Do I Continue Active Surveillance or Consider Intervention?

Posted by anjalid30 @anjalid30, May 29, 2023

Age: 76 Male, Diet: Life Long Plant Based Lacto Vegetarian, no tobacco, no drug and no alcohol use.

History: Prostate cancer detection-
No bothersome urinary symptoms, No gross hematuria, dysuria or recent UTIs. Digital Rectal Exams (DRE) -Normal
PSA 10.57 ng/mL 10/31/2018
MRI (2019): IMPRESSION: PIRADS 5 lesion confined to Prostate: PIRAD 5 Lesion of the posteromedial left peripheral zone at the base with long segment capsular abutment and left seminal vesicular abutment, but no macroscopic extracapsular disease or seminal vesicle invasion within the limitations of this non-contrast exam. Volume: 23g
Biopsy May 2019:
Prostatic Adenocarcinoma (Pathology findings) cancer of glandular epithelial cells, Gleason 3+4=7, WHO Grade Group 2, Perineural invasion present - suggest that diagnosed Prostate cancer is intermediate favorable risk. Left mid Gl 3+4 (1 out of 2, 30%), right bottom Gl 3+4 (1 out of 2, 20%), left ROI- Gl 3+4 (2 out of 11, 10%, +PNI). Four of the biopsy samples contain signs of cancer, but no more than 50% of a biopsy sample (4 out of 15=27%) showed the presence of prostate cancer cells.
Prostate Cancer Oncotype DX Genomic Test (Provides additional Information by predicting if the cancer has grown outside the prostate or high-grade disease) Score = 37
Urologist suggested Active Surveillance (with Delayed Intervention), The prostate volume was 28.9 cc., The prostate length was 46.4 mm., width was 40.3 mm. , height was 29.5 mm.)

CABG (Heart Bypass surgery) July 2019

Prostate MRI 11/2021: No significant Change from 5/2019.

On Prostate Cancer Supplements & Natural Remedies:
12/4/2022 (The prostate volume was 25 cc., length was 42 mm., width was 41 mm. , height was 28 mm.)
Prostate Specific Antigen: PSA is 3.1 ng/ ml (blood test 12/15/2022) (Max is 6.5 for my age), Previously was 6.5 in June 2022.

Question: Continue Active Surveillance? / Consider Intervention? Radiation? Any suggestions? (Prostate Surgery is negated due to comorbidity and age)

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

@rockin2047

I am also 76 yrs old like you but except for my PCa diagnosis, am in quite good health. What has caught my eye in my pathology report was the finding of "perineural invasion present" just like your report. My gland has 3 lesions 2 of which are GL 6 and the third is a GL7. The GL7 tissue was sent out for a Decipher test which resulted in a Low Risk score of 0.37. Just had a second opinion with a medical oncologist at Medstar Georgetown Hospital who advised me to not worry about things since I was in his opinion Low Risk and should only consider Active Surveillance (AS). However, after reading all about perineural invasion (PNI), it was a big wakeup call for me. About 31% of those with PCa have PNI. To learn more on PNI and how it can influence your treatment go to these 2 articles: https://www.healthline.com/health/prostate-cancer/perineural-invasion-prostate-cancer AND also this one https://malecare.org/perineural-invasion-on-prostate-biopsy-does-it-mean-that-i-have-advanced-prostate-cancer/ . The second one looks dated as of 1998 but there may be newer info you can find on the internet. In summary, I intend to put AS on the back burner until I find out more about where PNI is located in my prostate (ie has it penetrated a nerve OR is tracking along side of it).To answer this I plan on writing a letter to the pathologist since she was the one who found the PNI. The main thing is to NOT allow the cancer to get outside of the prostate. What are your thoughts?

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Thanks for helpful information. It has thrown lights. I have started research more.
Recent Article (Medically reviewed by Teresa Hagan Thomas PHD, BA, RN — By Jacquelyn Cafasso on October 24, 2022): https://www.healthline.com/health/prostate-cancer/perineural-invasion-prostate-cancer
Thanks Again

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Prostate cancer supplements??

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I would cut out that Bad boy cancer and hope for another 20 years , it is a gamble that is worth taking. I am 76, gleason 9, had surgery, 13 months of ADT and Erleada CRPC and hoping for 8-10 more years maybe hopefully more. Working hard on staying alive! Good Luck You are not too old to be aggressive in this battle

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@vjlvpjalways

Prostate cancer supplements??

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I am not a doctor. Good to talk to an Ayurvedic Doctor.
I did Google Searches
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003704/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425142/
https://www.ayurvedacollege.com/blog/prostatecancer/
https://www.planetayurveda.com/prostate-cancer/
http://ayurveda.alandiashram.org/ayurvedic-treatment/prostate-cancer
https://vibrantayurveda.com.au/ayurvedic-management-benign-prostate-conditions/
I took and am taking Ayurveda medicines which reduced PSA from 6.5 to 3.2. Do not know the effect on Cancer though.
1. Himplasia made by Himalaya Wellness Company
https://himalayawellness.in/products/himplasia
https://www.google.com/search?q=Himplasia&sa=X&rlz=1C1SQJL_enUS881US881&biw=1920&bih=880&tbm=shop&sxsrf=APwXEdfLcyWZ0lNbrCENvEKRgNmr0xzk_g:1687463587470&tbs=p_ord:p&ei=o6aUZNbxG_mOur8P6PCh-A0&ved=0ahUKEwiWz87d09f_AhV5h-4BHWh4CN8Quw0IggwoAg#spd=14192419694719911917
2. Prostaid by Baidyanath
https://www.storeela.com/product/baidyanath-prostaid-50-tablets-pack-of-2/
https://www.baidyanath.com/about-us
3. Charak Pharma Prosteez Tablet Useful in Prostate Enlargement
https://www.amazon.com/Artcollectibles-India-Prosteez-Prostrate-Hyperplasia/dp/B01JH0V7VY/ref=sr_1_7?crid=2NG2SVBRQQFGR&keywords=prostate+medicine+ayurveda&qid=1687463976&sprefix=prostate+medicine+ayurveda+%2Caps%2C129&sr=8-7
4. Prostact Tablet by Kerala Ayurveda
https://www.keralaayurveda.biz/product/prostact-tablet
5. DIVYA PROSTOGRIT TABLET - Ayurvedic Medicine by Patanjali.
https://www.patanjaliayurved.net/
Best Luck

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