Husband just diagnosed with PC
My husband was just diagnosed with PC. He was having issues with increasing PSA. DRE’s were all good. Prostate size 34 cc. PSA first check 3 years ago in 2016 was 2.6, 2017 3.5, 2018, 4.1 so he was sent to see urologist. The Dr we saw said no reason not to re-check in 6 months. At the 6 month check up his PSA was 4.73,then the next 6 month check up 5.24.I finally talked my husband into doing a biospy on Aug 8th. The results we received are below. Any in put would be helpful.
We are scheduled for a second opinion in Sept at Vanderbilt. What questions do we need to ask. I’m worried about the perineural invasion that the urologist didn’t mention.
With this cancer is there a greater chance of spread because of perineural invasion?
Adenocarcinoma,Gleason 3+3 =6 (Grade group 1) with perineural invasion.
Leftbase 1 core Gleason 3+3= 6 core involvement: 80% (14 mm) discontinuous
Left mid: 1 core Gleason 3+3=6. Core involvement 90% (15mm) discontinuous / fragmented
Left Apex: 2 cores 3+3=6 Gleason
Core involvement:10% ( 2mm) <5% (0.5mm)
Right base: benign prostatic tissue
Right mid: 1 core 3+3=6 core involvement:<5% (<0.5mm)
Right apex: benign prostatic tissue
Comments Gleason Score can be grouped and range from grade 1 to grade 5
Partin table (PSA 5.24 Gleason 
+3=6
Clinical stage OC EE ISV NM
T1C ( non palpable) 90 9 1 O
TC2 ( palpable <1/2 lobe 87 12 1 0
Test - T2b, c ( palpable > 1/2 lobe , bilateral). 76 22 1 0 result
Positive margins 25.8
3 year recurrence - free survival 84
5 yr recurrence- free survival. 75
Assumes clinical stage T1,2
Total % cancer: 15%
Total length of cancer. 32 mm
Total # of involved cores 5
Total cores: 12
Longest tumor in single core: 15 mm*
Max core involvement 90%
# of cores with >50 % involvement 2*
* discontinuous Tumor measurement
1LB:20,17 2 LM:15,15,4 3LA:16,14
4RB:19,17. 5RM: 20,14 6RA: 15,12 12/198 (NN1) (AAC,blc)
Comments
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Correct
murphy,
Your husband's results are a bit of a mixed bag, but you are correct that the most worrisom issue is the perineural involvement, which CAN be a conduit for the disease to escape the gland. P.I. means that cancer cells are under the lining of the nerve bundles, but do not at this point prove escape from the gland. His results also mention positive margins, meaning the tumor is against the wall of the gland, and is also problematic.
His Gleason at 6 suggests non-aggressive disease, but he has a fair amount of volumeric involvement. So, as I said, there is good and bad.
If his first meeting was with a urologist, who will be a surgeon, it is best that his second opinion NOT be a urologist, but rather a radiation oncologist. Based on this one result, it seems likely that surgery or radiation would be curative in his case; it should be readily beatable.
Vanderbilt is excellent, and a good choice.
max
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HusbandCorrect
murphy,
Your husband's results are a bit of a mixed bag, but you are correct that the most worrisom issue is the perineural involvement, which CAN be a conduit for the disease to escape the gland. P.I. means that cancer cells are under the lining of the nerve bundles, but do not at this point prove escape from the gland. His results also mention positive margins, meaning the tumor is against the wall of the gland, and is also problematic.
His Gleason at 6 suggests non-aggressive disease, but he has a fair amount of volumeric involvement. So, as I said, there is good and bad.
If his first meeting was with a urologist, who will be a surgeon, it is best that his second opinion NOT be a urologist, but rather a radiation oncologist. Based on this one result, it seems likely that surgery or radiation would be curative in his case; it should be readily beatable.
Vanderbilt is excellent, and a good choice.
max
Thanks for your comments. The Dr we are seeing is an urologist/Oncologist. They said we would get a tour and get to see the different kinds of medical procedures they offer and speck to different DRs on those prcedures. Do you think we should ask for a PET scan also to see if it’s contained or not?
Murphy
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PETMurphy549 said:Husband
Thanks for your comments. The Dr we are seeing is an urologist/Oncologist. They said we would get a tour and get to see the different kinds of medical procedures they offer and speck to different DRs on those prcedures. Do you think we should ask for a PET scan also to see if it’s contained or not?
Murphy
I will leave it for some of the other guys to give their opinions regarding PET scans.....
max
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PetPET
I will leave it for some of the other guys to give their opinions regarding PET scans.....
max
Max,
thanks again for your responses.
Murphy
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List of Questions for second opinions
Murphy,
Welcome to the board. You doing well in getting a second opinion, however, I think it should include questions regarding your first doctor's comments not written in the report.
The diagnosis is all set in the first sentence described by the pathologist; "Adenocarcinoma,Gleason 3+3 =6 (Grade group 1) with perineural invasion". The final comment added by the urologist regards the clinical stage, but he is not precise only assuming it to be T1 or 2. The data used for such a conclusion is based on the results from the predictable Partin tables, results from exams investigating (OC) organ confinement and (EE) extraprostatic extensions and (ISV) invasion of seminal vesicles) and (NM) involvement of lymph nodes or far metastases. I wonder what king of image studies were done.
Sincerely I would recommend you to get a mpMRI or PET before deciding. The described ratio for Positive margins of 25.8 is low but if existent extraprostatic extensions become a high probability that would stage your case as T3. The report doesn't indicate recommended treatment but I believe that the doctor is providing probabilities of recurrence in case you chose surgery. He describes "3 year recurrence - free survival 84%; 5 yr recurrence- free survival. 75%". This is low to assure success. In other words your husband case may need further salvage treatment if he decides in having prostatectomy.
I suggest you to read more about prostate cancer and prepare a List of Questions for your next appointment. You can include all what I suggest above added to other questions you may formulate from these links;
https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/talking-with-doctor.html
https://www.cancer.net/cancer-types/prostate-cancer/questions-ask-health-care-team
Please note that I am not a doctor. I am a 19 years survivor and continuing patient of PCa with loads of experience acquired from my own researches and treatments.
Best wishes and luck.
VGama
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Second opinionVascodaGama said:List of Questions for second opinions
Murphy,
Welcome to the board. You doing well in getting a second opinion, however, I think it should include questions regarding your first doctor's comments not written in the report.
The diagnosis is all set in the first sentence described by the pathologist; "Adenocarcinoma,Gleason 3+3 =6 (Grade group 1) with perineural invasion". The final comment added by the urologist regards the clinical stage, but he is not precise only assuming it to be T1 or 2. The data used for such a conclusion is based on the results from the predictable Partin tables, results from exams investigating (OC) organ confinement and (EE) extraprostatic extensions and (ISV) invasion of seminal vesicles) and (NM) involvement of lymph nodes or far metastases. I wonder what king of image studies were done.
Sincerely I would recommend you to get a mpMRI or PET before deciding. The described ratio for Positive margins of 25.8 is low but if existent extraprostatic extensions become a high probability that would stage your case as T3. The report doesn't indicate recommended treatment but I believe that the doctor is providing probabilities of recurrence in case you chose surgery. He describes "3 year recurrence - free survival 84%; 5 yr recurrence- free survival. 75%". This is low to assure success. In other words your husband case may need further salvage treatment if he decides in having prostatectomy.
I suggest you to read more about prostate cancer and prepare a List of Questions for your next appointment. You can include all what I suggest above added to other questions you may formulate from these links;
https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/talking-with-doctor.html
https://www.cancer.net/cancer-types/prostate-cancer/questions-ask-health-care-team
Please note that I am not a doctor. I am a 19 years survivor and continuing patient of PCa with loads of experience acquired from my own researches and treatments.
Best wishes and luck.
VGama
VGama,
Thanks for the information and the links. I’m starting to put together a list of questions for the second opinion. The Urologist who did my husband biospy didn’t say a lot other than surgery to remove prostate because their was a lot of cancer and to save radiation incase of a recurrence. He said my husband could do AS for a little while but not to take long to decide.We ask about a MRI and he said why we have already found cancer, no reason to do one.Needless to say this Dr will not be doing my husbands surgery. I want my husband to go out if state to a top hospital for surgery but he doesn’t want to go so far away from home due to follow ups. I read Vanderbilt is good hospital and it’s not too far from home. I just pray we get more information from the second opinion so we can make the best decision possible.
Murphy
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Being confident on the physicians treating us is the best option
Murphy,
I agree that you should procure the best. Trusting the physician treating us is a good step forward for success. Your husband should be full confident at the timing of the decision.
I am not familiar with the Vanderbilt hospital but Max above recommends it. I also think that second opinions should be obtained from specialists in different fields (Surgery and Radiation) but you need firstly to get additional data/information on your husbands' present status so that doctors will provide you their best recommendation. Contrary to what your first doctor told you, an image study is essential to verify the extent of the disease. The DRE plus the PSA and the Partin Tables do not give a real picture of what is going on. An MRI can identify the involvement of lymph nodes which is not covered by a biopsy or a DRE. Furthermore, a Bone scan would also add info to the decision (most useful in future consultations). A CT does not replace an MRI.The age of your husband and any illness he has/had can influence the choice of a treatment too. I would recommend you to get the full panel of a blood test (liver, kidneys, thyroid and heart) that will help in the discussions ahead too. You can even get a second opinion on the biopsy slides to verify if a tertiary Gleason grade exists. The gland has a normal size (34cc) so that the PSA corresponds well to the high number of positive needles (5 out of 12). I recommend you to get all data (or copies) into your own file to help you when going around.
Traditionally, none contained cases are spared for radiation from the beginning. EBRT can do the job of surgery covering the whole gland plus surrounding areas if these are identified by the image study. Surgery would remove the whole gland (dissecting the cancer within) but as the doctor comments above the present data shows that it will not be enough requiring addition salvage treatment (IMRT) which would add more risks and side effects to the ones from surgery.
I think that you need to read more about the risks of treatments and how they are chosen. The doctor and the hospital attending your husband will not take part in the final decision process. They will require before the treatment a signed agreement reliving their responsibility from any worse outcome.
Please read the following links;
https://www.cancer.org/cancer/prostate-cancer/treating.html
https://www.webmd.com/prostate-cancer/prostate-cancer-treatment-options#1
Can you share more info on your husband? How old is he? Does he have any symptoms? What made him to consult an urologist? Did anybody in his family contract PCa?
Please note that prostate cancer does not spread overnight. The present status would not alter much in two/four mounts. He needs treatment but it should be done coordinately and timely. He may like to participate in this forum and make questions to us survivors directly.
Best wishes,
VGama
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Cancer CentersVascodaGama said:Being confident on the physicians treating us is the best option
Murphy,
I agree that you should procure the best. Trusting the physician treating us is a good step forward for success. Your husband should be full confident at the timing of the decision.
I am not familiar with the Vanderbilt hospital but Max above recommends it. I also think that second opinions should be obtained from specialists in different fields (Surgery and Radiation) but you need firstly to get additional data/information on your husbands' present status so that doctors will provide you their best recommendation. Contrary to what your first doctor told you, an image study is essential to verify the extent of the disease. The DRE plus the PSA and the Partin Tables do not give a real picture of what is going on. An MRI can identify the involvement of lymph nodes which is not covered by a biopsy or a DRE. Furthermore, a Bone scan would also add info to the decision (most useful in future consultations). A CT does not replace an MRI.The age of your husband and any illness he has/had can influence the choice of a treatment too. I would recommend you to get the full panel of a blood test (liver, kidneys, thyroid and heart) that will help in the discussions ahead too. You can even get a second opinion on the biopsy slides to verify if a tertiary Gleason grade exists. The gland has a normal size (34cc) so that the PSA corresponds well to the high number of positive needles (5 out of 12). I recommend you to get all data (or copies) into your own file to help you when going around.
Traditionally, none contained cases are spared for radiation from the beginning. EBRT can do the job of surgery covering the whole gland plus surrounding areas if these are identified by the image study. Surgery would remove the whole gland (dissecting the cancer within) but as the doctor comments above the present data shows that it will not be enough requiring addition salvage treatment (IMRT) which would add more risks and side effects to the ones from surgery.
I think that you need to read more about the risks of treatments and how they are chosen. The doctor and the hospital attending your husband will not take part in the final decision process. They will require before the treatment a signed agreement reliving their responsibility from any worse outcome.
Please read the following links;
https://www.cancer.org/cancer/prostate-cancer/treating.html
https://www.webmd.com/prostate-cancer/prostate-cancer-treatment-options#1
Can you share more info on your husband? How old is he? Does he have any symptoms? What made him to consult an urologist? Did anybody in his family contract PCa?
Please note that prostate cancer does not spread overnight. The present status would not alter much in two/four mounts. He needs treatment but it should be done coordinately and timely. He may like to participate in this forum and make questions to us survivors directly.
Best wishes,
VGama
Murphy, Vanderbilt s indeed top-notch, and a major medical school as well. The best cancer centers in the Southeast are regarded as Duke (NC), Emory (Atlanta), and Vanderbilt. A longer travel would be to MD Anderson in Houston, regarded as one of the best cancer centers in the world, undoubtedly in the Top 5 worldwide. Moffitt Cancer Center in Tampa is best-of-the-best also, and seems to have a special reputation specifically against prostate cancer.
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HusbandVascodaGama said:Being confident on the physicians treating us is the best option
Murphy,
I agree that you should procure the best. Trusting the physician treating us is a good step forward for success. Your husband should be full confident at the timing of the decision.
I am not familiar with the Vanderbilt hospital but Max above recommends it. I also think that second opinions should be obtained from specialists in different fields (Surgery and Radiation) but you need firstly to get additional data/information on your husbands' present status so that doctors will provide you their best recommendation. Contrary to what your first doctor told you, an image study is essential to verify the extent of the disease. The DRE plus the PSA and the Partin Tables do not give a real picture of what is going on. An MRI can identify the involvement of lymph nodes which is not covered by a biopsy or a DRE. Furthermore, a Bone scan would also add info to the decision (most useful in future consultations). A CT does not replace an MRI.The age of your husband and any illness he has/had can influence the choice of a treatment too. I would recommend you to get the full panel of a blood test (liver, kidneys, thyroid and heart) that will help in the discussions ahead too. You can even get a second opinion on the biopsy slides to verify if a tertiary Gleason grade exists. The gland has a normal size (34cc) so that the PSA corresponds well to the high number of positive needles (5 out of 12). I recommend you to get all data (or copies) into your own file to help you when going around.
Traditionally, none contained cases are spared for radiation from the beginning. EBRT can do the job of surgery covering the whole gland plus surrounding areas if these are identified by the image study. Surgery would remove the whole gland (dissecting the cancer within) but as the doctor comments above the present data shows that it will not be enough requiring addition salvage treatment (IMRT) which would add more risks and side effects to the ones from surgery.
I think that you need to read more about the risks of treatments and how they are chosen. The doctor and the hospital attending your husband will not take part in the final decision process. They will require before the treatment a signed agreement reliving their responsibility from any worse outcome.
Please read the following links;
https://www.cancer.org/cancer/prostate-cancer/treating.html
https://www.webmd.com/prostate-cancer/prostate-cancer-treatment-options#1
Can you share more info on your husband? How old is he? Does he have any symptoms? What made him to consult an urologist? Did anybody in his family contract PCa?
Please note that prostate cancer does not spread overnight. The present status would not alter much in two/four mounts. He needs treatment but it should be done coordinately and timely. He may like to participate in this forum and make questions to us survivors directly.
Best wishes,
VGama
NVGama,
My husband is 56, he’ll be 57 in November. No family history of PC. He has no symptoms at his yearly physical when his was 53 the Dr did blood work and his PSA was 2.6 in 2016, PSA 2017 3.5 , PSA 2018 4.1. DRE‘s have all been smooth no lumps, or hard spots. We saw the urologist because of the steady increase of PSA and it getting over 4.0. My husband didn’t want a biopsy so the urologist said with nothing felt on DRE , and small increases in PSA my husband could just be checked every 6 months. At our 6 month check- up his PSA was 4.53 and the dr said we could do a check up in 6 months. Next appt on July 10 PSA was 5.24 the urologist still was saying we could just monitor PSA in another 6 months but I told him and my husband why continue to do that not knowing if it’s cancer or not. The DR said his numbers didn’t reflex an aggressive form because they were not high increases. I ask him was he 100 percent sure it’s wasnt aggressive because I had read if some men having aggressive cancer without huge increases. I told him I wanted my husband to have a biopsy so we would know what was going on since he had no symptoms of anything. He got up and said I’ll let you and your husband decide if you want the biopsy then walked out with I’ll be back in a few minutes. My husband agreed finally to biopsy. When the results came back I think the Dr was surprised about the amount of cancer detected.
I have one question. Do we need to request that the DR we are seeing at Vanderbilt,to have the biopsy slides looked at by another pathologist or will they automatically have this done since we are getting our second opinion done there?
Thanks again
Murphy
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Cancer centersCancer Centers
Murphy, Vanderbilt s indeed top-notch, and a major medical school as well. The best cancer centers in the Southeast are regarded as Duke (NC), Emory (Atlanta), and Vanderbilt. A longer travel would be to MD Anderson in Houston, regarded as one of the best cancer centers in the world, undoubtedly in the Top 5 worldwide. Moffitt Cancer Center in Tampa is best-of-the-best also, and seems to have a special reputation specifically against prostate cancer.
Max,
Thanks so much for information on Vanderbilt. I’m glad to know it’s top-notch since I know I can’t get my husband to go out of state. I really appreciate this site. So much information and so much help. It’s hard to feel so helpless but the information shared on this site is wonderful when you are feeling so overwhelmed.
Murphy
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Uro 2nd opinion does not include by norm a pathologist review
Murphy,
I also think that the previous doctor's judgment was erroneous. The constant increase of the PSA deserved an earlier action to find the reason for the increase. In 2017 the PSA (3.5 ng/ml) was already above the normal level for a 55 years old man with normal DRE.
Regarding the second opinion on the biopsy slides, this is not done by norm when consulting other physician. Your husband does not need to repeat the biopsy procedure but you need to collect the slides at the previous clinic. You have paid for it and they are yours together with the pathologist's report. Then you need to inform Vanderbilt of your intent. Probably they would like to check the slides firstly before the consultation with the doctor. It makes sense in doing so and you can at the same time request to postpone the consultation to a date that would allow to have the results of the biopsy's second opinion in hand for the doctor's review. Call Vanderbilt and inquire what to do. They may contact directly the previous laboratory requesting them to send the slides. (?)
Many guys in this forum (and I) have requested second opinions on the slides before advancing with a decision. Many got upgraded and many got downgraded. There are also those that become confused for the difference in the results. Sincerely, not everybody needs a second opinion on the biopsy results if the first laboratory doing the analysis is a reliable institution. I believe that your previous doctor requested this job at some laboratory which clinic can be investigate for reliability.
As I commented before, trusting the team caring about our case is important.You are doing well in investigating the details behind PCa. Diagnosis, then Clinical stage, then treatment decision, then follow-up.
Best of lucks to you both.
VGama
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Path reportVascodaGama said:Uro 2nd opinion does not include by norm a pathologist review
Murphy,
I also think that the previous doctor's judgment was erroneous. The constant increase of the PSA deserved an earlier action to find the reason for the increase. In 2017 the PSA (3.5 ng/ml) was already above the normal level for a 55 years old man with normal DRE.
Regarding the second opinion on the biopsy slides, this is not done by norm when consulting other physician. Your husband does not need to repeat the biopsy procedure but you need to collect the slides at the previous clinic. You have paid for it and they are yours together with the pathologist's report. Then you need to inform Vanderbilt of your intent. Probably they would like to check the slides firstly before the consultation with the doctor. It makes sense in doing so and you can at the same time request to postpone the consultation to a date that would allow to have the results of the biopsy's second opinion in hand for the doctor's review. Call Vanderbilt and inquire what to do. They may contact directly the previous laboratory requesting them to send the slides. (?)
Many guys in this forum (and I) have requested second opinions on the slides before advancing with a decision. Many got upgraded and many got downgraded. There are also those that become confused for the difference in the results. Sincerely, not everybody needs a second opinion on the biopsy results if the first laboratory doing the analysis is a reliable institution. I believe that your previous doctor requested this job at some laboratory which clinic can be investigate for reliability.
As I commented before, trusting the team caring about our case is important.You are doing well in investigating the details behind PCa. Diagnosis, then Clinical stage, then treatment decision, then follow-up.
Best of lucks to you both.
VGama
VGama,
We are calling Vanderbilt to see what we need to do on the pathology slides being looked at again. Thanks so much for all your help. God bless everyone on this site for helping newly diagnosed PC.
Murphy
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InsightsMurphy549 said:Path report
VGama,
We are calling Vanderbilt to see what we need to do on the pathology slides being looked at again. Thanks so much for all your help. God bless everyone on this site for helping newly diagnosed PC.
Murphy
Murphy, Vasco gave you a perfect overview of biopsy review/ Second Opinions.
The great value of a biopsy is in confirmng PCa. Subjectivity can enter due to the fact that Gleason is determined by the degree of abnormality of the cells. It is sort of like judging sublte shades of color in a painting, not simple.
PCa biospy and prostate imaging are very given to false negatives, but false positives almost never occur. I have a friend about 80 now. He had a positive diganosis of PCa about 17 years ago and went on A/S. He had another biopsy a few years later, and it was negative for PCa. But a few years ago,a third biopsy again found PCa. So, he has had PCa the whole time, it is just that the second biopsy missed it, due to the small amount of involvement. His PSA continues to rise, but as of today he has never received any curative treatments, and most likely never will.
Get the second opinion, but it seems clear that curative response is needed in his case. What that response will be depends on the experts and his choice. Many people recommend that second opinions not come from another doctor in the same practice as the first doctor, for obvious reasons. Second opiniopns are essentially formal consultations, and not hugely expensive, usually.
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Insights aallInsights
Murphy, Vasco gave you a perfect overview of biopsy review/ Second Opinions.
The great value of a biopsy is in confirmng PCa. Subjectivity can enter due to the fact that Gleason is determined by the degree of abnormality of the cells. It is sort of like judging sublte shades of color in a painting, not simple.
PCa biospy and prostate imaging are very given to false negatives, but false positives almost never occur. I have a friend about 80 now. He had a positive diganosis of PCa about 17 years ago and went on A/S. He had another biopsy a few years later, and it was negative for PCa. But a few years ago,a third biopsy again found PCa. So, he has had PCa the whole time, it is just that the second biopsy missed it, due to the small amount of involvement. His PSA continues to rise, but as of today he has never received any curative treatments, and most likely never will.
Get the second opinion, but it seems clear that curative response is needed in his case. What that response will be depends on the experts and his choice. Many people recommend that second opinions not come from another doctor in the same practice as the first doctor, for obvious reasons. Second opiniopns are essentially formal consultations, and not hugely expensive, usually.
Max,
Thanks for your help, it is much appreciated. You all are a great group of people to come onto this site and to help people who are trying to fine answers .You have helped alleviate a lot of my fears.
Murphy
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Second opinion Vanderbilt
Vanderbilt confirmed Gleason 6 on biopsy second opinion pathology for all 5 slides that were positive. The Dr we saw said my husband has the option of surgery or active monitoring. He said he was recommending monitoring.The Dr is doing other testing. A genetics test and scheduled a MRI on February 3 with an Artemis Fusion biopsy on February 24. The DR said if the genetics come back that this could change into something aggressive then we would move up the MRI and the biopsy to sooner. The Dr said we needed to see the whole picture to make a decision.My husband doesn‘t want to do surgery if he can monitor a Gleason 6 cancer. I really just want him to have surgery to have it removed. What are some opinions on just monitoring with MRI’s and Biopsies?
Thanks
Murphy0 -
Active Surveillance involves a strict regimen
Murphy,
Though both of you are affected and involved in the process, the decision on your husband's treatment becomes very personal to him. I do understand your wish in eliminating the bandit the soonest but monitoring is not bad too if the condition allows it. They call it Active Surveillance (AS) which procedure is recommended to low aggressive cases. This is not giving up to a treatment but just postponing the intervention to the timing when the need to treat becomes more evident. Young patients benefit from AS because it avoids the risks of radical therapies, keeping the quality of life while still young. Several survivors in this forum are doing just that successfully. You can read their stories searching for the entries of the participants in this link; https://csn.cancer.org/node/320410.
However, active surveillance is not easy. It involves a regimen of commitments that some patients do not like to follow latter. I wonder if your husband knows about the details. I think that AS is good choice to those with low aggressive cases and stable PSA that show no symptoms but one needs to have the courage to sleep with the enemy every night. This is not for those that freak-out or worry too much. Some guys choose AS at the beginning but latter stop it because of mental stress or for the nuisance from the demanding periodical exams and tests, in particular for the annual (or biennial) biopsy.
In any case, Vanderbilt (a reliable institution) only accepts AS patients if their case is confirmed to be low aggressive. The genetic test have to be negative to aggressive type of cancerous cells even in low Gleason grades. I would recommend you both to research on the details involved while waiting to confirm that such is your best option or if a radical would give you more peace of mind from the beginning. Here are links;https://www.cancer.org/cancer/prostate-cancer/treating/watchful-waiting.html
https://www.cancernetwork.com/oncology-journal/active-surveillance-prostate-cancer-how-do-it-right
https://www.nejm.org/doi/full/10.1056/NEJMoa1606220
You are doing it well in procuring the best. Just continue.
Best wishes
VGama
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AS?
Hi,
Being the fact that he has perinueral invasion means to me that the cancer is getting close to leaving the gland, not good. If the cancer was deep inside the Prostate at a 3+3 then if it was me I would wait. If it was my choice knowing what the facts are I would want to have my Prostate removed to keep the cancer from spreading outside of the gland. But, you and your husband need to do what is right for your family. Good luck on your decision for your treatment plan. This is just my opinion based on what I have learned and not a medical diagnosis, I am not a doctor but a 4 yr. cancer survivor.
Dave 3+4
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IssuesVascodaGama said:Active Surveillance involves a strict regimen
Murphy,
Though both of you are affected and involved in the process, the decision on your husband's treatment becomes very personal to him. I do understand your wish in eliminating the bandit the soonest but monitoring is not bad too if the condition allows it. They call it Active Surveillance (AS) which procedure is recommended to low aggressive cases. This is not giving up to a treatment but just postponing the intervention to the timing when the need to treat becomes more evident. Young patients benefit from AS because it avoids the risks of radical therapies, keeping the quality of life while still young. Several survivors in this forum are doing just that successfully. You can read their stories searching for the entries of the participants in this link; https://csn.cancer.org/node/320410.
However, active surveillance is not easy. It involves a regimen of commitments that some patients do not like to follow latter. I wonder if your husband knows about the details. I think that AS is good choice to those with low aggressive cases and stable PSA that show no symptoms but one needs to have the courage to sleep with the enemy every night. This is not for those that freak-out or worry too much. Some guys choose AS at the beginning but latter stop it because of mental stress or for the nuisance from the demanding periodical exams and tests, in particular for the annual (or biennial) biopsy.
In any case, Vanderbilt (a reliable institution) only accepts AS patients if their case is confirmed to be low aggressive. The genetic test have to be negative to aggressive type of cancerous cells even in low Gleason grades. I would recommend you both to research on the details involved while waiting to confirm that such is your best option or if a radical would give you more peace of mind from the beginning. Here are links;https://www.cancer.org/cancer/prostate-cancer/treating/watchful-waiting.html
https://www.cancernetwork.com/oncology-journal/active-surveillance-prostate-cancer-how-do-it-right
https://www.nejm.org/doi/full/10.1056/NEJMoa1606220
You are doing it well in procuring the best. Just continue.
Best wishes
VGama
Vasco is correct to note that the deciding factor between A/S or curative treatments (radiation or prostatectomy) is frequently the psychological disposition of the patient. 'Worriers' (like me) could never be still with A/S. Even calmer types often have an intuitive demand within themselves to 'get it out.'
When I began at this Board years ago (following several years at Lymphoma) I rhetorically asked about Watchful Waiting (another term used in the past for systems similiar to A/S, although some guys object to the term).
I said, 'WHAT exactly am I WAITING for ? For the diesease to get too bad to cure ?' A significant percentage of the guys here had either radiation or surgery immediately after diagnosis with low-aggression cancers, but still had relapse years later. It just happens. This is not scare tactics, but a presentation of what transpires in a not-uncommon number of cases. Besides having no medical training, I am in no way 'anti-A/S.' I have a good friend who has been on A/S for perhaps 15 years now, with no issues at all.
Vasco of course is correct that ultimately it is your husband's decision. Cleveland also is correct that perineural invasion suggest an avenue of spread, even in a low-aggression case. I would DEMAND an answer regarding perineural involvement from his urologist. And all are right that you are being a valuable source of assistance to him,
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A/S would have been a bad choice for me
Sorry to hear your family is having to deal with the terrible cancer diagnosis. You are doing great researching and learning from some of us who have gone through the same experience. It's ok to get 2nd, 3rd, 4th medical opinions too. I posted my comments that active surveillance would have been bad for me on another discussion board at https://csn.cancer.org/node/320410 so I won't repost my comments here. I think most of us participate in active surveillance from the first time we get an elevated PSA. From that point on we have to actively monitor the PSA and if it continues to be elevated or if there are other signs/symptoms, we progress to a MRI or biopsy. If the biopsy comes back with a GS 6, current medical literature appears to support continued A/S, although other factors have to be taken into consideration as well. Other survivors have already commented for A/S to be effective, one has to continue to monitor, see the doctor, etc. etc. It is very important. All the way up to my elected surgery, my mind tried to convince me to only do A/S which may have been OK except for my GS7 and my family history. You can see my story at https://csn.cancer.org/node/320408 if interested. I thought about having a second biopsy done by another facility/doctor because my one core 3+4=7 had an incredibly small percentage of 4 detected. But I proceeded with treatment and elected surgery and I can't tell you how grateful I did just that (elected treatment) because it identified diffuse cancer throughout over 30% of my prostate. Either treatment - radiation or prostatectomy probably would have been successful based on current medical listerature but I chose surgery for many reasons I listed in my story. Everyone's case is different so you are doing an awesome job learning as much as possible. For me, I just couldn't sit back and take a risk with my extended (generations) positive family history.
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