a recent MRI and do you know the staging?

 

User
Posted 17 Mar 2021 at 14:13
Echo that AS needs regular MRI as well as PSA checks
User
Posted 17 Mar 2021 at 14:23

I had an MRI in Sept - staging T2(c). Also had a CT Chest/Abdo/Pelvis with Contrast in January and no significant abnormalities were noted

User
Posted 17 Mar 2021 at 14:40

So as you probably know T2C means there is cancer in both sides of the prostate but it is still contained.

At T2A I felt I'd reached a point after a couple of years on AS where I needed to make a decision about treatment. As my preferred route was surgery (and I wanted nerve sparing) I don't think I could have waited much longer.

Its not just the spreading that you need to think about - its the treatment options you may have.

User
Posted 17 Mar 2021 at 14:45

Thanks for that. The other option/recommendation for consideration from the MDT was surgery. I would prefer surgery to RT but my current concern is how do I know if the cancer has spread too far for surgery to be an option? The only real measure currently is a quarterly PSA test with an annual MRI/DRA. So if my PSA remains quite steady for the year, I will continue with AS.

User
Posted 17 Mar 2021 at 15:29
The T2c would usually rule out AS but as you only had 3 positive cores, I assume that this was one small core on one side and 2 small cores on the other. I also assume that your biopsy found adenocarcinoma rather than one of the rarer types as, if it was a rare prostate cancer, AS would have been ruled out I think. We regularly say that every man's cancer is different but years & years of data shows that adenocarcinoma is usually very predictable - as the cancer becomes more active, the PSA rises. A stable PSA usually reassures that the cancer is not active. The annual MRI and DRE are an essential part of confirming this though; don't be persuaded to delay those later this year.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 18 Mar 2021 at 00:05

Hi

The key question you asked .. quote  "how do I know if the cancer has spread too far for surgery to be an option".

As Lyn , Mike and others have 'alluded' to, no one knows precisely.  (see my profile and others that have  posted) . Put in the mix, your own fitness, whether still working, partner/family if they know your dx. (positive/negative pressures to do something)   You are still very much in the 'curative' stage, as Lyn states, PSA will give an indication, nothing more or less.   I 'sat' on my PSA value in many ways, and things worked have worked out fine.  However we were still quite surprised when told ... started to transgress the capsule..  It tends to focus the mind..  Again lesion(s) could have been in that position for a year or 2, you can't reverse engineer/project a single biopsy, a consultant suggested to me, probably +7 years from the initial mutant cell..   Obviously surgery is only one option, and will give the greatest impact re. ED.   The right time is when you think it's right, in many ways. Maybe 'gut feel' in my case. It is very difficult as like so so many men, there are no symptoms, and being in hospital, for a major op, felt very surreal.. many others who have posted may relate to that.        All the very best

Regards Gordon

 

Edited by member 18 Mar 2021 at 00:07  | Reason: Not specified

User
Posted 18 Mar 2021 at 04:04
My friend, G 3+4=7, has been on active surveillance for five years. He is now very fastidious about his diet, and likewise quarterly PSA tests, annual hi-res MRI scans and consultations with his specialist.

Whenever I see a man with a G 3+3=6 diagnosis, I am wont to point out that if he had critical illness insurance, many insurance companies would not pay out as the condition of G6 is not considered ‘life threatening’!

Whether the ‘not life threatening’ comment assuages some of their fears, I don’t know, but best of luck to you whatever you decide to do.

Cheers, John.

 
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