Excuse the length but I think it is a very interesting and rarely discussed case.
I am 70 years old, in good health, with a PSA of 7.52. According to my biopsy, 5 out of 12 samples show Gleason 3+3 in the peripheral zone, all on the left side and in less than 50% of the tissue, which would be classified as T2a.
According to an MRI, there is a PIRADS 4/5 lesion (11mm) in one of the same areas indicated by the biopsy, and two lesions (also 11mm) in the transitional zone—one on the right and one on the left. There is no extraprostatic extension or metastasis according to biopsy, MRI, CT scan, and bone scan.
It has been demonstrated that cancers in the transitional zone are much less aggressive than those in the peripheral zone.
One of my oncologists thinks I am still a T2a and can continue with active surveillance (AS) since the lesions in the transitional zone shown in the MRI (assuming they are cancer) would be even slower growing because they are in the transitional zone.
But the other oncologist says no, that I move to T2c because I would have bilateral cancer and wants me to choose between prostatectomy or brachytherapy, and no longer AS.
Both consider that a biopsy of the transitional zone is not necessary.
Putting aside the literal clinical guidelines (which I believe apply to the peripheral zone), why, in practice, should some supposedly small and indolent adenocarcinomas in the transitional zone change my staging from T2a to T2c and prevent me from continuing my AS treatment? Does any of you have experience with cancer in the transitional zone? What do you think?