Gleason 6 (3+3) treatments

Clandeboyle,

I chose radiation, 5 fractions in two weeks in Rochester, MN. I thought it had the least amout of side effects and way less evasive than surgery.

Don't kid yourself Gleason 6 - IS CANCER . Furthermore when a Pathologist performs a report on a removed prostate after a prostatectomy they often UPGRRADE the Gleason score they thought , prior to the surgery . Therefore if a 2nd Pathology report is performed on your Biopsy slides - the also often find a higher grade of cancer - If 6 , an upgrade to 7 .
Be cautious . Check your PSA , DRE and an MRI with the T3 machine ,not the old T 1.5 , with & without contrast for improved picture clarity to determine if there are any changes in your cancer growth .
Have the MRI prior to moving to any 2nd , 3rd etc Biopsies . I.E. Use the latest MRI for your TRANSPERINEAL ( NOT TRANSRECTAL ) MRI Fusion Biopsy . - Get the Gold standaard REAL TIME , IN- BORE BORE OR GANTRY BIOPSY . If available in your area .
MRI Fusion Biopsies are NOT - REAL TIME as claimed by most Uncologists .
Fusing your MRI with the Biopsy equipment software can slightly muddy the targeting accuracy .

Good points. I have never considered Gleason 6 to be anything else but cancer, it is the Mayo Clinic and others that are debating the issue between irregular cell, and cancer. Whatever anybody calls Gleason 6 it does not change the dangerousness of the situation, especiaaly in my case with a father who at 64 his Gleason 9 escaped the prostate. I am 58 and had a small lesion Gleason 7 removed from one side of the prostate along with all of the Gleason 6. The other side still has Gleason 6. My PSA Yesterday was 2.5 down from 4.4 in December. I have an MRI scheduled at Mayo in rochester in September with contrast. I will check to see what MRI machine they are using. I have learned that fasting for the right amount of time can slow down digestion, and give much better pictures. I don't have any illusions that the HIFU I had last year will be my last treatment. Thanks for the reply, and good information!

I haven't decided on any treatment yet, mainly because I haven't been offered any yet. As my PSA just jumped up to 6.4, I suspect he may offer something now, but I never know what this guy is going to say and he's very difficult to even talk to. I have requested a 2nd opinion, but that may take 4 - 6 months in Canada (if they even allow it).

Joe

PSMA PET scan should be able to identify location of any cancerous lesions w/ PSA over 4.
Individual lesions may be able to be radiated.
Or the scan will assist in determining next options.
Best wishes (layman not Dr here)

Always have an Enema for a rectum cleanout before your MRII .

I'm not sure where you live in Canada . Near Toronto you will not wait for months for a 2nd opinion .
Regarding an MRI after all this time I would go to Buffalo , ProScar or Windsong in Williamsville -- $ 536 USD wait time a few days or 2 weeks .
Any Urologist worth his salt would request a CURRENT MRI to see what has changed plus use this recent MRI for a MRI Fusion Biopsy .
You may also consider a Liquid Biopsy ( Biomarker Test ) to determine the aggressiveness of your cancer .

Four months ago, Gleason 3+3=6 ; 40% of one core of 12 was abnormal at biopsy. Low risk Grade Group 1; MRI was clear prior to biopsy. PSA was elevated at 6.4.

Treatment discussion: Possible RARP or radiation treatments discussed but agreed presently unnecessary.

Active surveillance underway via repeat PSA 6 months after first biopsy. Will consider repeat biopsy one year after the first.

Generally you would get an MRI. If anything is found they can do a directed biopsy toward any lesion. Generally a positive biopsy will drive the MRI. Generally no need to get a biopsy once you know you have cancer until they can see a lesion to biopsy in the MRI. If you did a biopsy first and they found a lesion in the MRI you would likely have a 2nd targeted biopsy.

If I had 1 core out of 12 with Gleason 3+3 = 6 , I would immediately request a 2nd opinion of my Pathology Result . Additionally for your Doctor to suggest RARP or Radiation up ffront is very concerning . IS HE A UROLOGIST or your GP. ?
I don't know a Urologist who would propose this treatment in your circumstance .
Get a 2nd Urologist opinion in addition to a 2nd Pathology reading .
On active surveillance " Regular scheduled PSA , Plus an MRI 1 year out from your original diagnosis to determine if there is any change in your tumor . If so , this would be followed by a 2nd Biopsy . Always a current MRI before each Biopsy .
Read Dr. Patrick Walsh's 5th Edition Book " Guide to Surviving Prostate Cancer " -- Educate yourself . Buying this book will be the best money you will ever spend .