Newly diagnosed with prostate cancer and still gathering information

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.

Can not agree more . AS should be VERY active as soon as 3+3 is discovered. I would suggest from personal experience to do biopsy every 2 years ( and MRI even more often). We had only 2 biopsies with measly 12 cores (2019 and 2025) and MRI every 2 years and 3+3 became 4+3, IDC-P with cribriform ! 🙁
BTW, my husband did not have Decipher but he did have some other genetic test and came as "low risk" in 2019. Sure ...

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.