Was on active surveillance, now gleason 3+4: Any advice?

@htc929 you can send email to Zhou, Ming< Ming.Zhou@mountsinai.org> to ask about second opinion on biopsy pathology. There's a fee of course, I forget how much but maybe about $500.00?? He's one of the best in the world.

His response to my email a few months ago was:

Thank you for asking me to be part of your care decision. Please do the followings:
1. Contact the pathology lab that processed your prostate biopsy specimen(s)
a. To let it know that you’d like to request your specimens be sent out for 2nd opinion review
b. You probably will be asked to fill out a request form
c. Supply the lab with the shipping address (he included shipping address in his email to me)

@jeff1963 thank you i will do that

@htc929
Not sure where you live and if you live close to any major medical institutions close. But even if not still can be sent as they can do over medical records sites.

But yes most major medical institutions do second opinions by supplying the other medical institution withy your medical records.

I had this done as wanted second opinion even though my first was at Mayo. I merely notified the second institutions I wanted a second opinion and they handled the paperwork to do it.

I was diagnosed 3+4 14 years ago. But it was just 5% of one core on an 8 core biopsy. You didn’t mention extent of cores that are positive. Or PSA density. Those would be good to know. I maintained AS for 14 years until it went to 4+4 last year, then proton radiation happened. My psa at that time was 6.

Thanks. I had 2/19 cores positive with Gleason 3+3 and 3+4. Under active surveillance. PSA jumped from 7 to 11 on Ozempic. Has anyone heard of this ? Began modified citrus Pectin and is now back to 7 . Any thoughts ?

@wcsanford4 This rise in PSA has been reported by quite a few men taking Ozempic.
Right now, the speculation is that it affects male hormones somehow, but not much more than that specifically.
Phil

I would not advise you what to do because of variables but I was about your age and had initially a Gleason 6. Active surveillance 3 years which I decided on after given options from urology/ oncology. Genomic testing indicated slow growth. Psa bounced around 5 to 8.2. I had 3 biopsies during the 3 years of AS.
MRI showed 1.8 centimeter lesion at apex and biopsy brought me to 3 plus 4 =7. Local urologist / oncology recommended treatment at intermediate Gleason 7. Second opinion from Dana Farber also recommended treatment. Listened to radiology , oncology , surgeon at Dana Farber. I had RP and pathology read 2 centimeter lesion and EPE. But 5 lymph nodes removed were good and clean margins, bladder neck was cleared also. So far I’m testing every 6 months and 4 years out from surgery undetectable psa.
I’m feeling like I made a good decision and hoping praying for no reoccurrence. If I do have reoccurrence I’m told lots of options will keep me going and I will die from something else so
….. I am about to turn 70.
Get opinions from experienced PC people and ask questions is my best advice.

If I were you, I would find a Center of Excellence with multi-disciplinary treatment options. I would definitely get treatment (no more active surveillance) but I would consider targeted short term SBRT, HDR or IMRT possibly with a short course of ADT.

I am not a big fan of surgery and my clinical profile was similar to yours. I opted for the above treatment plan and so far..so good.

Good luck to you.

RARP scheduled 3/13. I usually do my own yard work, edging, trim bushes ‘ grass cutting. How long will I need help with this after RARP? Thanks

@lyricw I was told to wait 6 weeks post-op to do any heavy lifting or doing anything repetitive like vacuuming