Received the news on Halloween. I have prostate cancer. Need advice.

By the way, I am 2 months shy of age 70.

You are a case where active surveillance would make sense. This was discussed At the PCRI conference today. With a low number of cores you have with a Gleason 6 score, and very little four in the 3+4 There really isn’t a lot of reason to do anything right away. You’re a low PSA score is another reason active surveillance makes sense. Prostate cancer grows very slowly you have a long time to make any decision.

You could get a PSMA pet scan to see if there is spread anywhere in your body.

The Radiation oncologist at the PCRI conference discussing active surveillance was pretty insistent that somebody like you should not be doing treatment yet. You could take a look at the video and see what’s going on.

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.

jeff's is excellent advice. I would want a consultation with a radiation oncologist as well, so I'd ask for a referral.
Sorry for your halloween news.

It’s good that you’re in information-collecting mode. That will guide you towards an appropriate decision.

> It’s always a good idea to get 2nd opinions on biopsies — not necessarily because you don’t trust the 1st one or don’t like that opinion. But, because much of the interpretation of images and scans is often as much an art as it is a science, and it’s dependent on the skill and experience of the person reading the slides. It’s good to have an independent set of eyes reviewing the biopsy.

> Since you have a “4” cell type in the Gleason score—> In the MRI or biopsy reports, were the words cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma mentioned? (If not, that’s good.)

> also, ask them to calculate your: % Free PSA, PSA Doubling Time, and PSA Density to see if those are ok or if they indicate any concern.

> the genetic (germline) test will check a few dozen markers that may be related to prostate cancer in addition to BRCA1/BRCA2. (See attached chart for the key markers.)

> I would also ask to bump-up PSA testing to every 4-6 months rather than annually (and calculate those three - % Free PSA, PSA Doubling Time, and PSA Density - at every PSA test). Tracking PSA more actively going forward is important.

After you see your current doctor get at least a second opinion, preferably at a top level hospital like Mayo, Anderson or MSK.
Then talk to as many men, who have gone through this, to get an idea of what is ahead.
Then decide what suits you best.
Good luck.

@frank1956
Your doctors are the ones to recommend treatments for you. They have your medical and mental health history. Your age 70 indicates many more years of life expectancy.

I had almost the same Gleason scores. The Mayo R/O recommended 20 rounds of photon SBRT radiation with hormone treatment. He then ordered Decipher and bone scan. Bone scan was negative and the Decipher indiacated low risk versus intemediat risk that biopsies indicated. Then Mayo R/O removed the recommendation for hormone treatment just radiation only.

I then went to UFHPTI for second opinion. The R/O there agreed with my diagnosis from Mayo (medical records transferred there) but wanted another test done PSMA. That too came back negative. UFHPTI recommended 30 rounds of radiation proton beam.

I did not get a recommendation from either R/O or my Mayo PCP for active surveillance not did I want to do it. I wanted to address the cancer the earliest I could based on success rates when PC is caught early.

What others did with their treatments was based on their experience and their PC including doctors having their full medical history to make recommendations. We do not have that history nor are we PC medical experts just sharing our experience and what we did with our PC diagnosis, test, treatment, and recovery.

Consider a second opinion when you get all test results (Decipher, PSMA, etc.). Good luck.

A little heads up. When I was diagnosed with two cores of cancer, one at 3+4, I decided on removal. I wanted the cancer gone. My pathology report came back that the core was actually 4+5. Just make sure your biopsy scores are accurate! Best wishes👍🙏

In same boat waiting to set up surgery .

I would agree with others about getting a second opinion which you can do as a telehealth from a center of excellence.

I watched the added video, but it doesn’t seem to discuss much about the accuracy of the PSA or PSA trending and intensity over a given period of time. That may be worth a discussion with your doctor.

I had a PSA of 10.2 and a history of my brother having cancer. Out of the five Radiation oncologists I spoke with, only one suggested active surveillance as a choice. One of my issues, was that everybody is different so when you check the PSA over whatever the given period of time, I did not want to get into a situation where all of a sudden I was forced into taking drugs with heavy duty side effects, potentially, curable or not curable. That issue was not discussed in the video and one that was important to me as quality of life was a focus in my personal research.

@jeffmarc
Thank you, Jeff. I am a UCLA patient. I believe they do have an Active Surveillance program. I will discuss with my doctors next week to see if I am qualified.