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How fast/slow does an adenocarcinoma grow?

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User
Posted 04 Jul 2022 at 21:51

I have just been diagnosed with Gleason Score 3+3 Prostage Cancer (adenocarcinoma). My PSA was 8.8 in Feb 22 having risen from 5.9 in August 21.


I have been offered 4 options for treatement; Active surveillance, radical prostatectomy, external beam radiotherapy and permanent seed brachytherapy. I have been advised that NICE guidance is for active surveillance, however as I am relativley young I am also being offered the other options as well.


I have cancer in two quadrants with ASAP in a third. I've had two sets of MRIs/Biopsies. The first was in January 21 and the second only recently. My first biopsy identifed ASAP in one quadrant which has now changed to cancer with total percentage cancer of less than 5% (9 cores). My recent MRI identified the new area of ASAP. The other quadrant with cancer wasn't identified as an area of concern on the MRI and only one core was taken in the biopsy of which 10% to 20% (2mm) was cancerous.


My thoughts so far on treatment options is that rather than wait until it becomes a problem is to get it dealt with now. It seems that the younger one is, the better the outcome. The radical prostatectomy also seems to offer more options in the event that it isn't cured. There are however the risks of the side effects from the surgery to consider.


When it comes to considering my options it would be useful to understand what range of speed an adenocarcinoma can grow at. This will help me consider at what age I might be needing treatment if I were to choose active surveillance.


I have put some details on my profile of my path to diagnosis. 


Thank you to everybody who contributes to this forum. Whilst this is the first time I have posted, it has been a really useful source of information to me since my GP first suggested getting a PSA test in November 2020.

User
Posted 05 Jul 2022 at 06:52
Another view: You have a cancer that is already impacting your quality of life (disturbed sleep) it may also start to impact your potency. These effects will only get worse, and the alternative treatments are pretty barbaric or require PSA suppressing drugs that make AS more difficult.
Also the cancer may be much worse than MRI or biopsy can see, upgrade at prostatectomy is very common and you may miss an opportunity for a cure.

I was offered the same choices as you albeit at 54, I watched my dad die of PC so I had no doubt I wanted it out. My choice proved to be correct as I was upgraded to T3A.
User
Posted 04 Jul 2022 at 23:22

Hi Denis, from your profile I can see your PSA has been up and down a bit around a PSA of 6, and though it is 8.8 now it could bob up and down a bit around this figure. Your prostate is twice the normal size 51ml vs average of about 25ml. So with a big prostate it is no surprise your PSA is highish. From the scans and biopsies it is pretty clear this cancer if untreated will eventually develop, but no one knows how fast.


Whenever I post on this forum I generally advise people to take the least invasive treatment possible, and in your case Active Surveillance is the least invasive on offer. One of the mains reasons I advocate such an approach is to counter the other people around you who seem to always advocate the most aggressive approach, it seems cancer causes a very strong emotional response in people.


So I would advocate perhaps another six months of AS. if it then stayed above 8.5 I would probably give serious thought to seeds brachytherapy. If it went below 7.5 I would almost certainly stay on AS for another six months.


I can't see a circumstance where I would risk the side effects of a prostatectomy with your fairly low grade cancer. 


Now if you were to have a prostatectomy they would remove all the prostate and as your cancer is small they would probably get it all out, so you would almost certainly never die of prostate cancer. If they treat it with radiation they will probably cure it but in 20 years it may just return somewhere else in the prostate. In fact if you lived until 90 I'd say it would be very likely you would again have prostate cancer, but personally I would prefer have another 15 years of continence and erections, and then look at dieing in my 80s, than take a risk with a prostatectomy at 60.


 

Dave

User
Posted 05 Jul 2022 at 10:04

I agree with francij1's reasoning and with a similar cancer score to yours ( lower PSA but higher grading) and roughly the same age as you when diagnosed (63) I opted for surgery after spending 3 months on AS. Accepting we are all different, apart from not being able to ejaculate, 6 months on I only have a slight leakage when lifting something very heavy and though I do not get as hard as I did pre-surgery I do not have any issues when engaged in penetrative sex.


 


If interested, my timeline etc can be found under my profile.


 


Ivan

User
Posted 05 Jul 2022 at 10:23

Score: T2a Gleason 3+4.


My surgeon suggested I could wait a year on AS and he thought l would be OK. BUT he strongly suggested action now while 'younger' and fitter would have a better outcome. I think there is a mental element you have to be able to overcome. My brother is on AS but knowing how laid back he is then I can see how he can handle it. I am the opposite.

User
Posted 05 Jul 2022 at 10:48
Agree with franci1 comment. You say that one area has changed to cancer so the cells are changing and have changed over the last 3 months (if I’ve read your post correctly). If there was no change to PSA or no new areas of concern then I see the logic with continuing with AS. This is not the case, but it all depends on how you feel about it and if you can deal with it mentally.

On diagnosis, my husband just wanted the dammed thing out - he’s15 weeks post op and doing well. AS was not an option for him, however we have a friend who was advised AS grade 2 Gleason 3+3. He couldn’t cope at all mentally and felt it was a ticking time bomb. He opted for surgery and had a RP 8 weeks ago and his cancer was upgraded to a T3a with a Gleason of 3+4.

I agree with your thinking, get it dealt with now as it’s not going to disappear. Good luck and best wishes x

User
Posted 09 Jul 2022 at 13:51

 


I was initially diagnosed (2017) with Gleason 3+3 in 1% of samples from a guided  TRUS biopsy after a TURP. In August 2021, after MRI & transperineal biopsy, I was diagnosed with stage T2b, Gleason 3+4 in 75% of 20 samples and was advised that active surveillance no longer appropriate. That is not a particularly slow progression. 


After my RALP last November, the subsequent histology upgraded my cancer to T3a. I'm pleased I had it done. 


Good luck


Peter


 

User
Posted 09 Jul 2022 at 14:26
I think the NICE guidance is that a template biopsy should be done for any man considered suitable for AS - the TRUS is not enough. Peter's case is a good example of this; I doubt very much that it progressed from a T1 to a T3 in the space of 4 years and it is not common for a gleason to change (3+3 becoming a 3+4) so it seems the original TURP and TRUS missed the important bits.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 09 Jul 2022 at 15:00

Yes Lyn. I had those doubts following the results of the TP biopsy. Also, because my MRI report  in 2017 designated my lesion as P5, although I know that's always an educated guess. We don't always get second chances at this and I am just grateful that my T3 was only pushing the boundary of the capsule. A while longer and my relatively straight forward case may have been a different story. 


Peter


 

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User
Posted 04 Jul 2022 at 23:22

Hi Denis, from your profile I can see your PSA has been up and down a bit around a PSA of 6, and though it is 8.8 now it could bob up and down a bit around this figure. Your prostate is twice the normal size 51ml vs average of about 25ml. So with a big prostate it is no surprise your PSA is highish. From the scans and biopsies it is pretty clear this cancer if untreated will eventually develop, but no one knows how fast.


Whenever I post on this forum I generally advise people to take the least invasive treatment possible, and in your case Active Surveillance is the least invasive on offer. One of the mains reasons I advocate such an approach is to counter the other people around you who seem to always advocate the most aggressive approach, it seems cancer causes a very strong emotional response in people.


So I would advocate perhaps another six months of AS. if it then stayed above 8.5 I would probably give serious thought to seeds brachytherapy. If it went below 7.5 I would almost certainly stay on AS for another six months.


I can't see a circumstance where I would risk the side effects of a prostatectomy with your fairly low grade cancer. 


Now if you were to have a prostatectomy they would remove all the prostate and as your cancer is small they would probably get it all out, so you would almost certainly never die of prostate cancer. If they treat it with radiation they will probably cure it but in 20 years it may just return somewhere else in the prostate. In fact if you lived until 90 I'd say it would be very likely you would again have prostate cancer, but personally I would prefer have another 15 years of continence and erections, and then look at dieing in my 80s, than take a risk with a prostatectomy at 60.


 

Dave

User
Posted 05 Jul 2022 at 06:52
Another view: You have a cancer that is already impacting your quality of life (disturbed sleep) it may also start to impact your potency. These effects will only get worse, and the alternative treatments are pretty barbaric or require PSA suppressing drugs that make AS more difficult.
Also the cancer may be much worse than MRI or biopsy can see, upgrade at prostatectomy is very common and you may miss an opportunity for a cure.

I was offered the same choices as you albeit at 54, I watched my dad die of PC so I had no doubt I wanted it out. My choice proved to be correct as I was upgraded to T3A.
User
Posted 05 Jul 2022 at 10:04

I agree with francij1's reasoning and with a similar cancer score to yours ( lower PSA but higher grading) and roughly the same age as you when diagnosed (63) I opted for surgery after spending 3 months on AS. Accepting we are all different, apart from not being able to ejaculate, 6 months on I only have a slight leakage when lifting something very heavy and though I do not get as hard as I did pre-surgery I do not have any issues when engaged in penetrative sex.


 


If interested, my timeline etc can be found under my profile.


 


Ivan

User
Posted 05 Jul 2022 at 10:23

Score: T2a Gleason 3+4.


My surgeon suggested I could wait a year on AS and he thought l would be OK. BUT he strongly suggested action now while 'younger' and fitter would have a better outcome. I think there is a mental element you have to be able to overcome. My brother is on AS but knowing how laid back he is then I can see how he can handle it. I am the opposite.

User
Posted 05 Jul 2022 at 10:48
Agree with franci1 comment. You say that one area has changed to cancer so the cells are changing and have changed over the last 3 months (if I’ve read your post correctly). If there was no change to PSA or no new areas of concern then I see the logic with continuing with AS. This is not the case, but it all depends on how you feel about it and if you can deal with it mentally.

On diagnosis, my husband just wanted the dammed thing out - he’s15 weeks post op and doing well. AS was not an option for him, however we have a friend who was advised AS grade 2 Gleason 3+3. He couldn’t cope at all mentally and felt it was a ticking time bomb. He opted for surgery and had a RP 8 weeks ago and his cancer was upgraded to a T3a with a Gleason of 3+4.

I agree with your thinking, get it dealt with now as it’s not going to disappear. Good luck and best wishes x

User
Posted 09 Jul 2022 at 13:51

 


I was initially diagnosed (2017) with Gleason 3+3 in 1% of samples from a guided  TRUS biopsy after a TURP. In August 2021, after MRI & transperineal biopsy, I was diagnosed with stage T2b, Gleason 3+4 in 75% of 20 samples and was advised that active surveillance no longer appropriate. That is not a particularly slow progression. 


After my RALP last November, the subsequent histology upgraded my cancer to T3a. I'm pleased I had it done. 


Good luck


Peter


 

User
Posted 09 Jul 2022 at 14:26
I think the NICE guidance is that a template biopsy should be done for any man considered suitable for AS - the TRUS is not enough. Peter's case is a good example of this; I doubt very much that it progressed from a T1 to a T3 in the space of 4 years and it is not common for a gleason to change (3+3 becoming a 3+4) so it seems the original TURP and TRUS missed the important bits.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 09 Jul 2022 at 15:00

Yes Lyn. I had those doubts following the results of the TP biopsy. Also, because my MRI report  in 2017 designated my lesion as P5, although I know that's always an educated guess. We don't always get second chances at this and I am just grateful that my T3 was only pushing the boundary of the capsule. A while longer and my relatively straight forward case may have been a different story. 


Peter


 

User
Posted 09 Jul 2022 at 18:28
Thank you everyone for all your posts. They have given me food for thought. It is the fact that one sample from a quadrant that was considered OK in the MRI was 20% positive that makes me think that I'd rather go for treatment now rather than AS. I still have a month before my appointment with the consultant so I have plenty of time to dwell over my options.
User
Posted 09 Jul 2022 at 19:19
20% of one core is tiny; 80% would have been worrying. More important to know whether the 20% was in the middle, towards the urethra or towards the outer edge.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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