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Gleason 3+4 Active Surveillance?

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User
Posted 11 Nov 2022 at 10:02

Hi, I have G 3+4 with a PSA of 9, tumor stage IIA.


I am 69 and have been recommended RARP or RT. Has anyone out there with  G 3+4 gone for AS?


Best wishes and thanks in advance for any info, Tony

User
Posted 11 Nov 2022 at 15:48

In the early days of my diagnosis, I also begged the nurse for AS. I obviously was still very naive about the whole PC thing, I had not invested a lot of time in the research and felt the best option giving all the side effects was AS. However, I felt a little crushed when my request was denied, the nurse told me in no uncertain terms Gleeson 6 was the absolute maximum to go on AS, I was 3+4. So in the end I went for the surgery. I am in my mid to late 50s.

User
Posted 11 Nov 2022 at 14:07

From the information you've provided you appear to be lucky enough to have had an early diagnosis of cancer,  Early treatment  stands a good chance of a} preventing spread and b) removing all of the cancerous cells.


Do you have some specific reasons for wanting to go with AS?


Jules


 

User
Posted 11 Nov 2022 at 14:36

Hi Tony,


Did you get a TNM score? The T will give you an idea on the tumour and where it’s located, if it’s close to the edge they might want to get it dealt with rather than risk and cells escaping. I assume your medical team don’t think AS is suitable if it isn’t one of the recommendations but definitely worth asking why.


Best of luck 

User
Posted 11 Nov 2022 at 16:22

My score was T2a Gleason 3+4 PSA 8.75. So not particularly bad on the scale of things. However, AS was not offered as an initial option. I was told by the surgeon that I could wait a year and would probably be OK, but absolutely could not wait any longer than that. 'Probably' is a guess not an absolute so it made sense to get on with the treatment while the cancer was almost certainly localised and move on with my life.

User
Posted 11 Nov 2022 at 17:21

I am quite a strong advocate of getting the minimum treatment possible, to avoid the side effects.


One very strong consideration is how much longer do you expect to live. Another is how tolerable are the side effects. And of course, will this treatment cure the cancer or at least hold it under control until something else kills you.


Well at 69 you would hope for another 15 years of reasonable health. So the next question is will AS hold off this G3+4 T2a PSA9 cancer for 15 years or maybe 10 years and accept a small reduction in life length. The short answer is with some G4 present probably not.


If you were 80 and only expecting to live another five years, I would agree AS would be a good option, but at 69 with some G4. I think you need treatment.


Is HIFU possible? That has very few side effects.

Dave

User
Posted 11 Nov 2022 at 18:16

Many of us here don't feel ill when diagnosed. I had one symptom, going to the toilet 3 times in the night instead of 1. Hardly life threatening. That's the issue with PCa if you start to get noticeable symptoms then I'm afraid you might be on a less favourable path.  

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User
Posted 11 Nov 2022 at 14:07

From the information you've provided you appear to be lucky enough to have had an early diagnosis of cancer,  Early treatment  stands a good chance of a} preventing spread and b) removing all of the cancerous cells.


Do you have some specific reasons for wanting to go with AS?


Jules


 

User
Posted 11 Nov 2022 at 14:36

Hi Tony,


Did you get a TNM score? The T will give you an idea on the tumour and where it’s located, if it’s close to the edge they might want to get it dealt with rather than risk and cells escaping. I assume your medical team don’t think AS is suitable if it isn’t one of the recommendations but definitely worth asking why.


Best of luck 

User
Posted 11 Nov 2022 at 15:48

In the early days of my diagnosis, I also begged the nurse for AS. I obviously was still very naive about the whole PC thing, I had not invested a lot of time in the research and felt the best option giving all the side effects was AS. However, I felt a little crushed when my request was denied, the nurse told me in no uncertain terms Gleeson 6 was the absolute maximum to go on AS, I was 3+4. So in the end I went for the surgery. I am in my mid to late 50s.

User
Posted 11 Nov 2022 at 16:22

My score was T2a Gleason 3+4 PSA 8.75. So not particularly bad on the scale of things. However, AS was not offered as an initial option. I was told by the surgeon that I could wait a year and would probably be OK, but absolutely could not wait any longer than that. 'Probably' is a guess not an absolute so it made sense to get on with the treatment while the cancer was almost certainly localised and move on with my life.

User
Posted 11 Nov 2022 at 17:21

I am quite a strong advocate of getting the minimum treatment possible, to avoid the side effects.


One very strong consideration is how much longer do you expect to live. Another is how tolerable are the side effects. And of course, will this treatment cure the cancer or at least hold it under control until something else kills you.


Well at 69 you would hope for another 15 years of reasonable health. So the next question is will AS hold off this G3+4 T2a PSA9 cancer for 15 years or maybe 10 years and accept a small reduction in life length. The short answer is with some G4 present probably not.


If you were 80 and only expecting to live another five years, I would agree AS would be a good option, but at 69 with some G4. I think you need treatment.


Is HIFU possible? That has very few side effects.

Dave

User
Posted 11 Nov 2022 at 17:31

Hi, thanks for all the replies. 


Because I dont feel ill, it seems counter intuitive to have major surgery. But of course at one level at least, I can understand why it needs to happen.


Naturally I will take on board all the information supplied on here and elsewhere, and do my best to process it.


It serms like the operation is the best way forward, but unsuprisingly am not looking forward to it 🤔😢


The immediate pain I am fairly sure I can deal with. It's the long term side effects and the fear I'll never feel this healthy again that scares me big time. 

Edited by member 11 Nov 2022 at 17:33  | Reason: Not specified

User
Posted 11 Nov 2022 at 18:16

Many of us here don't feel ill when diagnosed. I had one symptom, going to the toilet 3 times in the night instead of 1. Hardly life threatening. That's the issue with PCa if you start to get noticeable symptoms then I'm afraid you might be on a less favourable path.  

 
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