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Not sure test results and recommended treatment match up
About eight years ago, after a routine checkup, I got a call from my gp that my blood workup produced a psa level of 14! Referred to head of Urology at a local teaching hospital. After a few more PSA tests that bounced around and settled in well below 10, I had an MRI. Good news: PI-Rads 2. Have been getting regular PSA screening at all of my yearly physicals, and the plan was we'd be ok if it stayed below 10. I'm now 71 and have a large prostate. Fast forward to my physical Summer of '24 and my PSA went to 10. Three months later 12. Back to the teaching hospital and an MRI came up with PI-Rads 5 lesion in the posterior right PZ with abutment of the capsule in the mid/base and possible extension into the right seminal vesicle. Fusion biopsy followed. 5 cores were taken from the "area of interest." 5 additional cores on that side of the prostate, and 6 additional cores from the left side. Of the 5 in the area of the lesion, one core had showed a tumor of less than 1 mm or 5% of the core with 3+4=7. Approximately 15% of this small tumor is grade 4. One core from the left side showed 3+3=6 (about 70% of the core). All other cores exhibiting benign prostatic tissue.
My Urologist is strongly recommending a prostatectomy. Main concern is the "possible" extension into the seminal vesicle and that there is some cancer in the lesion. It makes sense to get it out while the getting is good, but it seems extreme to me. Will be meeting with a radiation oncologist Monday and am scheduled for a Pet scan in a week. Half of me thinks we may be jumping the gun and half thinks this might be a golden opportunity to have it out and be totally done with it. Anyone else had this type of situation? Had they found 3 or 4 cores with a significant amount of cancer, I wouldn't hesitate taking the "nuclear option," but a bit torn about this decision. Thanks.
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I had surgery when I was a 3+4 at 62 years old. My father had radiation and died From PC. I figured I’d have surgery so that I could have radiation later, Which eventually happened after 3 1/2 years.
After surgery, they changed my Gleason to 4+3. This is very common, The initial Gleason score is just based on the biopsies, not your whole prostate. I started off as a 3+4 and 15 years later I’ve had four relapses, And waiting for my fifth, which will eventually come.
Unfortunately, there’s no way to tell you, whether or not the volume of cancer or lack there of reduces or increases your risk. Everybody is different. It’s not just the Gleason score that can give you an idea about what could happen, A decipher test can tell you a lot more About whether or not, you may have more issues in the near future.
I had surgery 15 years ago, Things have gotten a lot better with a different techniques of treating prostate cancer. You also have many other non-radiation treatments are HIFU, cryotherapy, TULSA-PRO or more (others here will recommend). Not all of them work in your case, but you Could investigate them.
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6 ReactionsHi 'petep', My diagnosis was similar to yours = 3+4 and on one side.
I chose RP since it would/could include seminal vesicles; which is did on the one side.
A follow-up MRI showed the prostrate area free of PC but I had a 'small spot' of PC on one rib.
While the docs and surgeon acted relatively fast (diagnosed in Nov 2021 and RALP in Jan 2022) it MIGHT not have been fast enough to prevent that "one spot" that necessitated ADT (Lupron for 24-months).
Yours also has some aggressive cells (the "4" in the biopsy) and is also near the capsule wall (as was mine).
Therefore, I'd add that there's no need to panic, but consider moving your team with all due haste. Continue your process of decision making with the obvious determination you have.
God Speed and a blessed resolution for you.
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2 ReactionsAs others have mentioned, any treatment you choose is not one and done. We will all be monitoring this for the rest of our lives. I chose Tulsa Pro at Mayo for Gleason 7 (4+3) in July. I liked the technology and much lower risk of side effects ( I have had none). What really sold me was when the radiologist told me that all other options were on the table if the cancer returns. My story:
https://connect.mayoclinic.org/discussion/tulsa-pro-experience-mayo-clinic-mn-july-2024/
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1 ReactionI am in the same situation as you . I have been on Active Surveillance for a year . My year-over-year Bone & CT scan was clear . I have planned a PEMA PET CT Scan .
My short list options at this juncture are NanoKnife , TULSA PRO , or Monotherapy SBRT .
NO ADT SHIT FOR ME - MY PRIORITY IS " QUALITY OF LIFE "
I also agree with jeffmarc , Your Urologist is a surgeon - Remove it ( not treat it ) Radiation Oncologists want to Radiate . You have many more options . Investigate all your Focal Therapy options . Immunotherapy , HIFU , Cryoabalation , NanoKnife , TULSA PRO - etc.
p.s. Can you purchased Dr. Patrick Walsk's 5th Edition book " Guide to Surviving Prostate Cancer " ? A must study book , to educate patients to make " An informed - Educated Decision " . Not an uninformed knee jerk decision you will regret .
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1 ReactionIn 2009 I had 4 lobe biopsy at VA. 2 lobes had cancer, 1 was a maybe, 1 clear. I went to Mayo Clinic Rochester 2 months later for removal. All 4 lobes had cancer. Point is, biopsies can't always tell what type and how aggressive the cancer is. Watching and waiting gives cancer a chance to spread. Now at age 76, I'm glad I had a prostatectomy and I'm still alive. I've had three cancers, all bad, all different, surgeries for all. My thought on cancer: if a tick gets on me, I want it off before it bites. If I have cancer, I want it out before it spreads. Has worked well for me. Best wishes on whatever track you take. You can get through this..
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