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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.
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@ovstampco
I can see others responding to your concern over infections.
First a biosy is not over invasive. There are two methods. Transrectal and Transperinial.
Transrectal comes with a 1-2% (some will give different % but this came from my Mayo urologist). And yes that infection can be very serious. However with this procedure that do have anti biotics given. It is usually done without anesthesia and a lot of us don't like that. The urologist goes in our rectum and then up into prostated to do biopsies.
Transperinial is usually done with anesthesia. The risk of infection is very very low. The scrotum is used to access the prostate. You are asleep an thus don't feel anything before, during, after. I had my biopsies done transperinial and it was very easy. I had no pain afterward. If they had not told me it was over I would not have thought it was done.
Remember PSA are only something to watch. A PSA at or below normal levels does not mean you do not have cancer. I was 3.75 (Below 4 is considered normal) and I had prostate cancer. I higher than normal PSA does not mean you have cancer. It could be BPH or infections, or irritations. Whay my urologiest and R/Os stated is the steady rise of PSA levels that are most concerning and the cause of it needs to be diagnosed.
I and many others can give you our experiences with biopsies. They are a very common surgery and if you have transperineal it comes with very very low infection and very little discomfor or any at all like I had.
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Hug
4 ReactionsIn reply to ovstampco, you said Kaiser would not allow a follow up biopsy to your MRI which showed lesions. Are you on Medicare? Medicare approved every step of my prostate cancer evaluation. And with Medicare you can go to any Dr. / hospital.
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Hug
1 ReactionJust an update , I received the results of the latest PSA test - it came back as 10.3 . So over the last year and a half the numbers have been , in order : 10.9 , 11.0 , 8.6 and 10.3 . So I'm going to keep on AS for the time being - my next test will be in about 6 months . This is keeping with the plan of monitoring unless the numbers unless and until they hit 13 or above in which case I'll get the biopsy and if the gleason score is worse than 3+4 I'll prepare to throw the kitchen sink at the issue . I guess the one positive note is at this time the numbers aren't increasing ....
A couple other things maybe someone can explain to me - there was a note on the report under " Free PSA " giving a number of .68 - what is the relevance of that number ? Also , to clear up a previous question I do not have BPH - my prostate size is 35 cm in volume . Last question .... I keep seeing comments about the PSE test and that its 93-94% effective in distinguishing aggressive vs. indolent cancers - why is this test not recognized as being credible with most health care providers ? It's not invasive and sounds to be very accurate - what's the problem ? It seems to me that it would be an invaluable tool for many people .
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2 ReactionsFree PSA: https://www.healthline.com/health/prostate-cancer-free-psa#purpose
I'm a little confused ..... my report said my free PSA numbers were .68 ng/ml is that bad ? The number doesn't seem to correspond to the numbers on the listed charts ... like 0-10% and over 25% - so .68 is very unfavorable ?
It is the reason why forums such as this are critical. The adoption of better tests and treatments are slow annd especially through insurance provider approvals, unless you are being treated by the best at the leading PCa centers. It is now easy to find PSE test centers.
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Hug
2 ReactionsAccording to the chart posted on the website @survivor5280 provided, .68 (or 68%) is very favorable…
My general comment would be that you’re trying to understand too much at once. First, get the basics straight; then, just one step at a time understand the next to build on that knowledge,
> you’re 68y; have had 4 PSA tests in the last 2 years; each test with a lower number than the last.
—> You don’t mention what those PSAs were or what your % Free PSA is, so there’s no way to know what to do with that information.
> you’ve had a 3T-MRI which showed a small 5mm lesion contained in your prostate with no sign of migration
—> But, you don’t mention the PIRADS scores, or whether there were any other suspicious issues.
So far, you haven't specifically mentioned anything that would even warrant a biopsy, much less a PSMA PET scan. For that matter, you also haven’t mentioned anything that would even warrant active surveillance or any treatment at all.
What are all of your numbers? With those it will be possible to consider what steps should be next.
(With a low-grade, localized prostate cancer, I was on active surveillance for 9 years, before eventually being treated with proton radiation.)
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1 ReactionIt’s important to be sure that you get the units right on the free PSA number. If it’s a percentage, then .68 would be 68%. But if your total PSA is 10.3 ng/ml and your free PSA is .68 ng/ml, then your free PSA percentage is .68 / 10.3 = 0.066 or 6.6%.
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3 Reactions@ovstampco Have you purchased Dr. Patrick Walsh's book " Guide to Surviving Prostate Cancer " or followed Dr. Mark Klotz U Tube Videos on Prostate Cancer to educate yourself ?
Did you know individuals with VERY , VERY LOW PSA numbers can have aggressive PC . Also those with VERY, VERY HIGH PSA numbers may not have prostate cancer ?
Did you know PSA' s can be in the thousands ? The highest recorded over 20,000 - Yes over twenty thousand .
As requested by others on this forum we require more minute details of your situation before commenting with any specific authority .
Good luck .
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