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Newly Diagnosed and Need Help
First, I would like to extend my appreciation to all those who contribute to this site. I have been an observer ever since I was diagnosed and now have to decide what to do. I would appreciate your insights. I am 75, my wife died from glioblastoma and I moved to PA from FL to help my daughter who is paralyzed on the left side from 2 strokes (genetic veinous interference.) So I have a reason to live. I’m in great shape and work out 4 times a week. No co-morbidities.
This all started sort of cavalierly I insisted on a PSA test with my PCP on 3/15/26. 2 years prior is was 3.7, most recently it was 6.1. His comment was “what would you do if you had PC?” My response was “depends on the score.” Referred to a urologist, insisted on an MRI and that came back PiRads-4 on 4/12/26. Results below. The urologist recommended a biopsy, got it on 5/10/26.) Results on 6/1/26. See below:
My question is, what should I do from here? I plan on a second opinion on the pathology, most likely from John Hopkins, but assuming the initial pathology is correct, what do people think is my best path forward?
I have access to John’s Hopkins, UPMC and UPENN. They are all commutable.
Biopsy:
1. Prostate, right posterior medial, biopsy:
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group: 1), involving 2 of 3 core biopsies.
The carcinoma involves the cores with total linear lengths of 1 mm (10%), and 4 mm (20%), respectively (approximately 10% of the entire tissue submitted).
2. Prostate, right posterior lateral, biopsy:
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group: 1), involving 3 of 4 core biopsies.
The carcinoma involves the cores with total linear lengths of 5 mm (30%), 6 mm (60%), and 1 mm (10%), respectively (approximately 20% of the entire tissue submitted).
3. Prostate, right base, biopsy:
Benign prostatic tissue, no tumor present.
4. Prostate, right anterior medial, biopsy:
Benign prostatic tissue, no tumor present.
5. Prostate, right anterior lateral, biopsy:
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group: 1), involving 2 of 4 core biopsies.
The carcinoma involves the cores with total linear lengths of 1 mm (10%), and <1 mm (5%), respectively (approximately 10% of the entire tissue submitted).
6. Prostate, left posterior medial, biopsy:
Benign prostatic tissue, no tumor present.
7. Prostate, left posterior lateral, biopsy:
Benign prostatic tissue, no tumor present.
8. Prostate, left base, biopsy:
Benign prostatic tissue, no tumor present.
9. Prostate, left anterior medial, biopsy:
Benign prostatic tissue, no tumor present.
10. Prostate, left anterior lateral, biopsy:
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group: 1), involving 20% of 1 of 3 core biopsies.
The total linear length of carcinoma is 2 mm in the core.
11. Prostate,Right middle prostate sole left, biopsy:
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group: 1), involving 4 of 4 core biopsies.
The carcinoma involves the cores with total lengths of 10 mm (80%), 12 mm (discontinuous, 80%), 2 mm (20%), and 5 mm (50%) (approximately 60% of the entire tissue submitted).
MRI:
Impression
PI-RADS version 2.1 Score: 4 , high probability of prostate
cancer in the right posterolateral peripheral zone midgland.
No evidence of extraprostatic extension. Differential
diagnosis also includes sequelae of infectious/inflammation.
Findings to be relayed and documented by Teleradiology
assistant to the referring physician. A notice that an
imaging finding is present on this exam which may require
follow up will be sent to the patient.
Narrative
EXAM:
MRI PROSTATE WITHOUT AND WITH CONTRAST
HISTORY:
Elevated prostate specific antigen (PSA).
PSA value: 6.4 ng/mL
COMPARISON:
CT abdomen and pelvis May 2024
TECHNIQUE:
Multiparametric prostate MRI utilizing standard sequences
in three orthogonal planes without and with intravenous
contrast.
CONTRAST: 8.2 mL Vueway intravenously.
FINDINGS:
PROSTATE:
Volume: 3.1 x 4.4 x 4.5 cm for a volume of 32.1 mL, PSA
density is 0.2 ng/mL/cc based on ellipsoid calculations.Quality: Good
Hemorrhage: None
Peripheral zone: Diffuse linear and wedge-shaped hypo
intensities.
Transition zone: Moderate heterogeneity consistent with
prostatic hyperplasia.
Lesion 1:
Location: Right posterolateral peripheral zone midgland
image 15 series 1007, 1008, image 17 series 801
Size: 5 mm
T2: Moderate T2 hypointense area
DWI: Focus of positive restricted diffusion
DCE: Mildly positive
Prostate margin: Abuts the prostate margin for less than 2
cm.
Lesion overall PI-RADS 2.1 category: 4
PELVIS:
Neurovascular bundles: No evidence of involvement is
identified.
Seminal Vesicles: Unremarkable.
Lymph Nodes: No lymphadenopathy.
Urinary Bladder: Unremarkable.
Osseous Structures: Unremarkable.
Other: Trace bilateral fat containing inguinal hernias.
I greatly appreciate your feedback.
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@marymellen
Be aware that your son’s chance of getting prostate cancer is more than 100% higher than somebody That doesn’t have a father with it. That doesn’t mean it will happen, but it is a much higher chance it will.
He should get tested at least once a year if possible
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2 Reactions@jeffmarc
Thank you. I didn’t know that his chances of getting it were increased. He also has a cousin on my side of the family who died of prostate cancer at the age of 53. Add to that the fact that I was diagnosed with breast cancer six years ago.
@jeffmarc
I meant to say that I did know his chances were increased
@marymellen
Your son Could consider getting an hereditary genetic test. That could make a big difference in how he feels about his future.
My father died at 88 of prostate cancer, That increased my risk a lot. My mother gave me BRCA2, which also increased my risk a lot. I got prostate cancer at 62 because of the BRCA2 and my father, my brother got it at 77 because he didn’t have BRCA2, but he had a father with PC.
There are many other genetic issues that can cause prostate cancer to happen sooner. One guy in this forum, got it at 45 because of a genetic problem.
My mother never had any cancer because of her BRCA2, But both of her sisters got breast cancer, and one of them died of it has did her daughter. My grandfather died of pancreatic cancer when he was young.
You could get the hereditary genetic test just to see if it’s in your family, but with his father also dying of it. A single test for him could eliminate the problem from both sides of the family..
Younger people don’t usually like to do this, But it could give him some comfort if he can do it and Nothing comes up.
Just some things to consider.
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3 Reactions@jeffmarc
Thank you I am going to talk to him about seeing a specialist and getting genetic testing done. He was already going to get genetic testing done because of a genetic heart condition and related gene that have already shown up in two generations of our family, including his generation. So they could do all the testing at one time.
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Hug
1 ReactionWOW. I put my MRI and Biopsy results into AI and got some super information. It really helped in helping me make a decision. It consistently says Active monitoring. I plan on getting some biological gene testing done to see how aggressive this cancer is. I was amazed at the information I got back.
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Hug
1 ReactionWith G6, active surveillance would be likely recommended by any urologist. Even G7 as long as you are 3 + 4 and not 4 + 3 or unless you have a high decipher (I fell into that category, 3 + 4 but high decipher).
As someone who works extensively with AI, be wary of the response. For one it's likely cached, so not the latest (you tell the AI to "refresh your knowledge" and "think hard" and "no guessing or cached answers" to help overcome that). Remember there is very little "I" in AI, they are web scrapers who can intelligently assemble a readable response based on multiple sources, and those sources may be garbage. AI needs trained to answer properly. I'm not saying what it gave you is wrong, just to verify it outside of AI.
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Hug
7 Reactions@survivor5280 I have a PhD in physics so I do a lot of research on this. I’m a “measure 3 times cut once” sort of guy.
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1 ReactionReading through all of your info & thoughts;
At 75y, see Mayo Clinic’s age-based PSA chart (attached).
Your PSA Doubling Time was concerning, and certainly warranted additional testing.
> MRI PIRADS 4: high likelihood that clinically significant prostate cancer is present.
> PSA Density is 0.2 ng/mL/cc: A PSA density of <0.10 ng/mL³ is considered favorable, while >0.15 ng/mL³ is generally the cutoff for biopsy evaluation.
> Biopsy: Gleason 6(3+3).
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Here’s the thing. Since a “true” 6(3+3) doesn’t metastasize nor kill you (https://youtu.be/NV8QHzbgamI), the point of active surveillance is to track the status of the disease (to ensure it’s a “true” 3+3) and only treat it if it becomes medically-necessary (just as you would with any other disease, injury, or illness).
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I chose to be on active surveillance (for 9 years total), at 56y, initially PSA 4.2, PIRADS 3, Gleason 6(3+3), localized. Having been down this road, here’s what I would do with your diagnostic status:
> active surveillance (keeping it truly “active”)
> regularly track Total PSA & Free PSA
> get biomarker (genomic) test
> get genetic (germline) test
> confirmatory MRI/biopsy in a year
> spend this time getting up to speed on all aspects of prostate cancer diagnostics and treatments.
> come up with a treatment game plan in case your numbers change direction.
> Enjoy life.
Thanks for your input. I’ve been researching PC for 3 months or so. I plan on having the Decipher test and others on the biopsy materials. Also active surveillance every 6 months for PSA and MRI. I will check my PSA every 3 months but the Dr said 6. I really want to make sure the Gleason 6 is truly indolent. I’ll let you know how things progress.
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