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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.

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 

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,

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?

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!

 
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