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Biopsy Results - Suggested active surveillance (AS)
Greetings, first - thanks to all who contribute to this support group, its been very helpful. After a PRADs 4 MRI (indicates contained in gland) on 11 JUN 26 with no jump or out of normal range PSA reading, got a transperineal fusion biopsy on 7 JUL 26. Path report says 12 cores, all but 2 are benign. For the 2 not marked benign: Sample: Prostate, left medial mid, needle core biopsy: Prostatic adenocarcinoma, Gleason grade 3+3 = 6 (Grade group 1), 1 mm focus. Tumor involves 1 of 1 core. Tumor involves 10% of submitted tissue.
Prostate, left medial apex, needle core biopsy, atypical small acinar proliferation, favor benign.
PSA over last 5 years was between .5 and .7 most recent .6
ExoDs: 34.58 on 22 JUN 06
I have asked for decipher test and aim to get 2nd opinion on pathology.
For now recommendation is Active Surveillance, repeat biopsy in one year, PSA checks every 6 months and potential MRIs every 1-2 years . If repeat biopsy is same then biopsies every 2-3 years.
What are your thoughts on this approach? Anything else I should be considering or doing? Additionally, for those that have had 2nd opinions on pathology, did you find much variation in reports? I found it curious and interesting that provider said some in my situation opt for surgery or radiation because of the anxiety of living with it.....not because its a mortal threat.
Thanks again for all the support and information.
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HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
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Firm believer in AS you are good candidate. AS also called watchful waiting in lymphoma circles and I did for several years. Your Doctor is correct though that the anxiety and stress of knowing and worrying about having cancer inside of you and just letting it there is to much for some. AS and WW under monitoring is safe and retains quality of life.
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Hug
1 ReactionAS all the way. Anyone who treats does not know the side effects (doctors do not tend to explain the full negatives of surgery or radiation). If you are 70+ there is a good chance you may never need to treat. If 50 you can hopefully delay the negative effects for many years.
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Hug
2 ReactionsYour numbers look real good. Under no condition, should you do any treatments with this low a biopsy result.
If you want to get a second opinion, the below doctor was probably the best in the country. He has seen hundreds of thousands of biopsies. You actually can call him and talk to him before you Arrange to have him give you a second opinion. You can then speak to him on the phone after the fact about what has been found
You should realize that a biopsy only gets to about 1% of the prostate. Frequently the areas that do not show a PIRADS Score can have more cancer than those that do. I think your steps for following up should keep you ready if anything comes up. Your PSA is quite low and not really a problem. About 10% of prostate cancer patients don’t produce a PSA, Just something to be aware of.
Dr. Jonathan Epstein biopsy
https://advanceduropathology.com
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Hug
4 ReactionsYou might want to consider PSA blood test every 3 months.
Just curious if your PSA is .6 or 6 and if your prostate is enlarged? But as others have mentioned I would also support AS as long as possible. Exercise might help reduce some of the anxiety.
Active Surveillance is an appropriate approach to your very low grade findings. The key to understanding AS is the “active”. This is more than just watchful waiting as repeat biopsies as well as imaging are an integral part of the protocol; not simply watching the PSA. If you choose to have a second opinion on the pathology to confirm the low grade findings, that is always a reasonable choice (though it may mot be necessary if you are already being evaluated at a “center of excellence”). Every year that you can safely defer intervention (whether it’s surgery or RT) is a year less of potential treatment side effects. The impact of anxiety factor on your quality of life (especially if you are a younger patient) is the one mitigating factor that only you can address.
Just remember, AS does not mean you will never have treatment. I was on AS for 3.5 years for a Gleason 3+4, low Oncotype (Decipher equivalent) very localized disease (MRI solitary lesion) when my 6 month PSA suddenly doubled. My MRI remained unchanged, but repeat biopsy showed tumor progression to Gleason 4+5. Fortunately PSMA Pet Scan showed still localized disease.
I have since had SBRT and remain on ADT (planned for 1 year) with a good response. Even with the sharp focus of hindsight, I have no regrets about choosing AS when that was recommended to me.
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4 Reactions@ezupcic PSA is 0.6 and I am very active and exercise . Prostate was 27.3 cc volume at MRI and was 31 cc at fusion guided ultrasound but that is likely due to diff techniques/ technology. 65 yrs old.
@rbtsch1951
Watchful Waiting and AS mean the same thing but called different in the specific cancer types between lymphoma and prostate cancer Watchful waiting was around before AS became a known named protocol with prostate cancer. They just named it different. Regular CT imaging, specialized blood work and even a bone marrow biopsy are all standard with watchful waiting
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1 Reaction@wheel1 Thanks for your input and comments. In some ways it is a matter of semantics, but healthcare providers do differentiate the two approaches and recommend them in different circumstances.
@rbtsch1951
I think general practitioners might use those terms for any number of maladies, but specialists in certain cancers definitely have different intentions on what they do under those scenarios. One does need to know what it’s purpose is.