Received the news on Halloween. I have prostate cancer. Need advice.

Posted by frank1956 @frank1956, Nov 1 7:26pm

I previously had 2 benign biopsies in 2024. Urologist/Oncologist asked to follow up in a year. So on September 2025, I did PSA (5.4) and MRI (2 legions PI-RADS3, and PI-RADS4). These 2 legions are similar in size with the previous 2 MRI's from 2024.
Doctor ordered a biopsy. On Halloween day, the report came and it shows out of 18 cores, there are 2 Gleason 6, and 1 Gleason 7 (3+4), which is with 40% core, and G4 is 10%.
I am scheduled to see my Urologist/Oncologist on Wednesday. I will ask for a Decipher or Polaris test and a PSMA scan. Maybe a genetic test to check BRCA1, BRCA2 genes?
I am not sure what else to ask from the doctor. Any advice will be greatly appreciated.

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brianjarvis | @brianjarvis | Nov 2 4:40am

It’s good that you’re in information-collecting mode. That will guide you towards an appropriate decision.

> It’s always a good idea to get 2nd opinions on biopsies — not necessarily because you don’t trust the 1st one or don’t like that opinion. But, because much of the interpretation of images and scans is often as much an art as it is a science, and it’s dependent on the skill and experience of the person reading the slides. It’s good to have an independent set of eyes reviewing the biopsy.

> Since you have a “4” cell type in the Gleason score—> In the MRI or biopsy reports, were the words cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma mentioned? (If not, that’s good.)

> also, ask them to calculate your: % Free PSA, PSA Doubling Time, and PSA Density to see if those are ok or if they indicate any concern.

> the genetic (germline) test will check a few dozen markers that may be related to prostate cancer in addition to BRCA1/BRCA2. (See attached chart for the key markers.)

> I would also ask to bump-up PSA testing to every 4-6 months rather than annually (and calculate those three - % Free PSA, PSA Doubling Time, and PSA Density - at every PSA test). Tracking PSA more actively going forward is important.

gently | @gently | Nov 1 9:44pm

jeff's is excellent advice. I would want a consultation with a radiation oncologist as well, so I'd ask for a referral.
Sorry for your halloween news.

jeff Marchi | @jeffmarc | Nov 1 8:13pm

You are a case where active surveillance would make sense. This was discussed At the PCRI conference today. With a low number of cores you have with a Gleason 6 score, and very little four in the 3+4 There really isn’t a lot of reason to do anything right away. You’re a low PSA score is another reason active surveillance makes sense. Prostate cancer grows very slowly you have a long time to make any decision.

You could get a PSMA pet scan to see if there is spread anywhere in your body.

The Radiation oncologist at the PCRI conference discussing active surveillance was pretty insistent that somebody like you should not be doing treatment yet. You could take a look at the video and see what’s going on.

Here is a video with Dr. Laurence Klotz, one of the experts on active surveillance. He can give you answers as to why you would or would not be a good candidate for active surveillance.