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Newly diagnosed T1c Gleason 3+4 awaiting Decipher results.

Posted by pshea1 @pshea1, Mar 30 12:38pm

Am finding this group full of great information. Trying to learn as much about my diagnosis as possible. PSA 5.9, mri Pirads 4 small lesion on one side, nothing outside of prostate, biopsy 17 cores, 1 3+3, 4 3+4, 67ml prostate size, favorable intermediate description. Awaiting Decipher results. If below .5 suggesting Active Surveillance, if above suggesting ADT then continue Active Surveillance. Age 75, family history of PC, have controlled AFIB with Eliquis and been on hypertension meds for years, otherwise active and in good shape (6’1, 160). Live in Philadelphia suburbs. Are there other questions I should be asking? Should I be looking into focal therapies as an alternative treatment, my Dr isn’t impressed with recent focal therapy data regarding fewer side effects than radiation or surgery. Thanks in advance for any thoughts!

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Colleen Young, Connect Director | @colleenyoung | 3 days ago
In reply to @pshea1 "I have a question about seeking a 2nd opinion. While I still have not received my..." + (show)
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I have a question about seeking a 2nd opinion. While I still have not received my decipher score yet (due within a week or two) and therefore no final recommendation from my urologist as to treatment recommendations I wanted to get a 2nd opinion appt "on the books" so I could get in sooner rather than later. What I have found is that the process of getting into Abramson Cancer Center at UPENN is to schedule seeing a particular doctor in a particular discipline and asked me who I wanted to see, which of course I didn't know the answer. Their protocol was to steer someone my age to Radiation Oncology rather than Surgery. They said they could get all my testing data online and said they didn't need my actual biopsy slides for the appt, the written report would suffice. I was assuming they would want all the primary testing materials so they could make their decision based on their analysis of my test materials. Does this sound right or do I need to be more specific about what I want out of second opinion. I'm hoping to learn whether I am a candidate for focal therapies or not and if not what specific type of radiation protocol is recommended. Or is their recommendation Active Surveillance. Does this process sound correct? Are there any other things I should be doing to make sure the 2nd opinion is with the right person? As always thank for this groups thoughts.

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@pshea1, while not specific to UPenn or prostate cancer, you might find this blog post and member discussion helpful regarding tips on getting a second opinion:

- Tips for seeking a second opinion https://connect.mayoclinic.org/blog/cancer-education-center/newsfeed-post/tips-for-seeking-a-second-opinion/
- Tips about preparing for my second opinion appointment at Mayo https://connect.mayoclinic.org/discussion/second-opinion-tools/

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Paul Sweeney | @paulsweeney | 3 days ago

I'm also in a similar grade group (Gleason 3+4). I chose to go on active surveillance despite pressure for treatment. Nearly 4 years later, no progression.

If you do choose to go on active surveillance, there's a wealth of good evidence for dietary, exercise and supplemtantal interventions that make active surveillance more effective. Based on my research over the past 3+ years I've put together a free online resource that assesses the evidence for interventions and is updated every month. You can find it at evidence.zone in case it's useful.

I wish will all the best.

Paul S

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nittanylion | @nittanylion | 1 day ago

I was Gleason 6(3+3) for about seven years and then it went to 3+4. Had always told myself that if it advanced to Gleason 7 I would take action so had brachytherapy last July. Urologist really pushed me to do brachy, external beam and also ADT. I did a decipher and it came back favorable so decided to just do the one procedure which three different oncologists told me would/should be sufficient. So far everything is tracking positively but I did have a lot of post procedure issues surrounding urination. Had three emergency catheterizations and finally a supra pubic catheter that was in for 4 months.

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