Canceling Radical Prostectomy In favor of AS

@pv001
When you get your Gleason Score it is subjective of the urologist or pathologist. They are looking at your normal cells and abnormal cells. I think you saw this with two different opinions on Gleason Score. Since your original score was 3+4-7 which is intermediate risk consider asking for a Decipher test.

The Decipher test will give you a more precise risk level of your prostate cancer beyond subjective look of cells. I assume you did not have any tumors just suspicious areas that were biopsied.

I mentioned this as my experience with Gleason Score was 3+4=7 with risk level intermediate risk. My original treatment plan was radiation and hormone treatment.

My original Mayo R/O suggested to do a Decipher test and bone scan. The bone scan came back negative and the Decipher test came back low risk not intermediate risk. The treatment changed from radiation with hormone to radiation onlyl.

I got a second opinion on everything from UFHPTI. UFHPTI wanted to do an additional test called PSMA which came back negative. UFHPTI then concurred with diagnosis of low risk and radiation only treatment. I went with UFHPTI only because Mayo Jacksonville did not offer proton radiation only photon.

It is everyones personal choice what they choose to do but you should have all the test results you can get and what they mean to make your own informed decision.

I generally agree with most of the posts above and definitely agree with the recommendation to get a Decipher test. All my clinical markers (PSA, MRI, biopsy) indicated low risk slow growing Grade 1 Gleason 3+3 cancer yet my family history and high risk Decipher indicated otherwise. After many consults and much deliberation, I decided to pass on AS and go ahead with a RP last month at a center of excellence and performed by a highly regarded surgeon. And although I'm dealing with incontinence, the fact that my cancer was upgraded to Grade 2 Gleason 3+4 during the post-op biopsy, I'm comfortable I made the right decision.
As others have said, take your time, do your homework and make the decision that is best for you.

Add PSE (EpiSwitch') to the surveillance protocol. It seems to be the most accurate.
https://www.94percent.com/

congratulations on getting the surgery and making what is now confirmed to be the better decision. I really wish you good luck

Suggest taking some time on AS and arranging visits to doctors that do Tulsa Pro for when it is needed.

Interestingly both Penn Medicine and Sloan Kettering did not recommend Dechipher Test or PSMA PET Scan even though I specifically mentioned those! Due to the low grade they said they would not get any useful information from those tests! Penn Medicine is doing some trials so they said I coud participate and they would send my samples, but I won't know what type of test. Sloan outrightly said no for Dechiper. Both said no PSMA PET Scan! I don't know! Both are COE hospitals!

I was told the same by my UNC docs

Today I canceled my surgery scheduled for June 9th and will be going with one more biopsy (now at Sloan Kettering) maybe in late August. If things remain same, I will go on AS with 3 month PSA and 12 month MRI and 24 month biopsy (unless things change significantly with PSA). If we see any concern with next biopsy, then I will start treatment. I will be visiting this site more often to keep track on how things are going with others and any recent advances in treatment.

Jeff - thanks for the video. It helped me understand how I went from a couple of (3+4)=7 cores in my first biopsy, to several (4+3)=7 in my later biopsy, then downgraded to several (3+4)=7 after RALF prostate was evaluated.

Think you're right to wait on the prostatectomy with your diagnosis. Prostatectomy isn't trivial. It's surgery after all. And risks to such as errectile nerve bundles, etc, are real. Further, the continuing use of periodic biopsies in AS may soon be phased out with the continuing improvements in things like MRI. See
Oncological Safety of MRI-Informed Biopsy Decision-Making in Men With Suspected Prostate Cancer 2024
Charlie Hamm
This improvement may also aided by the wider use of AI in this area.
So time may be on your side here, including in the sense that prostatectomies themselves may be greatly improved two or so years hence when you might need one.
But discuss it fully with your medical team. These are thoughts of a layman.