Gleason 6 - PSA now 8 - time for surgery?

I was in a similar position to you, only my psa was 5-0 & diagnosed with Gleason 3+4. I never had tho option of AS so I opted for surgery, I like you thought at the age of 67 & still fairly fit ( still run 3 to 4 mile a day) that I may as well get the surgery done whilst still in good health. I was fortunate that the incontinence was not really a problem for me 95% continent on removal of catheter 7 days after surgery. I personally think the fitness & fact I used the gym regularly & did quite a few sit ups in the months before surgery was a big help. Of course you may decide to opt for one of the other treatments I.e. hormone & radiation treatment, brachytherapy, or other options available. Perhaps see what your psa is in February & decide with your family & urologist.

In my experience, although not medically trained a 3+3 is not a fast spreading disease but can obviously turn from a 3 into a 4 in the future.

All the best in whatever you decide.

Jeff.

Hi Andy... i am in same situation (G6 diagnostic)... but i am 52 years... :( and my PSA in august are 35.88 ng/ml and in october 11.70 ng/ml... in June are 5.85 ng/ml... Next week i will make a MRI and we will see.

I made a consultation at the MSKCC in New York and this is what they told me...

I can only tell you the big picture with respect to best evidence and what would be standard practice at MSKCC. As I mentioned before, you have a low risk cancer, something very common in men your age (probably around 1 in 4 men). Worrying about small details on the radiology or pathology report, or subtle mathematical considerations about the PSA are not going to help rational decision-making about your cancer care and, moreover, is probably very bad for your mental health. As I mentioned, there are many doctors in the US who are actually trying to change the name of your prostate disease so that it wouldn’t be called cancer at all.

I will repeat these key points below. You need to keep telling yourself these

1. ISUP1 cannot metastasize or spread locally. Indeed, there is a growing movement to actually stop calling this cancer altogether and describe it as a premalignant condition that needs monitoring in case it turns malignant.
2. In the light of (1), would you be very scared if I told you you had a premalignant condition?
3. The amount of GG1 disease is completely irrelevant, it does not raise your risk of anything other than having some higher grade cancer hidden in there. Which is fine because that would be found if you had more biopsies as part of active surveillance.
4. About 1 in 4 men your age have prostate cancer.
5. If you came to Memorial Sloan Kettering Cancer Center, there is close to zero change that you would be treated with surgery or radiation. You would go on active surveillance with possibly an offer of focal therapy.
6. PSA velocity is not a value for prediction in a man with untreated prostate cancer. Your overall PSA level is moderate and there’s nothing to worry about again, this is according to best practice guidelines.
   
   I thought I read that Pirads 5 has an injury? 
   Can you tell us if the MRI report indicates the size of the lesion or lesions?
   
   B.R.
   

I thought that any bladder neck invasion was at least a  T3 staging?

https://librepathology.org/wiki/Prostate_cancer_staging

Edited by member 13 Dec 2024 at 10:27  | Reason: Add link

You might be asking for everyone who had an upgrade to reply and come up with the wrong sample.   However mine was upgraded after the op from 4+3 to 4+4. 

With 2 discontinuous lesions 7mm and 12mm it sounds worth taking action.  Although from your profile I don't know if you've had an MRI, a biopsy doesn't usually say how large they are.

Your psa history is a bit erratic as well and with your history could be ambiguous.  

13/06/2024 6.6
11/05/2023 5.3
30/03/2023 6.3 (UTI at time of test)
15/08/2022 5.3
14/07/2021 4.8
16/06/2020 4.0
22/04/2019 4.6
13/04/2018 4.8
07/02/2017 4.7
08/11/2016 5.3

I think I'd be asking if a scan would be useful.   The doctor might also be cautious about overtreating if it's treated without one.   On balance I'd be thinking better safe than sorry but it's a tough call.   All the best Peter