Gleason 6 (3+3) treatments

@joel1
I would suggest getting a second opinion. 3+3 is considered low and at level they usually have active monitoring. A MRI can miss a lot of cancers. A biopsie can also as only taking tissues from certain areas.

Do you live close to a Mayo Clinic? How about Cleveland Clinic. There are many other top quaility medical facilities but try to find a oustanding one treating prostrate cancer.

I was told, the major reason for biopsy it to see if an MRI is needed. Now that you know you have irregular cells or cancer, an MRI w ill show when it progresses to a lesion, and then you can have a directed biopsy to see if the lesion needs to be removed. I used HIFU to remove my lesion.

Thanks. The MRI was done with contrast and they told me they just got a new magnet and the latest software. They rank your MRI outcome and mine was a 2 out of 5, which said "unlikely to develop any cancer", which I thought was interesting as we already know I have cancer.

I also have BPH and the doctor gave me Dutasteride (Avodart), but I'm afraid to take it as one of the side effects is that you develop a very aggressive cancer. However, if I don't take it he says I will need TURP surgery which also has side effects.

Joe @ 2 weeks short of a year sense surgery I still use lightest pad all the time. Most of the leaks are from dribble after urinating. Doing pt training now but I am not sure helping. While on feet working need to pee 10 times a day. Off feet can go hours without. I am talking to surgeon next week about this. As far as ED I posted on this form “Trimix good or bad idea” for more detail. Yes nature errections are back but not great . I had trouble before surgery. I am doing good and feel good about my decision to have surgery in my case cancer was very close to spreading outside the prostate. Surgery was robotic nerve sparring. I am now 59 will be 60 in a couple weeks. Not all Gleason 6 are the same some can be worse and many others can just do active servalance. May you find the correct treatment for yourself and have peace with that decision.

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.

It's actually the other way around. If the Urologist is suspicious enough to consider a prostate biopsy (>20% rise in PSA over 1 year, payable nodule on DRE, etc), an MRI before the biopsy is helpful to determine if there are any suspicious areas to particularly target in addition to generalized biopsy of the entire gland. It is always preferable to begin with the least invasive test and then progress to biopsy.

Thanks for your comment and question. I’ve see some of your other comments and they’ve always been intelligent and considerate. Kudos!

My apologies for not being clear regarding my comment. I only had a single biopsy experience January 2020. It was a US guided transperineal stereotactic mapping biopsy and they took 25 cores. My insurance (Aetna) would not authorize payment for anything more than a random TRUS biopsy so I paid the difference. MRI of December 2019 previously showed a 1.4 cm x 0.9 cm Pi-rads 4 lesion in the right anterior peripheral zone at the apex of the prostate. The biopsy revealed Gleason 6 (3 +3] (Grade Group 1] tumor in one of 4 cores 5mm discontinuously involving 25% of submitted tissue from the right anterior apex.

My November 2019 PSA (prior to the MRI and the biopsy) was 4.75. My next PSA reading was May 2020 (6 mos later) when the PSA jumped to 6.51. No further PSA tests, biopsies, or MRI’s were taken before I underwent focal brachytherapy in June 2020. I distinctly remember calling the RO and asking if we needed to repeat the MRI or biopsy with the precipitous rise in PSA in mind and I asked to have a decipher test run on PCa positive sample. I was told that none of that was necessary. All this was in the middle of the pandemic and I was assured that no further investigation was needed. That turned out to be incorrect.

MRI and a PET-PSMA scan in December 2023 showed two PI-RADS 5 lesions and involvement of two local lymph nodes. Two different medical teams from different center of excellence hospital systems weighed in with their belief that the 2020 biopsy missed significant cancer. I had salvage RP Jan 2024. The pathology showed Gleason grade 9 in one lesion and grade 8 in another EPE and a positive margin. The prostate bed was clear. I lymph node tested positive for PCa and a second suspicious lymph node could not be safely removed and will be treated with salvage RT. My post RP nadir was 0.40. I started Orgovyx and Zytiga in May 2024. My PSA is now undetectable. I start RT on the lymph node basin the first week in June. My outlook is hopeful.

I thought I was well educated in 2020 but I now realize that it would have been smarter to “pump the brakes” and seek a second opinion rather than rush into an experimental procedure that failed.

Thanks for the clarification. Good luck to you! Your outlook is hopeful.

Joe1, sounds like you definitely need a second opinion or a new doctor. Per your question, there are always risks associated with any of the PC treatments. With surgery, there is always a chance of incontinence and impotence, but this is significantly reduced if you have the radical prostatectomy at a center of excellence. I went with a robotically assisted radical prostatectomy 1.5 years ago. I had some incontinence and impotence for a few months, but both came back with time.

There are so many stories where men decide to go with active surveillance based on MRIs and biopsies. For myself, I just can't understand this option, unless there are other comorbidity issues (illness, other life limiting issues, significant age, etc.). Cancer is very tricky and can be deadly if not controlled or removed. When doctors say there is no need to address PC at Gleason Score 6, they are 100% trusting imperfect imaging tools and/or biopsies. For myself, I would be unwilling to roll the dice when it comes to cancer, regardless of GS rating of 6, 7, ...

It is important to keep a positive attitude and trust in the decision you ultimately make.

Good luck and hope all goes well.

Jim

My apologies for the mis-statement. I should have said I had a single biopsy procedure performed. The biopsy consisted of 12 needles/cores. Only 1 of the 12 cores had cancer in it, but it was US guided, so I think it was just a blind grid pattern.