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Gleason 6 (3+3) treatments

Prostate Cancer | Last Active: 2 hours ago | Replies (69)

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Hi, I’m a prostate cancer patient not an MD so please understand that my comments reflect my personal experience and are not medical advice.

May I respectfully ask what your last PSA number was?
Also may I ask whether you are having a “standard” PSA test or whether you are having a PSA -ISO test (PSA with reflex)?
Did you have an MRI guided FUSION biopsy or random?

It’s been my understanding that true Gleason 6 cancer never becomes a problem. The question then becomes whether your biopsy was thorough enough not to miss significant disease that would raise the score to a 7 or higher. My single biopsy showed a Gleason 6 and missed significant cancer that would have resulted in a score of at least 7. When the biopsy results didn’t match my MRI scan I should’ve insisted on a follow up biopsy before agreeing to treatment that didn’t eliminate the cancer the first time around.

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Replies to "Hi, I’m a prostate cancer patient not an MD so please understand that my comments reflect..."

Hi and thanks for the reply. My PSA is a 4.3, but I'm in Canada and I think they measure it differently. However, I was told it is within the normal range. I think it was just standard PSA as the ISO does not ring a bell. My biopsy was not MRI guided (just ultrasound), was 12 cores and only 1 core had the cancer and they told me it was a small amount. However, the biopsy also said my prostate was only 37cc in size, and the followup MRI said it was 62 cc, and the doctor told me the MRI is far more accurate, so that makes me wonder if they missed something in the biopsy as you say. The MRI didn't detect any tumors. Can I ask what treatment you had and how effective it was? Thanks Joe

Just curious. You said you had a "single biopsy" of your prostate. That is odd. As an Interventional Radiologist, we were doing US guided biopsies in the 1990s before the Urologists started doing them and eventually took over that procedure. Even back in the 1990s we were doing 8-12 biopsies throughout the gland. Of course, no biopsy of any organ can exclude cancer. You are taking a very small sample relative to the entire size of the gland and can miss tumor on the biopsies. As you allude to, using fusion guided techniques to guide the biopsy to any suspicious areas is very helpful. If the biopsy is negative for cancer or yields a G6, there should be short term follow up PSA. A 20% or more rise in the PSA over one year is concerning and usually warrants further investigation.