What to do: AS or RP?

User

Posted 12 Jul 2023 at 16:05

Hi all,

only just discovered this younger men section so thought to repost here.

I'm 46 and just been diagnosed.

Gleason 3+3=6.

1 core out of 24 returned with cancer. Left middle and size 0.7mm. No evidence of perineural invasion.

So the MDT have advised AS until September at least.

While i dont mind AS for now as i think mine is low grade, i understand the risk of spread not been picked on time so keen to get others experience please. Eventually i will probably get the surgery done as i want it out. But when, i don't know yet.

Reading through a lot of posts i don't think i have come across anyone who was diagnosed gleason 6 and that remained the same post surgery. The trend tends to be that the gleason grade goes up post-surgery. Is it me or is that the case?

If so, would that suggest that biopsy results are not always accurate or could it be that the cancer has changed between biopsy and surgery.

Thanks

User

Posted 12 Jul 2023 at 20:40

Cancer doesn’t change its aggressiveness; grade 3 cells (the least aggressive form of cancer) don’t mutate into grade 4 or 5. A biopsy, however, is essentially a random sampling of bits of tissue from your prostate, so if there is a small amount of G4 or 5 cancer there, the sampling can simply miss it. AS and regular PSA checks do sound the best way forward.

Best wishes,

Chris

User

Posted 12 Jul 2023 at 22:01

"Reading through a lot of posts i don't think i have come across anyone who was diagnosed gleason 6 and that remained the same post surgery."

A significant number of men with G6 wouldn't ever have surgery so not a lot of people for you to compare with. Also, some men get downgraded post-op (eg from 4+3 to 3+4) but we tend not to hear do much about it because a forum like this tends to be filled with the people eho have had difficulties - when it goes well, the member tends to stop posting.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 19 Sep 2023 at 13:31

I was originally diagnosed 3+4=7, but a second team at Addenbrookes (whilst looking into the RP option) have said it is actually 3+3=6, so have recommended AS. I am now leaning towards this for the time being.

User

Posted 19 Sep 2023 at 16:13

Originally Posted by: Online Community Member

Cancer doesn’t change its aggressiveness; grade 3 cells (the least aggressive form of cancer) don’t mutate into grade 4 or 5.

Is that true Chris?

I have read, regarding prostate cancer grading, that the grade and a cancer tumour’s level of differentiation can change over time and different areas in a tumour can have different levels of differentiation. This would seem to indicate that a well differentiated cancer (low grade) could, over time, become less differentiated and thus become high grade.

User

Posted 19 Sep 2023 at 23:08

My understand is that any prostate cancer cells have heterogeneity which means they are all different and get more different over time.

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