Knocking on Prostate Cancer Treatment Door

hgamit

So I was diagnosed with high volume Gleason 6 in February 2020. I had a 3TMPMRI in March 2021 (only PIRAD-2 mentioned). Yesterday I had another 3TMPMRI and they found a lesion in the peripheral zone: in left posterior lateral and lateral peripheral zones extending from the apex of the base. This lesion measures 1.2 x 0.4 x 1.3 cm. This appears more conspicuous since prior exam. Broad abutment of the prostate capsule. No extraprostatic tumor extension. This likely corresponds to previously biopsied Gleason 6 carcinoma although higher grade carcinoma is not excluded.

I am scheduled for a MR-fusion biopsy soon. Do you think Active Surveillance is now off the table because of the “broad abutment of the prostate capsule?”

Clevelandguy

Hi,

If I were you I would have a talk with both an Oncologist and Urologist to determine the location of your cancer. Peripheral means the edge, you need to find out if they mean the interior or exterior edge of the Prostate. In my humble opinion the edge does not sound good where cancer is involved. 3+3 is not as aggressive as a 4 or 5 but it’s still cancer. You don’t want it leaving the Prostate and invading your bladder, urethra, ect., not much better on the outer edge also.

Dave 3+4

centralPA

What PIRAD is the recent MRI? Sounds like a 4 or 5. Is it the same lesion as before, but bigger?

Your next biopsy will be critical. Best of luck!

hgamit

Sorry I forgot to mention yesterday’s PIRAD score was determined to be a 4. It’s baffling how it went from PIRAD-2 to PIRAD-4 with a abutment lesion in less than a year.

VascodaGama

Pirads has no meaning as a diagnostic conclusion. It is a predictive scale used by radiologists based on how one interprets the MRI image. Results vary on experience. Pirads 4 could have been there from the beginning.

The biopsy is the ultimate goal one should aim to reach to a conclusion. I believe that the doctor will direct some needles to the area identified in the image.

In any case, this time the biopsy is done not for the purposes of identifying cancer but to verify the extent/number of positive cores. Too many Gleason 6 would classify the case as risky, therefore not recommended for a simple AS.

Best

VG

ASAdvocate

True Gleason 6 is now acknowledged by leading prostate cancer experts as not being able to metastasize.

But, you need that MRI targeted biopsy to sample that lesion to assure that a higher risk cancer does not also exist there.

If no Gleason 4 pattern is found in those targeted cores, I would see no reason to leave AS.

Rob.Ski

What are the high volumes and what is your age? I had high two high volumes 70% & 100% with lesser in 4 other samples. The AS Nurse said I was the youngest in the program with high volumes like that. Surgeon told me there was a 60% chance of progression in next three years.

hgamit

When I was diagnosed in February 2020, the biopsy samples showed all Gleason 6 in 9 of 12 cores. My current age is 59 years old.

hgamit

The doctor also called me yesterday and wants me to have a MRI fusion biopsy in the next few weeks. I forgot to tell him if it was possible to have a trans perineal vs. trans rectal biopsy.

Rob.Ski

What % are the cores?

hgamit

The highest percentage core was around 60%. The rest of the cores involved were between 5-40%.

Rob.Ski

I think they consider above 50% high volume. My surgeon at Hopkins thought I was in the grey area for staying in AS with high volumes gleason 6. I was surprised, thinking he'd say it was time for treatment. Some folks on this site were thinking AS was probably over for me. I ended up staying in AS with the idea of any further progression I'd proceed to treatment. PSA went 4.7 to 5.3 6 months later and I decided to pull trigger. Preop MRI showed legion where previous ones didn't.

Waiting on pathology from RP, will post when I get it.

centralPA

Watched a couple of great youtube vids the other night, with Dr. Klotz talking, an advocate of AS. He brought up the discussion of Gleason 3 as cancer, and talked about how it never metastasizes, but it is cancer. Like some brain cancers and others, it does grow and push things around. It's still not your friend.

Worth a watch. I was particularly interested, because he talked quite a bit about AS for Favorable Intermediate Risk, a club that I am a member of. The first vid...

https://www.youtube.com/watch?v=zu3QWMq0oO0

Old Salt

It's a bit premature to discuss whether to discontinue AS. Just wait for the results of the fusion biopsy and then consult with the most knowledgeable medical folks.

ASAdvocate

https://csn.cancer.org/discussion/comment/1693739#Comment_1693739

I have to react to your comment about Klotz being the “king of AS”. Both Peter Carroll at UCSF and Bal Carter at Johns Hopkins started AS programs several years before the idea occurred to Klotz. Also, Klotz had to admit that Carter’s group had significantly less metastasis than his own. I admire Klotz’ interest in new approaches and his advocacy of AS. But, others were first, and with better results.

centralPA

OK, modified my post a little.