Did you choose active surveillance? Why was it a good choice?

You could be one of the people that does not produce much PSMA. Without producing PSMA a PSMA pet scan won’t show anything. I know at least one person that died of prostate cancer because it couldn’t be detected on the scan. He had no idea he had a lot of metastasis. When he finally discovered how severe it was he went as far as getting Pluvicto and Actinium in Austria, but neither worked because they require PSMA.

You might want to request an FDG PET scan, It can show cancer that can’t be seen in a PSMA pet scan when you don’t produce PSMA.

With a PSA at 5.25 something somewhere is producing PSA, That’s usually cancer if that’s what you’ve had in the past.

Definitely a strange case with a high PSA and no visible cancer.

Began AS in October 2023, after being diagnosed with low volume 3+4 and Decipher score of 0.22.

After an initial mpMRI showed PIRADS 3, 4 & 5 lesions, only one reduced T2 & DWI/ADC signal lesion (the original PIRADS 5) could be observed in my 12 month follow-up mpMRI.

So....yes...a 3+4 diagnosis (with low decipher score) can regress. I personally believe it may be due to my 90 minute/week vigorous aerobic exercise regiment, which I started upon PCa diagnosis...but who knows for sure...clinical studies & RCT's would suggest that could be the case.
https://jamanetwork.com/journals/jamaoncology/fullarticle/2783273
https://www.health.harvard.edu/mens-health/exercise-may-slow-prostate-cancer-growth
Recently, CoE institutions (UCSF & UCLA & John Hopkins) have all completed independent studies suggesting a healthy diet may also help slow PCa progression...but who knows for sure...

One thing I do know for sure is that my VO2 Max has increased from 40 to 47 and I have lost 25 lbs, since I was diagnosed.

- https://www.ucsf.edu/news/2024/05/427571/prostate-cancer-study-more-health-benefits-plant-based-diet

- https://www.uclahealth.org/news/release/low-omega-6-omega-3-rich-diet-and-fish-oil-may-slow-prostate

- https://www.hopkinsmedicine.org/news/newsroom/news-releases/2024/10/study-suggests-a-healthy-diet-may-help-keep-low-grade-prostate-cancer-from-progressing-to-more-dangerous-states-during-active-surveillance

I can say that I've had a radical prostatectomy, 11 years later my cancer came back and I've had 36 treatments of proton radiation therapy. Right now, I'm one active surveillance with a PSAof 5.25 and rising. Not sure what or when the cancer will show a metastasis somewhere. So far 4 PET scans have not showed anything. The thing is, you have to have a great outlook for tomorrow and educate yourself. Patrick Walsh's book will definitely help.
I believe however, that you should take a really good look at Medicare Advantage because it isn't a great insurance option and many doctors won't accept it. My Medicare and my supplemental insurance so far, have covered all of my expenses.

Follow your medical experts . Your Urologist should follow you closely on AS . I have a friend currently on active surveillance , for 7 years , with G6 and Gleason 3 + 4 = 7 . He just turned 60 last June . He has keept abreast of the emerging new advances over the years -- He has options today he did not have 7 years ago . He is currently considering NanoKnife should he decide , in concert with his Urologist , to discontinue his AS . He is also not opposed to other Focal Therapies as they advance .
You not have read my thread on my biopsy experience . Biopsy 1 A Transperineal MRI Fusion Biopsy 5 Cores - ALL Negative . Clearly in conflict with my MRI RADS 5 Score . My 2nd Biopsy a 16 Core with 6 cores in the same target area as Biopsy 1 . The 6 cores in the same target area as Biopsy 1 came back Gleason 3 + 3 = 6 .
A 2nd opinion on my G6 came back : ALL 6 CORES Gleason 3 + 4 = 7
A 3rd opinion : 4 Cores G6 2 Cores Gleason 3 + 4 = 7 . All other other cores of the 16 came back negative .
I hope this reinforces my advice . Get a 2nd or 3rd opinion of your biopsy slides .

Some people do AS for 3+4. Yes it can get worse. It can also not change for a while, giving a break before treatment. Unlikely to not get worse over time.

I have a question about active surveillance. I was given that option. But as jeffmarc has pointed out my 3+3 gleason 6 should be AS. But why would you wait on a 3+4. What are we waiting on. To get worse? Reduce the inevitable side effects? Would there be any likelihood its not going to get worse.

The 1st thing I suggest , Get a 2nd or 3rd opinion of your biopsy results Confirm you have Gleason 3 + 4 = 7
Active surveillance MAY bbe a good option with regular PSA ( EVERY 3 MONTHS ) FOR THE 1ST YEAR . Followed by a followup MRI to determine any growth of the liason .

As recommended in Dr. Patrick Walsh's Book 5th Edition " Guide to Surviving Prostate Cancer "
Everyone should get a 2nd or 3rd opinion of their Biopsy Pathology results .
Take my case : Biopsy # 1 A 5 core Transperineal MRI Fusion Biopsy - ALL NEGATIVE . This was in clear conflict with my MRI PI- RADS 5 Score . Biopsy # 2 , at my request not my Urologist was a 16 core with 6 cores in the same target area as # 1 .
All 6 cores came back Gleason 3 +3 = 6 . A 2nd opinion 4 cores Gleason 6 , with 2 cores Gleason 3 + 4 = 7 . TAKE YOUR PICK .
I would have a 2nd or 3rd opinion of my biopsy slides . I have been on active surveilllance for a year , and currently reviewing my other options . My recent year-over- year MRI ( My 3rd )
showed no change . My recent Bone and CT Scans were negative - No metastasis detected . I plan on a PSMA PET SCAN -- My call .

Pirad 2

No