Prostate Cancer Gleason 6 Group 1 + Hypogonadism

There must be more than Gleason 6 in your biopsy. The question is, was there something else on your biopsy that made him think you needed surgery rather than active surveillance.

Or is it that the doctor figures you get your prostate removed and go back on testosterone and it’s unlikely you will have prostate cancer pop up. You realize that having surgery will probably Cause major erectile dysfunction problems. Make sure the doctor uses nerve sparing to try to limit it. Surgery can also cause incontinence, though it usually isn’t permanent,

Under normal conditions, you could stop your testosterone treatments and that would result in your being exactly the same as somebody like me who is on ADT. My testosterone has been below 20 for almost all of eight years and actually below five. That allows me to survive with prostate cancer. You can live this way at least you can still get an erection and you don’t have to go through the surgery.

I’m not sure what kind of doctor you are seeing but doing a prostatectomy for a 3+3 is no longer recommended for most situations. Are you working with a center of excellence? It might make sense to get a second opinion before committing to surgery. Why wouldn’t radiation be an option, You should speak to a radiation oncologist. A lot less stress if you get radiation,

Normally, observation would be ordered. However, since my body no longer produces testosterone for over a decade, without the those injections I am in a world of hurt. Long term abstinence has a whole slew of its own consequences and is not an option.
With radiation, at least 18 months will be needed before I could resume injections. With Prostatectomy, 6 months. It’s a dilemma because there are lots of consequences with the radical prostatectomy too. Besides my Urologist, I am seeing the Urologist who performs the Davinci surgery, and I am also going to review options at the Moffitt Cancer Center in Tampa.

I am trying to determine if there us anyone in my situation who has been ok’d to continue testosterone injections with any of these options.

See a radiation oncologist.

I would agree that with 3+3 having your prostate removed seams way over-kill and opens the door for a bunch of other issues that will affect your life. Maybe I don’t understand the situation, but I’d certainly get more advice and opinions. Seams like keeping a watchful eye on it with PSA tests and other biopsies down the road.

I am a Gleason 6. I have been on TRT for about 6 years and was diagnosed with the prostate cancer about 3 years ago. Both my original urologist who recommended A/S and my new urologist at the Mayo Clinic are both okay with me staying on TRT. I believe if my cancer ever got to Gleason 8, metastases, then the TRT would have to stop.

@bobgolf How often are PSA’s and biopsies performed? I would think you’d have to be monitored very closely.
And they probably are not going to wait for G8/metastases to stop TRT - that’s like waiting for the whole block to catch fire before calling the fire department!
And worse, you would probably never be on TRT again after rounds of treatment involving heavy duty ADT.
You might want to reconsider gland removal if your Gleason ever gets to a 3+4 - IF your age and medical condition allow for it. Or radiation without ADT. Complete removal - before any spread - is the only way your TRT is going to continue smoothly. Radiation may not get it all if you have certain pathologies in your biopsy, but that’s to be determined.
And just an FYI, I am NOT a big believer in ‘when in doubt, cut it out’…but sometimes prophylactic removal of a body part does help you live a lot longer and better! Best,
Phil

@heavyphil I am on active surveillance with TRT, Gleason 6. Originally my urologist took me off TRT was pushing for prostatectomy, but Moffit Cancer Center put me back on TRT and has me on active surveillance. Blood test every 6 months, MRI every 12, and biopsy every 18 months.

Food for thought: There is a ton of emerging data that suggests that there is NOT a linear connection between testosterone and prostate connection.

There was a bipolar androgen study that showed small doses of testosterone increased cancer growth, while high doses (beyond saturation levels) actually stopped the cancer growth in later stage prostate cancer.

Another study out of the UK showed that there was NO statistical difference in outcome between those who were put on active surveillance, those who had radiation, and those who had a prostatectomy over 5, 10, and 15 year periods.

Several META and population studies showed that the patients they monitored over a multi year period who were on TRT and active surveillance showed no increase in PC growth. My Urologist has patients on TRT and active surveillance for several years with the same results.

Although the emerging data is not conclusive, it demonstrates that the prevailing theory that "using testosterone is like putting gasoline on a fire" is not accurate and that there is NOT necessarily a linear connection between the two.

These studies I found were enough to question three urologists who I consulted with who all admitted that "they really just do not know" and that there is much they have to learn about the interaction of testosterone and prostate cancer. One was the surgeon who was to perform the prostatectomy had I agreed to go forward with the procedure.

Disclaimer: I am not a doctor and you should always follow your doctor's instructions.

@floridanad Glad that your docs have you on close watch; and I agree that the PCa /T link should be challenged more often based on the studies you’ve cited and the ambiguity often seen in their respective amounts.
My main focus was on your comment about them (or you) waiting for a Gleason8/metastases before doing anything.
You’d want to act way before that! Good Luck,
Phil

@heavypilheavyphil the Mayo Clinic checks my PSA twice a year and I will be having a 3T mp MRI later this month. My two previous MRI's did not show any lesions, Pirads 2. My PSA is usually below 2. The whole thinking on testosterone has evolved alot in the last 5 years. Having a Gleason 6 like me stop TRT would be like have all men first diagnosed with Gleason 6 cancer immediately go on ADT. That just does not happen. I am 71 years old and play golf 3 times a week so I'm in fairly good shape. I've learned to just live with this cancer. When I was first diagnosed I certainly felt that I needed to do some treatment. But as you read the experiences of men on just about all of the treatments you find they mostly all have some negative issues. Its a tough deal. I study and research everything I can on prostate cancer knowing some day it may/will be time to treat it. The Mayo will probably do a biopsy again if something shows up on the MRI. From what I have read, prostate cancer is the only cancer where biopsy is done without an MRI in some instances. All other cancers they do an MRI first and only biopsy if something shows up. They never just start poking needles into the brain or some other area of cancer if there is nothing on the MRI.

@bobgolf Between the time my original Urologist took me off of Testosterone until the Urologist at Moffit Cancer Centers put me back on, was at least four months. My T levels went down to 51! I couldn't swing a golf club or function normally. I was a mess. This cancer is very slow growing, so we have time. Like you, I will be proactive if and when there is an increase. Statistically, I may be more likely to die of old age before this cancer becomes a real issue. So I too have learned to just live with it.