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Thank you all so much for the support.
Here is my thought process.
I have been reading several Pubmed papers, used perplexity.ai, Read about 105 pages on Dr. Walsh's book yesterday.
**FACTORS**
1. PSA went up from 1.2 in 2016, 1.86 in 2017 to 4.3 in 2024
2. Free PSA 6.9% (Sept 2024) (not a good number according to Dr. Walsh's book)
3. PSA density: 0.19 (statistical threshold limit is 0.15)
4. mpMRI found three lesions: Right anterior TZ in the apex to mid gland (1.4cm), Left posterior medial PZ in the base (0.4cm), Left posterior lateral PZ, mid gland (0.8cm)
5. 26 cores were taken in Biopsy.
6. Adenocarcinoma found in Right anterior medial (2 out of 2 cores: 50% and 30%)
7. Adenocarcinoma found in Left Anterior Medial (1 out of 2 cores: 30%)
8. Adenocarcinoma found in (ROI)-Right Anterior Apex-mid TZ (2 out of 3 cores: 60% of total tissue: Don't know why this does not say the % in each sample)
9. HGPIN in Right Base (statistically 25%-36% chance of developing cancer later)
10. HGPIN in Left Posterior Lateral (statistically 25%-36% chance of developing cancer later)
11. Atypical (ASAP) in Left Base (statistically 30% to 40% chances to be diagnosed 3+4=7 later on repeat biopsy)
12. My Report says Gleason score 3+3=6 (Grade 1)
**My Inference**
1. If Lesion in Right anterior was 1.5cm or more, it would be PIRAD 5
2. Percentage of adenocarcinoma in 5 out of 26 cores is 19.2%
3. PSA level jumped 109% from 2017 to 2023
4. Appears to me that my case is sitting on the upper limit of what is typically considered for active surveillance due to the volume of adenocarcinoma and PSA density.
**Question**
1. Is this still reasonable to watch and wait?
2. Is it okay to ask a surgeon if he does or has done a lot of surgeries using bladder neck preservation and nerver sparing techniques?
Replies to "Thank you all so much for the support. Here is my thought process. I have been..."
Doesn't look like any reason to rush. When I was first diagnosed at 3+3, I consulted with 4 urologists. All said just to watch it. Recommend you seek additional opinions.
Did you watch that video?
It discussed the over treatment of people with 3+3.
Why don’t you do the testing we recommended and see what it shows. Don’t panic until you have more information. Decipher and PSMA pet Will tell you a lot. A PSE test will tell you whether or not there is cancer in your body, Since 3+3 doesn’t always indicate cancer.
Yes, many RO’s And urologist will treat you with a 3+3.
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It seems to me as a layman that you would just be watching and waiting for things to get worse.
And as far as bladder neck preservation goes, ALL surgeons do this - the only thing that would prevent it is deep invasion of cancerous cells into that area. So I wouldn’t focus too closely on this one aspect. JMHO