Newly diagnosed with prostate cancer and still gathering information

It does sound a bit aggressive, IMO. A Decipher score of .51 is not terrible and just 2 cores of 3+3 is pretty much active surveillance.
But non invasive approaches, such as TulsaPro mentioned by @datatech or HIFU are better ways of dealing with your cancer at this point.
Remember , NO treatment is definitive for PCa - it can always come back no matter what. So take it slowly, keep your powder dry and let your treatment unfold step-wise, least invasive option first.
Your urologist will argue because he probably only does surgery, so you may need to seek help elsewhere.
Remember, you can always do surgery later. Best,
Phil

I got the same from the first urologist I saw with the same “if you don’t have surgery now you may not be able to have it later” he of course is a surgeon. Nothing positive about any other options. Radiation was mentioned in passing but wasn’t discussed except to say that he would not recommend it. His office called an hour later to set up the surgery. That’s when I decided there was time for a second opinion.

The results of your biopsy do not confirm what your doctor wants to do. You were working with a urologist it sounds like. Urologist do surgery, That is their answer to prostate cancer.

Someone with a Gleason six, and only two cores out of 10, would normally be put on active surveillance, not surgery. Yes, the decipher score shows you have a medium chance of something happening, But you could be on active surveillance for years before something actually happens. There’s been a lot of meetings lately where doctors discuss being over treated when someone has a Gleason six.

You should get a second opinion from a center of excellence or a Genito urinary oncologist, The ones that specialize in prostate cancer. Yes, at age 56 surgery may be a better option, but active surveillance may be an even better option for you.

Here is a video with Dr. Laurence Klotz, one of the experts on active surveillance. He can give you answers as to why you would or would not be a good candidate for active surveillance.

Sorry to hear...it was a shock to me 5 years ago with a very similar situation. The Gleason indicated an aggressive cancer but still contained and my PSA was 4.7, my prostate wasn't enlarged at all. After seeing two surgeons and one radiation specialist all three said I have to do something before it spreads out...well shit!!! One of my buddies had DaVinci robotic 5 years ago and still is incontinent, another choose radio active seeds but his wasn't aggressive and he is doing fine...I choose from a bunch of recommendations Dr Catalona at Chicago Northwestern for a radical prostatectomy. I never had incontinence from day one...but I have to use injections still for sex...but it works pretty well. Do your research and be thankful you found it...I am now 70 and my PSA every 4 months since is undetectable...your life will be different but you'll be alive and pretty normal

I'm also sorry to hear of your diagnosis. Back in October I was completely shocked when I was diagnosed with pc at 54 years old and no family history. My PSA had been gradually increasing on my annual physical exams. It became a concern to my GP when it went from a 3.09 to 3.7 in 6 months, then to 6.7, having gone from 3.9 to 6.7 in 6 months. I was sent to a Urologist who had me do a biopsy. The results showed 8 of 12 cores positive for pc. Gleason 4+3 on five of the eight and 3+3 on the other three cores. i also had an MRI and full-body scan which showed it was contained to the prostate. I met with several Urologists and Radiologists who all recommended radical prostatectomy due to my age. None had recommended active surveillance or radiation treatment. I had the DaVinci robotic assisted RP about 4 1/2 weeks ago, so I am still recovering. So far, so good. No incontinence issues...yet. I guess I can say may post-operative effects have been mild to mid. Still painful, more than I expected or was told to expect, but I treat it with Motrin or Tylenol which helps. I returned to work last week, but my job is mostly sedentary so it hasn't been too bad. For me, the worst part was having the catheter for 8 days, following surgery. Once it was removed, it hasn't been a cake-walk, but slowly getting better. Although I haven't experienced incontinence, from time to time I have a little leakage when going from sitting to standing or lifting anything over 15 lbs. I know its different for everyone, but this has been my experience.

I am new and was getting ready to ask a comment about another medical I have when I ran across the prostate cancer section. I had prostate cancer 8 years ago and have been cancer free with current PSA level .1 Your results are nearly identical to mine except before I had the biopsy was 4.3. It took me about 6 months to complete my research and by then it had elevated to 6.8. I chose to go with Cyberknife Radiation Therapy. It and Proton Therapy have the highest success rate without all the side effects that the other options have so for me it was a no-brainer. In addition, it takes only 2 weeks. However, Proton therapy is one month. I was walking 10k steps a day and swimming a quarter mild a day before, during and after. I had absolutely no side effects and felt nothing other than feeling my normal self. Hopefully your Urologist feels you meet the requirements to have it. If not surgery remains a good option. I had a family go with surgery. He had bladder control and diarrhea issues for a while but managed to get through it without any major problems.

Would you mind telling me your Gleason score ? Thanks in advance .

Gleason was 3+3(6), Decipher and Prolaris put me at low risk. MRI showed 1 tumor at .9cm, I had a 30 core transperineal biopsy with 9 cores positive, 5 cores were between 1 and 4 percent ( almost nothing ) and the other 4 were at the site of the tumor. PSA 4.6, CT PSMA showed no cancer at all, not even in the prostate, but biopsy and genetic study said it was there but mild. In one year, I grew a second tumor (likely due to finasteride) and had a mild abutment. Even as low grade as it was, I figured I no longer needed to be on Active Surveillance and chose the TULSA procedure in Dallas, Texas.

I saw a different Uro for a third opinion and he looked at a previous MRI and said I could probably go much longer and not do anything. But he also does DaVinci surgery so, he likely likes patients to wait and be force to have surgery.

No regrets on TULSA and if anyone have questions, do ask...I will be open with everyone about my experience.

Hmmm, OK. Well, I think that most URO's like to do DRE's and RP's. It seems to be in their nature. I had every offer of radiation, seeding, removal, and Active Surveillance. When you say your Gleason is 3+3(6) and a Decipher of 51 percent...that sounds a little off to me. Do you mean the Decipher was .51 percent. You need to get a physical copy of your Decipher report from the URO and look at it and tell us what the Genomic Risk is and what the 5,10,15 year risks are. What is your PSA?

Now, first it sounds like you had a trans-rectal biopsy which has a difficult time getting all the prostate sampled. A transperineal biopsy could sample the entire prostate from 18 to 30 cores and then you really would know what you have and where. You did not mention if you have any tumors and the size, that will take a MRI and frankly, IMO, a MRI should have been done prior to a biopsy.

If you have two cores positive, no tumors, Genomic Low Risk, you could probably do Active Surveillance for a number of years. However, if you do that, then you need to test PSA every 6 months and MRI every 9 to 12 months. Don't let doctors lull you into yearly PSA and MRI every two years. The problem with AS is that at some unknown time, the cancer can jump start itself and spread. Something you absolutely do not want.

You likely have more options than you know, and, if you can give the members here more information they can better help you. If you had only one small tumor you could do NanoKnife, a transperinal approach that leaves the sexual and urinary function virtually untouched. There is HIFU, a trans-rectal approach, there is TULSA, a trans-urethreal approach. But, until you have an MRI with contrast you are at a disadvantage deciding what is the best approach. And honestly, if you can find a doctor that does a transperineal biopsy, I would get one of those. They are painless afterwards, almost zero chance of infection, and you get a full sampling of the prostate.

I had a talk with two URO's and both said there is a growing belief that Gleason 3+3(6) low risk is probably not a cancer, or can be watched for years. I have read this as well in some medical literature from NIH or similar.

If I did not start with one tumor, and then grown a second, I would have stayed on AS for sure. Even though my Prolaris and Decipher put me at a low risk, at age 68 I just did not want to screw with this anymore and went for TULSA.