With a Decipher score of 0.29 has anyone done Active Surveillance?

@colleenyoung
Colleen I am so glad I found this Connect Group. It is a lot to take in especially since this was something I did not know a lot about my husband passed away over 14 years ago did not have this come up. He decided to do radiation. He had the SpaceOAR done to get ready for radiation treatments that are going to start August 17th. Working on food to get more protein in him.
I appreciate you being here. Now time to pray over the radiologist and this situation.

I, too, had a biopsy showing Gleason 3+4 cancer in just 1 of 18 cores and initially considered active surveillance. Through my research, I learned that not all Gleason 3+4 prostate cancers are the same. Some are biologically similar to Gleason 3+3 disease and may be excellent candidates for active surveillance, while others behave more like Gleason 4+3 or even more aggressive cancers.

I underwent a GPS genomic test, which indicated that my prostate cancer had an aggressive biological profile. If my genomic score had instead shown a low-risk biology similar to yours, I would almost certainly have chosen active surveillance—with regular PSA testing, imaging, and repeat biopsies when appropriate—rather than immediate treatment. Assuming the imaging and biopsies have not missed anything significant, I would consider that a low-risk decision, especially with a well-structured surveillance program.

From my perspective, active surveillance offers several important advantages. It avoids unnecessary treatment for men whose cancer may never become clinically significant. It also eliminates—or at least delays—potential urinary, sexual, and bowel side effects that could be associated with surgery or radiation. Finally, it gives you the opportunity to benefit from future advances in prostate cancer treatment that may prove to be both more effective and less damaging to normal tissues.

I had a RP on June 8. I returned a 3+4 on GS. My PSA had risen from 4 to 7 in 2 years prompting my gp to send me to urologist and biopsy. I opted for the RP as I just want rid of the cancer. For me the risks associated with wait and watch for exceeded the negative consequences of the RP being incontinence, sexual disfunction etc. The thought of knowing that the cancer is still working in me while I wait and watch gives me the hereby geebies . No thanks. Get it out, I say.

@kitrobbins
I completely understand your reasoning. Many men feel exactly the way you do, and peace of mind is an important consideration that shouldn't be underestimated.

For me, the key issue is that not all Gleason 3+4 cancers have the same biological behavior. Some are unlikely to cause harm for many years - or never - , while others warrant prompt treatment. That's why I think genomic testing, MRI findings, biopsy results, PSA trends, and other clinical factors are all important when making this decision.

There isn't a single right answer for everyone. Some men place the highest value on the peace of mind of removing the tumor as soon as possible, while others place a higher value on preserving their current quality of life and are comfortable with careful monitoring if the tumor is low risk biologically. Both are reasonable choices when they're made with all available test data including genomic tests, and a clear understanding of the risks and benefits.

I hope your recovery continues to go well and that your pathology and PSA are reassuring.