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Profile picture for georgemc

Decisions to be made after biopsy confirmation of prostate cancer.

Posted by georgemc @georgemc, Nov 11, 2025

SEEKING ADVICE: My PSA increased from 3.7 (02/2019) to 5.5 (02/2022) to 9.87 (09/2025). Had a PHI (Prostate Health Index) done 02/2025, with result an index of 40.2. Next was an MRI which confirmed the presence of two RADS 4 lesions (1.5ml and 0.7ml) on a 99ml prostate, resulting in the recommendation that I have a biopsy. An MRI Fusion Biopsy was done 11/3/2025. 14 specimens were taken. Nine were either benign prostatic tissue, or non-invasive, pre-cancerous. Five of the specimens were evaluated as Adenocarcinoma. Gleason Scores follow:
#1 - Gleason Score 3+3=6, Grade Group 1.
#2 - Gleason Score 4+3=7, Grade Group 3.
#3 - Gleason Score 4+3=7, Grade Group 3.
#4 - Gleason Score 4+3=7, Grade Group 3.
#5 - Gleason Score 3+4=7, Grade Group 2.
I have not seen my Urologist since the MRI, but am scheduled to see him on November 19 to discuss the results, and the range of possible next steps. I am seeking any comments, observations and/or recommendations that I should be considering before, and during that appointment. I am in good health, though admittedly a bit overweight, with marginally high blood pressure and cholesterol, both easily controlled with minimal medication. I hesitate to mention the last factor - my age. Within the medical community, there appears to be a general assumption that screening and/or treatment of those over 70 is not indicated, the assumption apparently being that at that age, one will likely outlive prostate cancer and die as the result of other conditions. I am not necessarily in agreement with that view. First, let me say that I have several family members, both maternal and paternal, who exceeded the 100-year mark, and I have every intention of doing the same. That being said, I am 90 years old. Comments, suggestions, recommendations etc., are invited, and would be deeply appreciated.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for jeff Marchi
jeff Marchi | @jeffmarc | Jan 6 5:19pm
In reply to @georgemc "Since my last posting November 11, I have had a PET scan, and consults with 3..." + (show)
Profile picture for georgemc @georgemc

Since my last posting November 11, I have had a PET scan, and consults with 3 oncologists. The PET scan showed no evidence of cancer outside the prostate. The first oncologist undertook to explain what all of the findings to date really meant. It boiled down to what @jeffmarc suggested, that though not extremely aggressive, it was aggressive enough to reject the idea of just waiting and watching, and given my age, surgery was not a particularly attractive option. The preferred approach was identified as radiation, either conventional or proton. I was referred to the Radiation Oncology Department of Sentra's Norfolk General Hospital, and to the Hampton University Proton Cancer Institute. I had very informative and objective in-depth consults with doctors at both locations, and now the decision is up to me. I am going to sit down with my referring oncologist to weigh the pros and cons, and to review the possibility that follow-on chemo or hormonal therapy might be needed. At the same time, I am exploring potential funding problems with Medicare and TricareForLife (available to me as a 2nd payer as a result of being retired military), I am afraid that either or both might be hesitant to authorize the expenditure of that much money, especially for the Proton Therapy, on someone who is identified in actuarial tables as having only 3.74 years left. We shall see!! God bless and good luck. Hang in there everyone.

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@georgemc
George I would not really be all invested in needing proton radiation. There is a minimal difference between proton and photon radiation in long-term survival and you are 90 years old.

I had 8+ weeks of photon radiation 12 years ago and I’ve had no secondary cancer from it after all these years. That’s pretty normal. There’s a very low rate of secondary cancer. Here’s information from a Stanford study Based on photon radiation.

In a study of about 145,000 men with prostate cancer, the team found that the rate of developing a later cancer is 0.5% higher for those who received radiation treatment than for those who did not. Among men who received radiation, 3% developed another cancer, while among those who were treated without radiation, 2.5% developed another cancer.
https://med.stanford.edu/news/all-news/2022/070/prostate-radiation-slightly-increases-the-risk-of-developing-ano.html
In order to protect yourself, you may want to have one of those barriers put in like SpaceOAR, Barrigel, or BioProtect to your protect your rectum from damage During radiation treatment.

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Profile picture for vircet
vircet | @vircet | Jan 7 1:47pm
In reply to @georgemc "Since my last posting November 11, I have had a PET scan, and consults with 3..." + (show)
Profile picture for georgemc @georgemc

Since my last posting November 11, I have had a PET scan, and consults with 3 oncologists. The PET scan showed no evidence of cancer outside the prostate. The first oncologist undertook to explain what all of the findings to date really meant. It boiled down to what @jeffmarc suggested, that though not extremely aggressive, it was aggressive enough to reject the idea of just waiting and watching, and given my age, surgery was not a particularly attractive option. The preferred approach was identified as radiation, either conventional or proton. I was referred to the Radiation Oncology Department of Sentra's Norfolk General Hospital, and to the Hampton University Proton Cancer Institute. I had very informative and objective in-depth consults with doctors at both locations, and now the decision is up to me. I am going to sit down with my referring oncologist to weigh the pros and cons, and to review the possibility that follow-on chemo or hormonal therapy might be needed. At the same time, I am exploring potential funding problems with Medicare and TricareForLife (available to me as a 2nd payer as a result of being retired military), I am afraid that either or both might be hesitant to authorize the expenditure of that much money, especially for the Proton Therapy, on someone who is identified in actuarial tables as having only 3.74 years left. We shall see!! God bless and good luck. Hang in there everyone.

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@georgemc Just keep in touch with this support group that has proven helpful to many -- older or younger alike.
https://connect.mayoclinic.org/discussion/encouragements-from-prostate-cancer-support-groups-share-yours/
I am gathering new and additional information for the book I authored, that I plan to publish the second edition. (The paperback format is mentioned in the above hyperlink; I can't add the link for the e-book version, this comment may be filtered out by Mayo Clinic's algorithm if I did.) I will be following up/keep updated on what you post in the future, and see if I can add anonymously in my book's second edition. I wish you well in the years ahead.

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Profile picture for jc76
jc76 | @jc76 | Jan 8 8:10am
In reply to @georgemc "Since my last posting November 11, I have had a PET scan, and consults with 3..." + (show)
Profile picture for georgemc @georgemc

Since my last posting November 11, I have had a PET scan, and consults with 3 oncologists. The PET scan showed no evidence of cancer outside the prostate. The first oncologist undertook to explain what all of the findings to date really meant. It boiled down to what @jeffmarc suggested, that though not extremely aggressive, it was aggressive enough to reject the idea of just waiting and watching, and given my age, surgery was not a particularly attractive option. The preferred approach was identified as radiation, either conventional or proton. I was referred to the Radiation Oncology Department of Sentra's Norfolk General Hospital, and to the Hampton University Proton Cancer Institute. I had very informative and objective in-depth consults with doctors at both locations, and now the decision is up to me. I am going to sit down with my referring oncologist to weigh the pros and cons, and to review the possibility that follow-on chemo or hormonal therapy might be needed. At the same time, I am exploring potential funding problems with Medicare and TricareForLife (available to me as a 2nd payer as a result of being retired military), I am afraid that either or both might be hesitant to authorize the expenditure of that much money, especially for the Proton Therapy, on someone who is identified in actuarial tables as having only 3.74 years left. We shall see!! God bless and good luck. Hang in there everyone.

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@georgemc
I had 30 rounds of proton radiation at UFHPTI and Medicare paid and covered. I had secondary insurance through FEHP being a retired federal employee which covered the Medicare co-pays.

I am not sure you posted but did you have the Decipher test?

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