PSMA PET CT question

@jeffmarc Semi annual biopsies? Whew, that's some aggressive monitoring, but a 3+4 with more than 10% 4 and cribriform, that's what needs to be done. A second Decipher might done as well over time as I have read of cases where they can go up too. Will be interesting to hear what happens on this. Please keep us posted.

Hi Chocchip

Sorry you joined our club, I had a similar diagnosis 2 years ago. Your somewhat stable PSA and favorable Decipher is a good thing however having the PC discovered via DRE is problematic as it could hint to possible EPE.
I was diagnosed with 3/4 with 10% 4 (favorable decipher.) Received a second opinion of 3/3 ! I had low PSA and MRI invisible PC with family cancer history so went with RALP.
Pathology post surgery was 3/4 with 30% 4 on a fairly large tumor mass.
Its good your doctor found it when he did and also that it images well so you have many options for treatment. A PETPMSA scan is a normal first step. All the best!

@wwsmith
You think semi annual biopsies are too much!

I had my first biopsy was 11/19/2009 it found nothing. Not even 3+3. Some PIN in one spot but nothing else.

My second biopsy was 1/7/2010 less than two months later. They took 10 cores. One was 3+4 none of the others had anything.

They did a CT scan and thought there might be something in my seminal vesicles so on 2/4/2010 I had a third biopsy. They took cores in the seminal vesicle area, and five other cores. 2 had 3+3 the others nothing. Seminal vesicles were clear, however. If they were not clear, they would’ve used radiation instead of surgery.

After surgery, they found I was a Gleason 4+3. Another case of biopsies not capable of finding everything.

@jeffmarc I understand doing multiple back to back biopsies when you are first trying to discover cancer given lots of indicators, but when you already have one positive biopsy then semi annual follow-up biopsies seems a bit unusual. But I guess in this case it makes sense where a guy is trying to delay treatment as long as safely possible.

@beachflyer THANKS! We chatted today with the UCSF urologic oncologist. He definitely is pushing AS and my husband seems to trust him (as do I - I sat in on the call). He is calling this "low risk GG2". Borderline GG1. Their own expert path lab reviewed the specimens and agrees: no cribriform and just 5% pattern four (vs 20%), but on two cores, not one. Doc wants to do his own confirmatory biopsy as soon as May or June. Will make that happen. I asked him about the DRE as the trigger for all this, and what that might indicate. That didn't concern him too much - he felt the subsequent MRI sort of superseded the DRE for what that's worth. He personally orders PSMA-PET for higher grade situations as a rule, but we didn't bother to ask if we should cancel it, given that the local urologist ordered and folks here think there's no downside (beyond radiation).

Thats good news Chocchip and UCSF is top notch. My best friend who is about 7 years ahead of me on the PC "train ride" is under their care with Dr Peter Carroll. His PC was found by DRE the same as yours. It amazes me that only 40% of men are actually being screened for PC as it is the #2 cause of cancer death (for men) in the US. I just attended the UCSD Prostate Cancer Summit in San Diego last weekend and they are very pro A.S. They stated for those who decide to delay definitive treatment and go on A.S. there is statistically no increase in outcome risk over choosing an immediate intervention (ie radiation, surgery). The issue they (UCSD Medical) stated is that many folks accept A.S. and then dont follow the A.S. protocols (repeat PSA, MRI, biopsy), and fall off the radar only to pop back up years later and find out things changed. Anyway, based on your low PSADT (PSA Doubling Time), low volume and favorable decipher, I think A.S. may be a good way to go for now.

@beachflyer Thanks for this excellent feedback. Glad to hear that UCSD and UCSF are on the same page then regarding AS, and nobody in this household is gonna get lazy about adhering to the AS protocol regimen. At the summit: Did Dr. Christopher Kane speak? We had considered getting a second opinion from him, but AS seems like it makes sense for now. We can wait till the confirmatory biopsy in May to see if we'd want that.

@chocchip
Yes , Dr Kane spoke and I found him very informative, confident, and someone I would trust for definitive care or for a second opinion.
If at some-point in the future my PC train ride stops off at the BCR station, I would likely be calling him!