Choosing Active Surveillance over any further treatment at this time

This is a new comment , not related to the last post I'm not sure how to start a new thread but this is my issue and feel free to reply with any insights . I'm 68 and over the last 2 years I've had my PSA tested 4 times - each test with a lower number than the last . I also had a 3T-MRI which showed a small 5mm lesion contained in my prostate with no sign of migration . My health care provider ( Kaiser - California ) will not approve any other test ( i.e. PSE , PSMA etc. ) I don't know if I can even talk them into a follow up MRI as it took me 2 months to approve of the first one after being rejected over and over ..... here is the reason I'm choosing AS over any further treatment at this time :
When considering the life expectancy and mortality risk between two 68-year-old men, one with untreated prostate cancer (PSA = 8.6, Gleason score of 3+4) and the other with normal PSA and Gleason levels (no prostate cancer), several key factors must be taken into account, including the severity of prostate cancer, overall health, and other potential causes of death. Let's analyze the two scenarios in detail.

1. 68-Year-Old with Prostate Cancer (PSA = 8.6, Gleason Score 3+4)
PSA Level (8.6): A PSA level of 8.6 is elevated and suggests the presence of prostate cancer, though it’s not extremely high. PSA levels can fluctuate and are influenced by several factors, but PSA is a primary marker used to detect prostate issues.

Gleason Score (3+4 = 7): A Gleason score of 7 indicates intermediate-grade prostate cancer. This means the cancer is more aggressive than a low-grade (Gleason 6) cancer, but it is not as aggressive as high-grade cancers (Gleason 8-10). Gleason 7 cancer has a moderate likelihood of spreading beyond the prostate if left untreated, although many men with Gleason 7 prostate cancer live for years without it spreading aggressively.

Life Expectancy & Mortality Risk:

Life Expectancy: For a 68-year-old man with untreated Gleason 7 prostate cancer and PSA of 8.6, life expectancy will be influenced by several factors:

Prostate Cancer Prognosis: Untreated prostate cancer with a Gleason score of 7 (especially 3+4) is typically not immediately life-threatening. However, the cancer may spread over time, affecting the individual’s overall prognosis. While some men with intermediate-grade prostate cancer can live for many years with good quality of life, others may experience progression.

Overall Health: If the person is otherwise healthy with no significant comorbidities, life expectancy could still be in the range of 15-20 years or more, though this could be shortened if the cancer progresses and metastasizes.

Mortality Risk:

Prostate Cancer Mortality: The risk of dying from prostate cancer in this case is moderate but not extremely high. Untreated, Gleason 7 cancer can eventually lead to metastasis, and advanced prostate cancer can become life-threatening.

Death from All Causes: The individual’s risk of dying from other causes (e.g., heart disease, stroke, accidents) is still significant, given age and the fact that prostate cancer is just one factor. The presence of cancer increases mortality risk compared to someone with no cancer, but the risk of death from prostate cancer itself is moderate.

2. 68-Year-Old with Normal PSA and Gleason Score (No Prostate Cancer)
Normal PSA and Gleason Score: In this case, there is no evidence of prostate cancer. The person’s PSA is within normal limits (under 4.0 ng/mL) and their Gleason score is not applicable, as there is no cancer present. This person does not face the risk of prostate cancer, which significantly impacts overall mortality and life expectancy.

Life Expectancy & Mortality Risk:

Life Expectancy: This individual is generally expected to live as long as the average 68-year-old. The life expectancy could be around 15-20 more years, depending on their overall health and lifestyle. Without cancer, they are not facing the additional health risks associated with untreated prostate cancer.

Mortality Risk:

Death from Prostate Cancer: There is no risk of dying from prostate cancer in this case.

Death from All Causes: Mortality risks are similar to the general population, depending on comorbidities and lifestyle factors. Cardiovascular disease, respiratory conditions, or other chronic conditions become more relevant risks with age.

Comparing Life Expectancy and Mortality from All Causes:
68-Year-Old with Prostate Cancer (PSA 8.6, Gleason 3+4)
Life Expectancy: Likely in the range of 15-20 years or possibly more, depending on the progression of the cancer and any other health factors. The cancer could progress, but Gleason 7 prostate cancer is typically not immediately fatal, and many men live for years with untreated or managed prostate cancer.

Mortality Risk:

Prostate Cancer Mortality: Given the Gleason score of 7, the risk of dying specifically from prostate cancer is moderate. Without treatment, there is a higher likelihood of progression to metastatic disease, which can increase mortality risk.

Mortality from All Causes: Increased risk of mortality from other causes (such as heart disease, stroke, etc.) compared to someone without prostate cancer.

68-Year-Old with Normal PSA and Gleason Score
Life Expectancy: Likely to be in the range of 15-20 more years, depending on overall health and lifestyle factors, since there’s no prostate cancer or other significant health issues.

Mortality Risk:

Prostate Cancer Mortality: Zero, since there’s no prostate cancer.

Mortality from All Causes: Similar to the general population for a 68-year-old, with risks increasing as the individual ages, but not specifically elevated due to prostate cancer.

Conclusion:
Life expectancy for both individuals is relatively similar, but the 68-year-old with untreated Gleason 7 prostate cancer (PSA = 8.6) may have a slightly reduced life expectancy due to the cancer’s potential to spread over time. However, many men with Gleason 7 prostate cancer live for many years without significant symptoms.

Mortality risk from prostate cancer is moderate for the person with Gleason 7 cancer, and their overall mortality risk (from all causes) is likely higher than that of the person with no cancer, due to the additional cancer-related health risks.

The individual with normal PSA and Gleason levels, being cancer-free, has a life expectancy similar to the general population, with typical risks associated with aging. Their risk of dying from prostate cancer is zero, but they may face the usual age-related mortality risks.

Overall, the 68-year-old with Gleason 7 prostate cancer has an increased risk of dying from prostate cancer and possibly a slightly higher overall risk of death from other causes, compared to the person with no prostate cancer. However, their life expectancy may still be fairly similar to the average for their age, especially if the cancer remains indolent and untreated.