Connect
Choosing Active Surveillance over any further treatment at this time
This is a new comment , not related to the last post I'm not sure how to start a new thread but this is my issue and feel free to reply with any insights . I'm 68 and over the last 2 years I've had my PSA tested 4 times - each test with a lower number than the last . I also had a 3T-MRI which showed a small 5mm lesion contained in my prostate with no sign of migration . My health care provider ( Kaiser - California ) will not approve any other test ( i.e. PSE , PSMA etc. ) I don't know if I can even talk them into a follow up MRI as it took me 2 months to approve of the first one after being rejected over and over ..... here is the reason I'm choosing AS over any further treatment at this time :
When considering the life expectancy and mortality risk between two 68-year-old men, one with untreated prostate cancer (PSA = 8.6, Gleason score of 3+4) and the other with normal PSA and Gleason levels (no prostate cancer), several key factors must be taken into account, including the severity of prostate cancer, overall health, and other potential causes of death. Let's analyze the two scenarios in detail.
1. 68-Year-Old with Prostate Cancer (PSA = 8.6, Gleason Score 3+4)
PSA Level (8.6): A PSA level of 8.6 is elevated and suggests the presence of prostate cancer, though it’s not extremely high. PSA levels can fluctuate and are influenced by several factors, but PSA is a primary marker used to detect prostate issues.
Gleason Score (3+4 = 7): A Gleason score of 7 indicates intermediate-grade prostate cancer. This means the cancer is more aggressive than a low-grade (Gleason 6) cancer, but it is not as aggressive as high-grade cancers (Gleason 8-10). Gleason 7 cancer has a moderate likelihood of spreading beyond the prostate if left untreated, although many men with Gleason 7 prostate cancer live for years without it spreading aggressively.
Life Expectancy & Mortality Risk:
Life Expectancy: For a 68-year-old man with untreated Gleason 7 prostate cancer and PSA of 8.6, life expectancy will be influenced by several factors:
Prostate Cancer Prognosis: Untreated prostate cancer with a Gleason score of 7 (especially 3+4) is typically not immediately life-threatening. However, the cancer may spread over time, affecting the individual’s overall prognosis. While some men with intermediate-grade prostate cancer can live for many years with good quality of life, others may experience progression.
Overall Health: If the person is otherwise healthy with no significant comorbidities, life expectancy could still be in the range of 15-20 years or more, though this could be shortened if the cancer progresses and metastasizes.
Mortality Risk:
Prostate Cancer Mortality: The risk of dying from prostate cancer in this case is moderate but not extremely high. Untreated, Gleason 7 cancer can eventually lead to metastasis, and advanced prostate cancer can become life-threatening.
Death from All Causes: The individual’s risk of dying from other causes (e.g., heart disease, stroke, accidents) is still significant, given age and the fact that prostate cancer is just one factor. The presence of cancer increases mortality risk compared to someone with no cancer, but the risk of death from prostate cancer itself is moderate.
2. 68-Year-Old with Normal PSA and Gleason Score (No Prostate Cancer)
Normal PSA and Gleason Score: In this case, there is no evidence of prostate cancer. The person’s PSA is within normal limits (under 4.0 ng/mL) and their Gleason score is not applicable, as there is no cancer present. This person does not face the risk of prostate cancer, which significantly impacts overall mortality and life expectancy.
Life Expectancy & Mortality Risk:
Life Expectancy: This individual is generally expected to live as long as the average 68-year-old. The life expectancy could be around 15-20 more years, depending on their overall health and lifestyle. Without cancer, they are not facing the additional health risks associated with untreated prostate cancer.
Mortality Risk:
Death from Prostate Cancer: There is no risk of dying from prostate cancer in this case.
Death from All Causes: Mortality risks are similar to the general population, depending on comorbidities and lifestyle factors. Cardiovascular disease, respiratory conditions, or other chronic conditions become more relevant risks with age.
Comparing Life Expectancy and Mortality from All Causes:
68-Year-Old with Prostate Cancer (PSA 8.6, Gleason 3+4)
Life Expectancy: Likely in the range of 15-20 years or possibly more, depending on the progression of the cancer and any other health factors. The cancer could progress, but Gleason 7 prostate cancer is typically not immediately fatal, and many men live for years with untreated or managed prostate cancer.
Mortality Risk:
Prostate Cancer Mortality: Given the Gleason score of 7, the risk of dying specifically from prostate cancer is moderate. Without treatment, there is a higher likelihood of progression to metastatic disease, which can increase mortality risk.
Mortality from All Causes: Increased risk of mortality from other causes (such as heart disease, stroke, etc.) compared to someone without prostate cancer.
68-Year-Old with Normal PSA and Gleason Score
Life Expectancy: Likely to be in the range of 15-20 more years, depending on overall health and lifestyle factors, since there’s no prostate cancer or other significant health issues.
Mortality Risk:
Prostate Cancer Mortality: Zero, since there’s no prostate cancer.
Mortality from All Causes: Similar to the general population for a 68-year-old, with risks increasing as the individual ages, but not specifically elevated due to prostate cancer.
Conclusion:
Life expectancy for both individuals is relatively similar, but the 68-year-old with untreated Gleason 7 prostate cancer (PSA = 8.6) may have a slightly reduced life expectancy due to the cancer’s potential to spread over time. However, many men with Gleason 7 prostate cancer live for many years without significant symptoms.
Mortality risk from prostate cancer is moderate for the person with Gleason 7 cancer, and their overall mortality risk (from all causes) is likely higher than that of the person with no cancer, due to the additional cancer-related health risks.
The individual with normal PSA and Gleason levels, being cancer-free, has a life expectancy similar to the general population, with typical risks associated with aging. Their risk of dying from prostate cancer is zero, but they may face the usual age-related mortality risks.
Overall, the 68-year-old with Gleason 7 prostate cancer has an increased risk of dying from prostate cancer and possibly a slightly higher overall risk of death from other causes, compared to the person with no prostate cancer. However, their life expectancy may still be fairly similar to the average for their age, especially if the cancer remains indolent and untreated.
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
Are these YOUR Gleason scores? Don’t see a biopsy in your history. Without a biopsy you can’t compare these scenarios to your particular situation.
-
Like -
Helpful -
Hug
4 ReactionsThere is a significant difference between Gleason 7 (3+4) and (4+3).
-
Like -
Helpful -
Hug
3 Reactions@ovstampco, I made your comment into its own discussion as per your request. See here:
- Choosing Active Surveillance over any further treatment at this time https://connect.mayoclinic.org/discussion/choosing-active-surveillance-over-any-further-treatment-at-this-time/
You must do what is best for YOU, overall, whatever that may be. If I had 3 + 4 at 68 and was otherwise asymptomatic then I might also choose AS. You aren't choosing to ignore this, you are choosing to watch it. Also, grade 6 is not really considered cancer by most measures today, so if you are 3 + 4 and not 4 + 3 then it's the same boat I was in when I was told that AS was best - until my Decipher said otherwise.
That Decipher was a big deal, and it was right. It said it was more aggressive than the biopsy said and when they removed my prostate it was worse and my cancer stage was upgraded. Perhaps that would be worth doing?
I'm glad you at least are keeping an eye on it. 68 today isn't what it was 20+ years ago where life expectancy was mid 70's, now it's late 80's - and why they keep moving the bar on social security. So you could have 20+ more years left in you and hopefully you'll be around to hang out with your friends, hug your grand kids or great grand kids and still be golfing!
-
Like -
Helpful -
Hug
5 Reactions@heavyphil
I agree with your question. Without a Gleason score, you really don't know what level of cancer you have or that you even have it. After the Gleason score which requires biopsies then you can get into Decipher, PSMA, etc.
I don't see where the poster had a biopsy and got a Gleason score. So, like I was when I got my MRI, they found suspicious areas. I was given a 70% chance that it was prostate cancer but until my biopsies were done, I was not a confirmed patient with prostate cancer thus not level, stage, type, etc.
I was 76 when I got diagnosed and got radiation treatments. It is a personal decision to have or not have treatments. Life expectancy is a statistic and does not reflect what your life span will be. Some individuals live into their 100s, some die very young, so statistics are just a mixture of numbers coming out to be a normal number. The type of medical and mental care you get goes a long way to your life expectancy along with self-care.
-
Like -
Helpful -
Hug
2 Reactions@ovstampco
I do not see that you had biopsies taken. That would give you a specific Gleason score. Did you have biopsies done?
Until you get a Gleason score you do not even know if your lesion or area seen is cancer. Many times suspicious areas are not cancer. When trying to decide on treatments you first need to know if you even have cancer. Then the level of it, the type, and risk level. Gleason scores are not perfect either they are subjective. Most urologist and R/Os will recommend Decipher test which more accurately define the level of risk of your cancer and then the medical provider can suggest appropriate treatments.
-
Like -
Helpful -
Hug
1 ReactionTo ovstampco:
I'm 73, Stage 4 dealing with it for 10 years, so I've been there and done most of that.
I read all the messages regarding the original post. And, I have to agree, it appears there is a lack of adequate information to determine exactly where you are in your journey. It's difficult to plan the best path forward. My opinion, why would a patient roll the dice, "hoping" for the best outcome, knowing if things don't go as wished, the outcome is dismal, instead of addressing the available medical treatment options head on and taking "luck" out of the equation. Everyone is different, best of luck, and stay positive.
-
Like -
Helpful -
Hug
4 ReactionsI might be wrong but this post to me looks like AI analysis of too many parameters with so much repetition and so on, so without reading all of the possible scenarios I would just advise (from personal experience) that you do biopsy of that lesion that is seen on MRI. Only after you know your gleason score you will be able to make any plans for surveillance. If you choose active surveillance than make sure you have MRI AND biopsy every 2-3 years or you will be living without knowing what is going on with your prostate. That gleason 6 can turn into 4+3 just like that.
-
Like -
Helpful -
Hug
4 ReactionsThe other piece I'd recommend is genetic testing. It's simple and non-invasive, and the presence or absence of mutations to (e.g.) BRCA1 and BRCA2 can give an early warning that the cancer's likely to become aggressive.
-
Like -
Helpful -
Hug
4 ReactionsWell written assessment, based upon your assumptions. However, as stated by others, you have chosen to use favorable assumptions.
Ultimately, I respect your own risk tolerance. Since you are asking for our opinions, I will offer mine.
If the assumptions were slightly changed to Gleason 7 (4+3) with a high Decipher score, the assessment in terms of quality of life changes significantly. Even adding the relatively inexpensive PSE, when considering the implications, provides some data to either support or contradict the assumptions.
With the slightly changed assumptions, the timing of treatment make a difference in the quality of life, if not life expectancy.
Factually, many of us have experienced, with lower PSA scores, biopsies that revealed PCa to be more prevalent than scans initially indicated or in the case of surgical first treatments, that the PCa had spread to the margin of the prostate, which often leads to PCa cells escaping the prostate and an eventual series of secondary treatments.
All of those less optimistic scenarios can be de-risked with a PSE test and if cancer calls are detected, an MRI guided biopsy accompanied by a Decipher test.
If the biopsy and Decipher confirmed Gleason 6 or even a Gleason 7 (3+4), you would have the normal data and assumptions to support your initial assessment.
-
Like -
Helpful -
Hug
5 Reactions