Understanding my dad's diagnosis

User

Posted 11 Jan 2025 at 14:34

Hi all,
My dad was diagnosed with prostate cancer in late November after an MRI scan and biopsy. The pca was described as low-grade by the nurse who called us with the diagosis, and it was suggested he should go on active surveillance, with another PSA test to be done in 6 months. At the time we were very relieved after a month of worrying. They also found some lumps in his colon on the MRI scan, so our mind turned from the prostate cancer to that until a recent colonoscopy thankfully gave the all clear on that front. Now our minds are naturally turning back to the prostate cancer and my dad's diagnosis, especially as we've just had a written summary of his diagnosis in the post today.

My dad's report mentions the following:

Preseting PSA 8.8
Summary: 23mL gland, left peripheral zone and anterior
PIRADs 4 lesions
Provisional stage: T2(3a??) N0 M0

Diagnosis: Prostate; 24 core template biopsies:- Prostatic adenocarcinoma in 5 of 24 cores- Gleason 7 (3+4) in 2 of 24 cores, GG2- Gleason 6 (3+3) in 3 of 24 cores, maximum extent 2mm (20% of core), GG1- No PNI or EPE- overall pattern 4 is about 5%

I know folks here won't want to give medical advice and that we should be talking to my dad's hospital about the diagnosis, but I'm really just wanting to know if the advice my dad's been given to go on AS is what people would expect with the above diagnosis? From my very limited understanding, the presence of gleason 7 pca, as well as the fact that my dad's cancer is near the anterior of his prostate (I assume that's the reason for the "t3a??") would usually suggest treatment should be considered. Or I am overinterpreting what is actually a fairly benign diagnosis?

I'd also be interested to know if anyone else had similar results at the point of diagnosis, and how things developed for them?

Personally I'm worried thay my dad has a gleason 7 pca and that's its location on the anterior of his prostate means it's more likely to spread outside the prostate. I'm also worried that the decision to put him on AS is influenced by his age (he's 76, though very fit and active) and the NHS being under pressure. We've not had any consultation with a doctor since his diagnosis, and it tooks a few unanswered phone calls and voice messages just to get a summary of his diagnosis in the post - it's obvious they are swamped at the hospital. And so I don't want my dad to fall through the cracks.

On the other hand, I can tell that my dad wants to put the diagnosis out of his mind, and I don't want to have him worrying unecessarily by pushing him to get a second opinion. I'm half hoping to be told here that I'm myself worrying uncessarily. But the other part of my brain is worrying that the diagnosis is more serious than we're assuming and that we might miss the window of opportunity my dad has for treatment.

Would be really helpful to get the opinion of those on here who have been through a similar diagnosis.

Thanks,

User

Posted 11 Jan 2025 at 19:20

Hello mate.

I'm sorry that your dad has a problem, but it's lovely to see that, as a son, you've taken time to find us and ask our opinion. Welcome to the forum. Your first post is great, full of detailed and relevant information.

Your summary of the situation is spot on. Your dad's PSA level is relatively low and his cancer grades are low. His prostate is about average size. He is 76 years old and many men of his age will have similar cancer that may never be detected.

Like you, my greatest concern is the cancer staging. Is it T2, confined to the prostate or is it T3a and slightly breached the capsule?

Your dad's age my be a factor into what further treatment, if any, is deemed suitable.

You can never be a 100% sure of anything with this disease, but I dont think your dad is in immediate danger or you need to rush into a decision.

In your dad's situation I'd probably go on active surveillance but would ensure that I was closely monitored, but that's a decision only you and him can make.

Best of luck to you both and please keep us updated. We will always be here to help and support you.

Edited by member 11 Jan 2025 at 21:06 | Reason: Typo

User

Posted 11 Jan 2025 at 22:54

Currer , I was diagnosed 11 years ago at the age of 62, PSA 7.7 staging was T2 at most but upgraded to T3 a after surgery. My surgeon/ consultant told me on diagnosis that if they did nothing I would still be here in 10 -15 years. I did have surgery followed by lots of minor procedures then salvage RT and have since had other curative intent treatments and am waiting for more treatment at the moment.

Has he had any previous PSA tests, they may give an indication of how the cancer is progressing.

It may come down to a balance of quantity or quality of life.

Thanks Chris

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User

Posted 11 Jan 2025 at 19:20

Hello mate.

Like you, my greatest concern is the cancer staging. Is it T2, confined to the prostate or is it T3a and slightly breached the capsule?

Your dad's age my be a factor into what further treatment, if any, is deemed suitable.

You can never be a 100% sure of anything with this disease, but I dont think your dad is in immediate danger or you need to rush into a decision.

In your dad's situation I'd probably go on active surveillance but would ensure that I was closely monitored, but that's a decision only you and him can make.

Best of luck to you both and please keep us updated. We will always be here to help and support you.

Edited by member 11 Jan 2025 at 21:06 | Reason: Typo

User

Posted 11 Jan 2025 at 22:54

Has he had any previous PSA tests, they may give an indication of how the cancer is progressing.

It may come down to a balance of quantity or quality of life.

Thanks Chris

User

Posted 11 Jan 2025 at 22:54

Thanks very much Adrian for your kind reply.

The thing I still don't fully undertand is how serious it would be if the cancer were to breach the capsule. Given that it's seemingly a low-grade cancer, would a doctor looking at my dad's case assume that his cancer could still be treated with e.g. radiotheraphy? Or once it's breached the capsule is it inevitable that it will spread? (I know you can't give anything like a definite answer about my dad's case specifically!) A lot of what I've read suggests there's a strong incentive to treat while the cancer is still contained in the prostate, but they haven't suggested that for my dad, and I don't know if that's down to his age.

Another question that's come to mind this evening: should we be asking about hormone therapy, which I gather can keep the cancer at bay without curing it? When I began reading about how prostate cancer is treated, I assumed hormone therapy was given as part of active surveillance, and as a precursor to surgery, but I think that was me misunderstanding things, and hormone therapy is very a treatment in and of itself.

I think I'm just struggling to recocile myself to the fact that nothing's going to happen for another 5 months, and that when it does happen it will only be another blood test.

User

Posted 11 Jan 2025 at 23:11

Hi Chris,

There was a PSA reading of 6.5 from December 2023, which was flagged as normal, though I can see it's right at the edge of the range. Before that was a reading of 5.5 in May 2023, and 3.3 in Apr 2022.

Do you know what sort of scale of increase they would be looking for as an indication of an aggressive or developing prostate cancer?

Edited by member 11 Jan 2025 at 23:12 | Reason: Not specified

User

Posted 11 Jan 2025 at 23:34

Hi again.

I know my own dad was diagnosed with prostate cancer in his late seventies. Ashamedly, I don't know what his exact diagnosis was and I wish I'd taken as much interest in his condition as you are doing for your dad.

However, I know that he was deemed too old for radical treatments and I believe was just given periodic hormone injections. I now know hormone therapy doesn't cure cancer but it slows it down. He carried on pretty much as normal until he passed away at 88 years old.

He did, however, struggle for the last month of his life. I know at this stage his PSA was over a thousand and the cancer had spread to his lower back and pelvis.

Until that final month he seemed pretty unfazed by the disease. If he'd been suitable for radical treatment, I don't know how he'd have coped with surgery or radiation, and the side effects those treatments often bring. I don't know if his quality of life would have been better or worse.

Edited by member 12 Jan 2025 at 00:28 | Reason: Typo

User

Posted 12 Jan 2025 at 00:11

I think you are right in so much as his age in your Dad's case and diagnosis means that it is less likely that radical treatment is recommended in present circumstances. If he goes along with this it is important that he is properly monitored so appropriate treatment can be given before the cancer breaks out of the Prostate and establishes in other parts of his body. However, if he is otherwise expected to live many years (long lives of family members, absence of life limiting problems etc), he may feel he would like radical treatment now, most likely HT and a form of RT soon, as this would help reduce the chance of spread. The acceptance of HT/RT does mean the likely possibility of various side effects which some find harder to cope with than others. At your Dad's age it has become less likely he would be offered a Prostatectomy.

Dad may be offered the choice of treatment now or AS and asked which route he choses taking into account the views of his Consultant/MDT. Men may come to different decisions having considered the pros and cons, so the choice is often left to the patient.

I suggest you and he read the 'Tool Kit' published by this Charity as here https://shop.prostatecanceruk.org//our-publications/all-publications/tool-kit?limit=100

Edited by member 12 Jan 2025 at 00:12 | Reason: to highlight link

Barry

User

Posted 12 Jan 2025 at 01:26

Originally Posted by: Online Community Member

Hi Chris,

Do you know what sort of scale of increase they would be looking for as an indication of an aggressive or developing prostate cancer?

That is one for your medical team or perhaps ring the nurses on this site on Monday, the number is at the top of the page. My current doubling time is between 2 and 3 months, I no longer have a prostate and my oncologist is talking about keeping my cancer controlled for 5 years.

If his team have suggested AS then I suspect they are not too concerned about his rate of rise.

Thanks Chris

User

Posted 13 Jan 2025 at 20:53

Thanks all for the replies. It's reassuring to read that what the hospital is suggesting for my dad is probably standard practice. I had been under the impression that gleason 7 and the possibility of t3a would usually prompt treatment right away. (Also reassuring to read of 10-15 year time frames - despite all I've read about most forms of prostate cancer being slow to develop, I've still had this worry about my dad's developing between now and the next PSA test in May).

From the replies, am I right in understanding that normally when a decision is made for active survillance there would be a consultation with a doctor and they'd discuss both the option for AS as well as possible treatment options if the patient isn't happy with AS? If so, my dad hasn't had that. It was one of the nurses who called through with the results from the biopsy, and mentioned that he didn't need to come in for any more appointments until the PSA test in May. I don't know if there's actually a doctor assigned to my dad. I'd like to try and get a bit more information from the hospital, even if it's just a phone call with one of the consultants, but I get the sense my dad wants to leave it as is and not ask questions. I know he definitely doesn't want a prostatectomy. He's very active for his age - does a lot of climbing - and I don't think he wants anything interfering with that or leaving him bedbound. But he might feel differently about other treatment options if we had a chance to discuss them with a doctor.

I think I'll try calling the Prostate Cancer UK nurses tomorrow. We did call some weeks ago and found it helpful, though I don't think either of us knew what we wanted to ask at the time!

User

Posted 30 Nov 2025 at 22:51

I wasn't sure whether to bump my old thread or create a new one - I hope this post is visible.

My dad's been on active surveillance since I first posted here in Jan. His PSA has been steadily climbing (up to around 15 on the last test), and he's also had some symptoms in recent months - waking up at night needing the loo, and general tiredness and fatigue. He's always been very active - keen rock climber, cyclist, lots of time in the garden and at his vegetable plots - but he doesn't have the energy he used to have and the change feels sudden enough that it's hard to attribute it simply to age. He had been worried these might be signs of the cancer spreading, so asked for another MRI, which they did last month. That's now come back and shown a second lesion on the other side of the his prostate, though thankfully they are still grading the cancer as T2, albeit now T2c - contained within the prostate but on both sides. (We don't have a gleason grade for the new lesion but I assume a further biopsy would be needed for that).

My dad's had two calls with the nurses at his hospital and they've suggested the cancer has now reached a stage where treatment would be warranted, though they don't seem to be suggesting there's any urgency. The initial suggestion was that he would have radiotherapy and hormone therapy, though we did also ask about prostate removal and they suggested we could have a consultation with a surgeon if my dad wanted that.

Right now, we're really unsure about the best way forward, and I'm wondering if anyone here has any advice. From what I've read online, my dad would be a candidate for prostatectomy so far as the cancer is thought to be contained within the prostate, but radiotheraphy might still be preferred so far as it has milder/fewer (?) side effects. But from what I can understand there is more risk with radiotherapy of the cancer recurring. Is that broadly accurate?

I had been hoping my dad would be offered RARP so far as it offers a definitive cure, but obviously it's not me having to undergo the surgery! And I don't know if I'm over interpreting the difference in cure rates between radiotherapy and prostatectomy.

I've also been reading online (mostly via the prostatematters website) about focal therapies - HIFU, nanoknife etc. Should we be asking about these? There's been no mention of these in our conversations with the nurses, and so I assume we'd have to ask about my dad being seen at a different hospital (we are near Southampton so that might an option). From what I can understand, these treatments are usually only an option for t2 stage cancer, though I don't know if my dad's t2c staging would rule them out?

My big worry about my dad's cancer has always been that the initial reports flagged the primary lesion as being very close to the edge of his prostate (there was a question of him being t3a), which I assume means a greater chance of it breaching the capsule, if it hasn't already in ways that aren't visible on the MRI. I also don't know if that should influence the treatment options.

The other complicating factor is that my mum is likely going to be undergoing a stem cell transplant early next year - a much more serious procedure that's going to need both me and my dad to act as her caregivers in the months afterwards. My dad is talking about delaying any treatment for his prostate cancer until mum is through the initial stages of the transplant - my feeling is that this might be more of an arguement for him having one of the more targeted therapies with fewer side effects, as I worry if we let his cancer sit for another ~9 months it will only spread.

Sorry for such a long and messy post. If anyone has any advice on how we weight up the different treatment options it would be appreciated.

User

Posted 01 Dec 2025 at 12:45

Hi, again.

I tried to reply earlier, but the damn 502 error, temporarily defeated me. 😕

I'm sorry that your dad's disease seems to have progressed. Mine did whilst I was on active surveillance. They did a repeat biopsy which showed an increased Gleason score 6 (3+3) to 8 (3+5) and later 9(4+5). I was also upgraded in staging from T2c to T3a. So I can fully understand your concerns.

As far as I'm aware, generally the side effects and outcomes, including risk of BCR, for surgery and RT/HT are pretty similar. Obviously the patient's age, general health and other factors can favour one treatment over another.

Here's an excellent video on all treatment options including possible side effects.

https://youtu.be/zYTU94-8pTc?si=1Z29_l8rbTwF6DHl

May be the consultants will direct your dad to a specific treatment but usually they leave that decision to the patient.

I appreciate your anxiety over delaying treatment if the the lesion(s) are close to the prostate wall. Only those with all your dad's results can comment on the risks of delay.

I'm not medically trained, but from my experience, I'd have thought the next step was a follow up biopsy.

Good luck and please keep us updated.👍

Edited by member 01 Dec 2025 at 13:31 | Reason: Typo

User

Posted 06 Dec 2025 at 17:14

Thanks Adrian for your reply, and sorry to be slow in acknowledging it. Thanks also for the London Cancer Alliance video - I shared it with my dad (not sure he's looked at it yet, though!)

We've got a bit further with things this week.

At the start of the week, he went to see a doctor privately in Southampton. He was there all day while my mum had an appointment at Southamptom hospital, and we had been discussing the day prior him getting a second opinion, so he just arranged the consultation on the spot and was able to meet with a doctor that same day. The meeting was quite helpful. It was suggested that the recent MRI scan wasn't great quality and so this doctor didn't feel we could say for sure that there's a second cancer lesion (I guess benign lesions in the prostate are possible?) He felt a second scan was needed, but tentatively suggested that my dad might be suitable for HIFU (if no second lesion, or if it's small and negligible), or alternatively RARP.

Since then, my dad has also spoken again to one of the nurses overseeing his NHS care. They've advised a different treatment path, which is hormone therapy to be followed by radiotherapy a few months down the line. Because my dad previously had a blood clot while flying and is on blood thinners, they are advising against prostatectomy, though also said we didn't have to rule it out if my dad wanted to discuss that option. They've also suggested focal therapy wouldn't be an option, though we didn't really get a reason as to why. We did mention the scan apparently being poor quality and asked whether another was needed, but the suggestion was that it likely wouldn't have a bearing on things - the increase in the PSA would be enough to warrant treating my dad's cancer irrespective of whether the second lesion that they think might be visible on the second scan is cancerous or not.

So it feels like there's only really one treatment option for my dad, at least under his current NHS care. I can tell he's wanting to put the cancer out of his mind again, and I think he is happy to go with the hormone therapy and radiotherapy on that basis.

From my perspective, I'm worried having read that radiotherapy isn't always expected to cure the cancer, and that there are few treatment options to look at if the cancer returns, with prostatectomy usually not being an option post-radiotherapy. Am I right to be worried about that, or am I over-interpreting what I'm reading? What are my dad's prospects if the cancer returns following radiotherapy?

The doctor my dad met privately seemed to think he would be suitable for HIFU, and I don't know if there's any benefit in my dad going down that route, even if it means going privately. As far as I can understand, HIFU would still leave open the possibility of prostatectomy or radiotherapy at a later date if the cancer returns/persists, and would have fewer side effects?

Edited by member 08 Dec 2025 at 13:29 | Reason: Not specified

User

Posted 06 Dec 2025 at 19:46

Hi again, mate.

In about the last year, your dad's PSA has risen, from about 9 to15. The follow up MRI indicates a possible second lesion. Do you know if the scan showed whether the first lesion had grown? Did it suggest the lesion(s) were still contained within the prostate and that the staging still appears to be T2?

If I were in your dad's position, I would want to try and establish what's caused the PSA rise. In my opinion a follow up biopsy would be beneficial and shed more light on the situation. They could recheck the Gleason score of the first lesion and check how cancerous, if at all, the second lesion is. I'd like this doing before deciding on any further treatment.

Edited by member 06 Dec 2025 at 23:12 | Reason: Typo

User

Posted 08 Dec 2025 at 13:52

Thanks for your replies Adrian, and for the headsup re. the doctor's name (I've just edited that!)

The suggestion is that it's all still contained within the prostate, yes, though if the quality of the scan is poor, I don't know if they can say that for sure. But in any case, they've now given a grading of t2c - contained within the prostate but on both sides.

My dad's received all of the prescriptons and paperwork for the hormone treatment today, and he's meant to start on it right away, to be followed by an injection of Prostap or Decapeptyl in 2-3 weeks' time. He's about to go abroad, so he's rung the hospital to ask if he can delay it, but I think he's otherwise minded to start on the treatment when he gets back next week.

I'm reading the side effects of the hormone therapy and I am worried how it will affect him, as all of his interests and hobbies are outdoors and it's obviously going to have an impact on that.

Re. a second biopsy. I know you cannot give medical advice, but is your feeling that a biopsy might throw up a more benign explanation for the PSA rise and that my dad's cancer might still be suitable for active surveillance, or is it rather that it might influence the choice of treatment? Knowing how my dad has been fretting over things in recent months, I think he's going to want to begin some form of treatment regardless, but if a biopsy is likely to influence the choice of treatment, then I feel he should ask for one.

I assume starting the hormone therapy won't preclude him going back to the hospital and asking for a further assessment of his cancer?

User

Posted 08 Dec 2025 at 22:20

Originally Posted by: Online Community Member

Re. a second biopsy. I know you cannot give medical advice, but is your feeling that a biopsy might throw up a more benign explanation for the PSA rise and that my dad's cancer might still be suitable for active surveillance, or is it rather that it might influence the choice of treatment? Knowing how my dad has been fretting over things in recent months, I think he's going to want to begin some form of treatment regardless, but if a biopsy is likely to influence the choice of treatment, then I feel he should ask for one.

Hello again, mate.

It seems to me that the PSA rise and the follow up MRI, have been deemed enough, without a follow up biopsy, to take your dad off active surveillance and start HT and RT as a radical treatment.

As far as I'm aware. Your dad's PSA rise could be caused by several factors.

It could be that his intial Gleason score was correct, but the initial low grade tumour has grown, increasing in volume and producing more PSA. Or his initial biopsy was under graded and he has a higher Gleason score than first thought, producing more PSA. Or the new, as yet unexamined, tumour has increased his PSA. Or, it is still possible, a non-cancerous condition, has caused the PSA rise.

Whatever the cause, they have decided that RT and HT is the best treatment option for your dad. It is unlikely that a follow up biopsy would have changed this treatment plan, but personally I'd have asked for one.

In your early posts, you seem to think that RT and HT are not as 'curative' as surgery. As far as am aware they are equally effective.

Best of luck and please continue to keep us updated.👍

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