Are all treatment options given at diagnosis?

The three basic treatments are focal therapy, Radiation and surgery. If you’re only 3+3 Gleason or 3+4 With very little 4, Then active surveillance makes sense. If it’s worse than that, you could get a few different tests like this decipher test or ExoDx or a couple of more to see if there really is a reason for treatment.

You don’t supply any information about your case, so it is really difficult to say much more.

I had the same thing.
It was "You've got cancer. You're getting the chop".
No discussion.

Fortunately, I'd already researched possible treatments for a Gleeson 4+3 & decided that I just want it out.

Unless a specific treatment is called for at the time of diagnosis, I see no reason to consider invasive treatments until such time as the lets watch it and see dictates that I do. I think most people could assume that prostate removal might be necessary and do their own checking.

The person who will discuss your treatment options with you post-biopsy will be a urologist. And they always prefer surgery unless your age or co-morbidities make it too risky. So, you will need to do your own research anf talk to a radiologist and an oncologist if possible.

In response to Jeff so are you saying that once they find out that you have a low grade 6, they should not describe options completely instead of just saying monitor or treat by …..? And explaining to you what likely happens?

@layingthegroundwork
We had a person in this forum that was a Gleason 6 But had 12 positive cores. In a rare case like that, where there are more than six cores with a G 6, the recommendation is to get it treated.

For the vast majority of people with a Gleason six treatment is not appropriate. The whole reason they stopped doing PSA tests 14 years ago was because people were being treated when they only had a 6. They should’ve been put on active surveillance. Why explain options when they aren’t necessary, it freaks people out.

I have a friend who 25 years ago had a prostatectomy that was botched and he was told after that he really had a Gleason five. Well, that’s not a real number, But apparently he was way over treated. He had a 6, but his tissue looked mostly totally normal. This is what was happening to people, So treatment really has to make sense.

@layingthegroundwork Are you in a hurry to have a treatment that will leave you dry with a good possibility of ED and incontinence? The entire no PSA tests was due to low Gleason 6 being overtreated. By the way there are only grades 1 to 5 (maybe someone will propose a grade 6 for when you die of prostate cancer). Gleason 6 is Grade 1. When you go to Grade 2 you should look at treatments, although continued active surveillance is still an option if the cancer is not aggressive. There is also a staging classification that goes from I to IV (with some subtypes in the stages).

A lot of doctors fail to go over all of the treatments especially the focal ones that may not be covered by insurance.

I would say it depends on the medical center you are going to. If they only do RP and Radiation and it is a private practice, they will suggest those two as a first line treatment. They want to get paid. I loathe private urology practices after my experience with mine. Greed before patient.

@layingthegroundwork - I’m not quite sure what you’re asking.

You’re under active surveillance right now, which is as basic a treatment as it gets, really - just watching and waiting. There really isn’t another treatment at that stage, other than doing nothing.

Are you saying that while at the watching stage, you’d like your doctor to explain all the possible scenarios that could come up, and all the treatments for those?

If so, I can say I’d not expect that nor would I want that, especially not at such an early point in your disease trajectory.

“Right now, you’re good, everything is low risk and contained and not aggressive. However, it could become more aggressive and began to grow. Should that happen, it could break through the cap and start to get into the nerves and surrounding tissue. Should that happen, we’d look at surgery to remove the prostate and here are all the pros and cons of that. We could possibly need to remove lymph nodes and some or all of your nerves. Depending on things, that could be a multiport laparoscopic surgery, or a single port laparoscopic surgery. Or if it’s not, we could treat with radiation, such as proton or photon…blah blah blah…and then there’s focal therapies…blah blah blah…HIFU…hormones…cryotherapy…” - you’d be there all week getting the rundown of every possible treatment for every possible manifestation of the cancer.

Maybe you could absorb all that and not be overwhelmed, but for me, that would be information overload, especially considering that once you move from active surveillance to the next level, most of those treatment options would no longer be pertinent to your particular case.

I should add, I never went through that period of watchful waiting. While I did have three MRIs and three biopsies over 4+ years (along with numerous other tests), they all came back as “Move along, no cancer here” until the last biopsy, when I was diagnosed as stage 3. That left me with exactly two treatment paths - surgical removal or hormones & radiation. I chose the surgery.

Good luck with your PCa, may it never grow any larger!

The sad and unfortunate reality is that "all" physicians give you between 8 - 15 minutes per office visit, most around 10-12 minutes. They do not give you or themselves adequate time to treat you with the dignity that you deserve. Armed with this knowledge, you need to be as diligent as you can about reading and gaining as much information about this unpredictable disease as is possible. Buy Dr. Patrick Walsh's book on prostate cancer (it is on Amazon). Prepare a written list of questions you have, and most importantly WRITE DOWN YOUR PHYSICIAN'S RESPONSES, so you can read them back to confirmed clarity: "so, your answer is that...(repeat it back to them - you may have not understood). I found that my physician had two traits: 1) He is very nice, always smiling, and it can potentially disarm you from asking any questions or "one more" question, as well as keep you from asking him to clarify what he just said. 2) He, like many urologists, has strong, definitive opinions and practices that his experience tell him are best for the majority of his patients. I was given time to ask: "So, what are my options...am I a candidate for Active Surveillance, or radiation therapy?" His response was fast and definitive: "I never do Active Surveillance, you are just giving your cancer two years to grow and get worse, and you never want to do radiation therapy on a prostate as your first course of action, because the radiation will 'fry' your prostate and turn it into a little walnut sized piece of concrete that is then extremely difficult to surgically remove after the fact, if the radiation fails." After that he quite firmly told me - with a smile - "I am taking your prostate". In other words, I had no choice with him, he was going to perform the radical prostatectomy. I am glad he did, because my pathology was a lot worse than the 12-core needle biopsy could ever show. He was overly confident with my Gleason 3+4=7 with just 10% cells being level "4." He said "we caught it early" with a smile. He was quite humbled and sullen when we got the surgical pathology report back, describing everything that put me in a pT3b diagnostic category. I remained a Gleason 3+4=7, but the pathology was not good: "it seems your cancer is quite aggressive." So, again, educate yourself...read the Walsh book. Do as many searches on prostate cancer and treatment as you can. Write down questions, and ask them to include repeating/paraphrasing the doctor's answers so you know exactly what they mean. They often think they are sparing us details that we don't really need to know - on top of not giving us enough time to ask questions. "Time is money" for a physician. If he can see 6-7 patients per hour vs 4-5, (s)he makes quite a bit more money.