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Active Surveillance vs Treatment Now
I'm 55 and my PSA in 2020 was 3.8, 2021 was 3.3, and 2022 jumped to 4.5. Got a biopsy and on this past Thursday learned I have prostate cancer Gleason 6. Most cores were Benign Prostatic Tissue.
6. Left Apex: Adenocarcinoma, Gleason 3+3=6 involving 1 core. Core involvement <5% (<0.5mm).
8. Right Mid: High Grade Prostatic Intraepithelial Neoplasia (PIN).
11. Right Lateral Mid: Focus of Atypical Glands, Suspicious for Low Grade Carcinoma.
The Urologist recommends active surveillance. I'm due back in 6 months for 3 appointments for PSA test, biopsy and MRI.
Does this sound right? Shouldn't we attack this cancer before it becomes aggressive? I'm not a fan of surgery based on the side effects, and I like what I'm reading about Proton Therapy. I highly doubt my private insurance would cover it though so I might be looking at radiation if I need to take action.
What's your point of view on active surveilance vs treatment now based on this?
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Hi, I was diagnosed with a Gleason 6, waited
1 year had another biopsy; Gleason remained at 6, but there was more cancer, so I started radiation, and eventually moved on to hormone therapy. I hope this was at least some help.
Philnob
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1 ReactionHi @philnob,
Thanks for your response. This does help! How old were you, and what drove your decision to do radiation and hormones versus surgery. Did your age factor into the decision at all?
Hello,
I was 64 years old at the time. I am now 74.
As I recall, surgery was never recommended as an option. I had my first biopsy after roughage was discovered on my prostate along with a rising PSA number. I did watchful waiting for one year, had another biopsy which revealed more cancer, then immediately moved on to external beam radiation. I was successful for one year when a rising PSA number revealed that metastasis had occurred before the prostate was treated with radiation. I moved on to hormone therapy and have been on it ever since with a PSA number holding at 0.26. I hope this helps.
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3 ReactionsMy 80year old memory says the Gleason score was 7. I will check with him in the morning and post to you if there is a difference.
Chris
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1 ReactionGood morning @paulchen. Jay just told me that sometimes pre-surgery it was an 8.
Thanks for waiting.
Chris
Thank you Chris! This is very helpful.
Reading "Surviving Prostate Cancer" helped to calm my nerves when diagnosed with Gleason 6 followed by a clean MRI. PSA 10. Multiple approaches to treatment, SBRT, IMRT, Active Surveillance, Radical Prostatectomy... not certain which route to pursue but will speak with Mayo Team as well as local Urologist and Radiologist. Important thing is to stay cool and not make super quick decisions based on fear.
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3 ReactionsI couldn't agree more @jb2buckwater. Calming the fear to make an informed decision can be easier said than done. As you ask questions of your team oncologist, urologist and radiologist, don't forget to be clear of your personal preferences too. Each option has likely side effects, benefits and risks. Knowing what is important to you and what side effect you may find easier to manage over another will also help guide your decision.
I'll be interested to hear what decision you make and the key factors that steered your choice.
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2 ReactionsI feel there is much confusion on this subject. I am 80 years of age with BPH. While pursuing steam treatment with my urologist for BPH he took at PSA that came in at 4.2. Now I am concerned about possible PC. He recommended biopsy but I am not comfortable with that because of risk of spread if it is cancer. We did a MRI and came back clean except for one 7mm lesion rated as "probably PC" by radiologist. Now I am taking PSA total and free test every 3 months. It indicates that the lesion is probably "not" cancer or if it is it would be low grade. So I am in "active surveillance mode. Doing another MRI soon to see if lesion has grown. At my age I being very careful with anything invasive. If it does grow perhaps a focused non invasive therapy is way to go without a physical biopsy. Assume it is PC and do it. Or do nothing if it grows slow.
I have been told that PSA up to 10 is not abnormal at age 80. Lots of variables. Add in BPH and it gets even fuzzier.