New diagnosis at 50

@mtcoastie
Another thing you could do to give you some comfort would be to both do a decipher and an Artera AI test. They will show the likelihood of you having prostate cancer recurrence if there is really a problem.

I was just speaking to somebody who has large cribriform. His Gleason is 3+4 but very low percentages. Large cribriform can be very aggressive But he’s had both the decipher test which came back very low and an Artera Ai Test, which also came very low showing that his chance of recurrence is quite low, even though he has one aggressive cribriform. He has spoken to almost every major doctor involved in prostate cancer diagnosis and they pretty much agree that he can wait and do active surveillance because the test show a very low chance of his cancer, becoming aggressive soon. He’s going to wait, Get PSA test tests regularly, Get an MRI annually, As well as a PSMA pet test. He doesn’t want to jump into something when it really isn’t necessary yet. He did get the Polaris test and found out that SBRT might not be good but IMRT is OK. This is the type of research some people go to in order to really properly evaluate their chances of the cancer being aggressive now.

My brother was on active surveillance for about six years and at 77 he finally had his PSA rise and the biopsy showed. He was a Gleason 4+3. He had SBRT radiation in three years later he’s doing fine.

Just wanted to give you some other points of view. Those videos are real useful for making decisions, however.

One other thing you could do is get a second opinion on your biopsy. There are expert doctors that can give you more information, Dr. Epstein is one of them. If you pay to have him check your biopsy, he will give you a lot of time on the phone in order to talk about what your options are. Not everyone wants to go this far, but if you are really anxious, this can give you more information to go on.

Dr. Epstein biopsy
https://advanceduropathology.com
Dr. Zhou

Send an email to Ming.zhou@mountsinai.org to inquire about a second opinion and ask for his specific instructions for the process.

In 2014, I started off with PSA of 4.5, Gleason 6 in biopsy cores, and active surveillance. I didn’t feel entirely comfortable with that, so in early 2015, I went for a second opinion and a second biopsy. More cores had cancer, and the highest Gleason score was 3+4. In April 2015, I had a RARP. My pathologic stage was pT2C, my maximum Gleason was still 7 (3+4), and I had a positive margin on the Right Apex. My Prolaris score was 1.7 and I had a 10-year risk of Biochemical Recurrence of 53%. My urologist/surgeon at the time remarked, ‘we didn't act too soon’. So, within the span of a year my status went from “go have a nice life, something else will kill you way down the line” to “I hope we got it all and we’re gonna keep a close eye”.

And ten years later (this past June), I was diagnosed with a local recurrence, with a PSA of 0.11 (had been undetectable for ten years). Just finished 8 weeks of radiation therapy, hoping once again that I’ve knocked it out.

Moral of the story: If I had not gone for the second opinion, I likely would be telling a very different story today, or perhaps not telling any story at all. Instead, I had a good ten years run after initial treatment, with a good shot at many more good years to go my recent radiation therapy.

Maybe active surveillance is the way to go for you, but right now you have the favor of time. A second, and even third opinion, seems like a good idea.

Best wishes for moving forward. Early detection gives you lots better options. Diagnostic tools and treatment options are vastly better than they were ten years ago, and continue to improve. Still tough decisions indeed. We’re with you.

lots of great advice, I would suggest three things.

1. Start seeing a psychologist and talk out this topic of active surveillance, your personality of being anxious, and self-awareness of what you have (have not done) in your life. Learning more about how you could/would manage this type of strategy will be very helpful. We all have a really good understanding of how we feel, but a professional will help to break through this superficial layer, help you expose deeper feelings and provide a better path of knowing how you feel about risk.

2. Keep up the education on prostate cancer. There is much to learn about the advancements of science and treatment. While things like castrate resistant cancer is far from your current situation, learning more about the entire portfolio of prostate cancer will position you to be less overwhelmed, more informed, and better prepared to listen and talk with doctors, rather than being lectured (I say this in a positive way).

3. Make your bucket list of life and make sure you are living it. 50 is a great age (I'm 54) where you can take a realistic inventory of what you want to do, and start doing those things. Perhaps you planned to retire at age 65 and live to 95, what if you retire at 60 and live to 90, what if you leave your high-stress job of today, take a pay reduction, and get a stress-free job. Get your finances in order, explore how you will de-risk your retirement funds in the coming years, create a will, assess what big expenses are coming up for your property and family.

Overall, tough decisions, but we are with you, and there is so much life to live, so here you go!

Don’t consider Active Surveillance as doing nothing. AS is a treatment plan with vigilant observation of your disease. Most of the data suggests that even if disease progresses on AS and requires intervention, the outcome in terms of disease free survival and mortality is not any less than with immediate intervention.

I read you post and being a "young" guy I'll share my husband's diagnosis in February at 55yo! and I'll just tell this so you see the progressions we've done so far, not to "one up" you, because I wish it wasn't the case!!
He went to the Dr with what he thought was just enlarged prostate, symptoms were peeing a lot and a bit of problems in the bedroom. Dr thought the same thing and did a PSA, it came back almost 300! Prostate Cancer!
That triggered a CT scan a few days later which showed it outside the prostate- so stage 4 advanced! Urologist referred to oncologist and said he'll probably recommend ADT drugs- chemical castration!
My husband would rather DIE than lose his manhood!
Sure enough the Dr was very clinical and said it's ADT (Firmagon then later Lupron -but my husband chose to just continue Firmagon) plus Zytiga pills and prednisone and over the summer he did chemo! And with all that 30% make it 3-5 years!
The Dr also scheduled a PSMA PET scan and once we got the results of that it was all over his body- I know have the picture of it and it showed up the cancer was EVERYWHERE! lungs, spine, pelvis, bones, of course prostate too! (No other organs though)
Now he's had a scan after the chemo and it's been over 6 months since it all started and the PSMA PET scan showed maybe 4 small places! 1 small thing on the lungs, pelvis, thigh and I think still in the prostate, but GREAT improvement! Yet we're cautiously optimistic. I thought the doctors would be happy but he just said it's good, keep doing ADT!
They did say early on that the 3-5 years, he'll probably beat because he's young and healthy otherwise and goes to the gym and eats right! We'll see.
Now that the holidays are upon us, how many Thanksgivings and Christmases will be have together? I can hope for 10? then our kids will be young adults at least.
It's such an odd feeling, knowing your days are numbered!
Hang in there and research options, my husband tried certain UNMENTIONED supplements and it wrecked his liver for a while, but after a month or two it healed itself and he's ok now.
He looks fine and feels fine now!

You may not need surgery.
Check out the book You can beat prostate cancer. (Marckini)
Helped me in knowing what questions to ask.

I forgot the "rape with a broomstick" biopsy.... gleason scores were mostly 9 and 10s combined, a few were lower, so very aggressive.

Your dad died early in life, but seemingly survived an often-seen 10-12 years post-diagnosis. My own father was diagnosed late in life and did nothing. He lived to 99 years and 10 months "with" prostate cancer for at least 15 or more years (just a guess...no one knew because he did not get PSA testing nor biopsy as he should have). But...you may have a genetic component at play here with diagnosis at such an early age, compared to the usual diagnosis in the 60-70 year old range. I would recommend the Decipher Test by Veracyte Labs (San Diego, CA). Your physician can order the test on your biopsied tissue. If you are unaware, it is a test that detects the presence of 22 prostate-specific cancer genes. You end up with a Decipher test "score" from 0.1 to 1.0. The lower the score, the better. The report score tells you have the probability and risk assessment for longevity and recurrence. Perhaps you have one or more genes that predisposes you to earlier occurrence and shorter longevity. But knowing that could result in an appropriate treatment or therapeutic course that gives you more time - because 72 years old is way too young to die these days. Good luck to you. Follow-up with us here with updates, making sure to remind us of your original post (age, father, Gleason score, etc.).

Hello-
I am on also dealing with a life of anxiety, having been on active surveillance now for some 5 years, with slowly rising PSA, and a steady Gleason Score of 6, less than 10% chance of metastasis. Heading in for MRI tomorrow and possible biopsy next month, which I have had every 1-2 years. This has been a good thing for my anxiety, in that we know what kind of cells they are (adenocarcinoma), and where to concentrate the biopsy.
One tip that I learned from the website videos at NutritionFacts. org is the the ingredient in (10-12) pumpkin seeds (pepitas) worked as well as a few of the commonly prescribed medicines for improving urinary flow and control issues. Worth a try if you are having problems.
Another good tip that my urologist just started was to ask a medical technician to do a quick ultrasound of my bladder, done after I give a urine sample. This shows if the bladder is completely emptying or not, test and results were done all in about 2 minutes time.

MT - Very similar to my case . My father was diagnosed at 62 , and passed away when he was 67 . This was 28 years ago now. He went on ADT right away but it only helped for about a year or so . There was no other ADT drugs at the time... now many ADT drugs , some to over-lap , many modes of treatment . I had operation and then about 3 years later EBRT of 22 session at PSA of 0.14 ...this brought me down to 0.066 now . EBRT was 2.5 years ago . I see Jeff Michi participated in blog to you - wonderful source of information and research . A nice fellow as well ! Dont forget AS is a treatment plan , and monitoring plan . I was never on it had Gleason 3+4 from the get go ! I like you have problems with anxiety and stress, as I was the only caregiver for my father and spent hours and hours in the palliative care award during his difficult times. I miss my dad so much. He was a very smart man and an engineer, a chemical engineer, but didn't seem to get along with Dr as well and didn't trust the whole process. Prior to an overseas trip with my mother 28 years ago, he did get a PSA test and that's what gave him his diagnosis. I can't remember what his PSA was, but he was 62 at the time and just thinking about retirement. He left it too long for sure. You on the other hand are very proactive and this disease will not get away from you. I can tell. You have this, just be proactive and educate yourself on all the possible therapies. Have at least 2 to 3 doctors to consult with to bounce opinions off of. I will pray for you Sir . James on Vancouver Island .