Suitably of CPG3 for Active Surveillance.

User

Posted 23 Jan 2026 at 19:14

I was diagnosed on 22nd December 2025. I’m 65 and generally in good health. The result of the biopsy was:

Two lesions pirads 4 (11mm & 13mm)

PSA 13.2

PSAD 0.33

3+4=7 with PNI

pattern 4 10%

longest length 14mm.

10 out of 15 cores positive

CPG 3

I have opted for AS. There were no other risk factors like EPE etc. I have now received my login for TrueNTH for surveillance and the first monitoring test is in one month.

Is AS a suitable choice? I’m pretty relaxed about the situation, but have read many stories now where treatment has been taken with what appears to be a lower risk category.

User

Posted 24 Jan 2026 at 00:40

Hi John,

Welcome to the forum, mate.

If your clinicians say you fit the criteria for AS. I'd give it a go. If things go awry you can always come off it and try something else.

I've just done a post on AS on another thread I'll see if I can find it and copy and paste it on here.

Edit: Found it. Its included in my first response on this conversation.

https://community.prostatecanceruk.org/posts/t33194-Advice-on-options-please#post313499

Edited by member 24 Jan 2026 at 00:54 | Reason: Add link

User

Posted 24 Jan 2026 at 01:18

Originally Posted by: Online Community Member

Hi John,

Welcome to the forum, mate.

If your clinicians say you fit the criteria for AS. I'd give it a go. If things go awry you can always come off it and try something else.

I've just done a post on AS on another thread I'll see if I can find it and copy and paste it on here.

Edit: Found it. Its included in my first response on this conversation.

That's Not My Neighbor

https://community.prostatecanceruk.org/posts/t33194-Advice-on-options-please#post313499

Thank you so much!

Edited by member 24 Jan 2026 at 01:20 | Reason: Not specified

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User

Posted 24 Jan 2026 at 00:40

Hi John,

Welcome to the forum, mate.

If your clinicians say you fit the criteria for AS. I'd give it a go. If things go awry you can always come off it and try something else.

I've just done a post on AS on another thread I'll see if I can find it and copy and paste it on here.

Edit: Found it. Its included in my first response on this conversation.

https://community.prostatecanceruk.org/posts/t33194-Advice-on-options-please#post313499

Edited by member 24 Jan 2026 at 00:54 | Reason: Add link

User

Posted 24 Jan 2026 at 01:18

Originally Posted by: Online Community Member

Hi John,

Welcome to the forum, mate.

If your clinicians say you fit the criteria for AS. I'd give it a go. If things go awry you can always come off it and try something else.

I've just done a post on AS on another thread I'll see if I can find it and copy and paste it on here.

Edit: Found it. Its included in my first response on this conversation.

That's Not My Neighbor

https://community.prostatecanceruk.org/posts/t33194-Advice-on-options-please#post313499

Thank you so much!

Edited by member 24 Jan 2026 at 01:20 | Reason: Not specified

User

Posted 24 Jan 2026 at 17:20

I don’t quite fit the criteria for AS. STRATCANS has AS for CPG 1 & 2. For CPG 3 it can be considered , particularly for non-MRI visible Gleason 3+4. I have two mid sized tumours and cancer in 10/15 cores, although pattern 4 is only 10%.

I am hoping to see similar people who are CPG 3 with similar biopsy outcomes on here who have opted for AS awhile ago and how they got on.

User

Posted 25 Jan 2026 at 08:19

Hi again John.

I'm a bit embarrassed to say, but until you mentioned it, I'd never heard of Stratcans, nor have I seen anyone mention it on here before.

When I was first diagnosed in 2020, they were just transitioning into CPG grades, cancer staging and risk stratification. I started a conversation on these changes and how they had changed NICE guidelines on those suitable for active surveillance.

https://community.prostatecanceruk.org/posts/t29997-T2c-disease-and-active-surveillance

I doubt anyone on this forum with CPG 3 will be on AS, but I may be wrong. Has your consultant deemed you suitable for AS?

I've inputted your details into the CPG calculator and it states:

Your Cambridge Prognostic Group is CPG 3

The prognosis from a CPG3 cancer is considered intermediate and depends on other factors such as age, general state of health and other medical conditions.

There may be a risk of the cancer spreading (metastasis) if left untreated. Treatment is therefore considered likely to be of benefit. Active surveillance, can be considered if a man is not keen on unable to proceed with immediate treatment.

Edited by member 25 Jan 2026 at 08:55 | Reason: Additional text

User

Posted 25 Jan 2026 at 08:54

There was some concern both on PSA density and core count. The STRATCANS tool didn’t allow input for CPG 3 which for me was the PSA >10.

PSA density is the value they referred to driven by PSA, but does allow for volume difference across patients. Mine at 0.33 Is above the 0.2 limit.

The core count I had two lesions on MRI each had three cores taken. All targeted cores were positive Then a grid of 12 more cores. Eight of the grid were positive.

The big positive was only 10% pattern 4 and no additional risk factors other than PNI which is common for my situation.

I think for as long as I can stay below 18 for PSA and remain T2 I’m happy to delay. The urologist agreed with that although set the PSA alert at 15

User

Posted 25 Jan 2026 at 09:13

I forgot to add. The urologist did mention that there were plans to extend AS to more cases of GPG3 specifically those with low percentage of pattern 4. I was wondering if anyone else on here might be in the same position.

User

Posted 25 Jan 2026 at 09:23

Hi again John.

On my profile, you'll see that my active surveillance failed and left me in a quite a precarious situation. Having said that, I'm a great believer in AS.

You seem very keen to push for AS and your urologist seems to have approved it, whilst your PSA is below certain limits.

The CPG calculator

https://cambridgeprognosticgroup.com/index.php

Definitely leans to treatment other than AS.

From my personal experience of AS, please ensure that you are thoroughly monitored.

Please keep us dated, and good luck, mate. 👍

Edited by member 25 Jan 2026 at 09:27 | Reason: Add link

User

Posted 25 Jan 2026 at 09:52

Originally Posted by: Online Community Member

There is no doubt that AS is being used far more than it was.

https://www.cancer.gov/news-events/cancer-currents-blog/2022/prostate-cancer-active-surveillance-increasing

It was once primarily used by those with low risk cancer (low grade Gleason 6(3+3), PSA <10, safely prostate confined PCa) but is now gradually being used more often for some intermediate risk, higher graded cancers.

I've been on the forum for the past 3 years and cannot recall anyone opting for AS with a similar diagnosis to yours. I think someone once had T2, Gleason 7 (3+4) but he had a lower PSA than yours.

User

Posted 25 Jan 2026 at 09:58

Cheers Adrian. Being positive about AS is in part for my benefit, keep the confidence high. Although I’m not officially a state pensioner for several months I have retired and have plans for 2026. Cancer treatments were definitely not on the list.

The monitoring is a prostatecanceruk initiative, TrueNTH first test is 24th February. Will update then.

I have some spreadsheets and written some code to predict PSA velocity and doubling time. Have some fun with the stats along the way.

User

Posted 25 Jan 2026 at 10:26

Originally Posted by: Online Community Member

Cheers Adrian. Being positive about AS is in part for my benefit, keep the confidence high.

It's great that you're positive and confident. You need that sort of attitude when you're on AS.

After surgery, I'm more anxious about getting a cancer recurrence, than I was on AS about possible disease progression.

Your AS may fail, about 30-40% of those on it, later need further treatment. However, 30% of those who have surgery or other treatments, also end up needing further salvage treatment.

My guess is, mate, that your AS, will give you at least a year or two of avoiding further treatment and the likely side effects of it.

Just ensure you keep yourself safe, so that if there is any disease progression, its dealt with in a timely fashion.

User

Posted 25 Jan 2026 at 11:17

Try sticking your stats in here:

https://www.mskcc.org/nomograms/prostate/pre_op

Gives you a risk based on thousands of previous cases.

Personally I would not entertain AS with a 4 in the G score, Certainly not with an 18 PSA score. Your consultant is not the one taking the chance - you are. So if the benefits of doing nothing suit you that's fine BUT I sometimes wonder why bother with a PSA and biopsy if you are not going to treat it...

User

Posted 25 Jan 2026 at 12:15

An interesting calculator. My prediction was 1 in 5 chance of spread and 70% chance of EPE. Doesn’t take account of the sliding scale of 3+4. It could be 2% pattern 4 and 2/12 cores with 2mm max length. Or 40% of pattern 4, 10/12 cores with 20mm max length. So maybe bias towards the more aggressive end.

You can’t predict how aggressive the cancer is from the PSA and even the biopsy might miss something, but do expect my PSA to remain well under 18 for at least a year. If not my PSAV would be over 4 and PSADT less than three years. That wouldn’t fit for a low percentage pattern 4 biopsy. Or remaining on AS. I had 18 cores taken so hopefully there isn’t some area of more aggressive cancer hidden.

Like Adrian I am considering that the end of the first treatment is also the start of the clock. If there is reoccurrence I’d rather that was when I’m as old as possible.

My treatment is active surveillance. I would never consider the risks of radical treatment outweighed the risk of living with G6. With my G7 I have a low percentage pattern 4 so it’s almost a G6. Worth the risk given my plans for 2026. And hoping for longer, but if not, I’m getting the information regularly that I need to choose a treatment.

My own analysis will I’m sure be more robust than the monitoring system. I have used the same mathematical analysis used in most major studies. As long as there isn’t too much variation in my results, after three results, I should be able to predict 12 months into the future.

If anyone is G7 and on AS I would like to hear your thoughts.

User

Posted 26 Feb 2026 at 14:48

Good news and a confidence boost from my PSA two days ago. My decision that I am suitable for active surveillance seems to be rewarded. There was always going to be some variation in PSA results. After all we are a biological machine, but 10.5 now gives me a good buffer below the alert value set at the MDT meeting. I expect it will be an MRI result (T3 or risk there of) that tips the scale against remaining on AS.

October 2025 PSA 13.2

February 2026 PSA 10.5

User

Posted 26 Feb 2026 at 15:42

Hi JohnPM

Your Gleason 3+4 is regarded as moderately aggressive. I had the same Gleason score with the cancer contained and clear negative margin and I opted for prostatectomy. That was 15 years ago and in spite of side effects I still think it was the right choice for me. My psychological state played a significant part in my decision. Have the consultants advised you to go for AS, if not perhaps you can discuss the details of the tumour and its closeness to the boundary etc. It is a difficult decision to have surgery.

'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.' Richard Feynman (1918-1988) Nobel Prize laureate

User

Posted 26 Feb 2026 at 18:00

Thanks for your insight very valuable. To wait or not for treatment is definitely a very personal decision. I think AS is gaining more traction as an appropriate option for favourable 3+4 recently. Not sure if NICE guidance will be updated, heard that it will be. Currently AS for CPG3 is recommended if the patient wants it. Rather than the primary recommendation like in CPG1&2.

Your observation about tumour size and location is definitely critical to the decision. I’m am predicting forward as best I can. My decision is definitely data driven.

Last November I had two tumours 11mm & 13mm in size. Not adjacent to the prostate edge. It’s been more difficult to find data on median tumour growth than for PSA velocity and doubling time. So it is a bit more of a rough estimate on my part.

For example predicting PSA change between results.

cP is current PSA

fP is future PSA at the next predicted test date.

λ Is the decay constant.

t Is the number of days between tests.

fP = cP × e^(-λ × t)

Then use linear regression for velocity and exponential regression for doubling time. Although it doesn’t work if the PSA results keep getting lower!

I have used 23% for tumour growth as it is the only data I can find from prostate studies. With volume growing by a factor of 1.23 I can estimate the increase in tumour diameter. Hence the change in distance from the edge. Looking forward using

V = (4/3) π (d/2)³

d(t) ≈ 13 × e^(0.0691 t) mm

0.691 is approximately natural log of the cube root of current 13mm tumour volume.

Using all this I predict both tumours remain smaller than 15mm and clear of the edge until the next MRI. Remaining on AS for five years is unlikely due to tumour growth in this model. A rough estimate, but it’s all I have for now.

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