Starting the journey at 51

Florida51

I had a physical in October and my PSA reading was 25 and was referred to a urologist. I had another PSA reading 2 months later and it was up to 27, so the Urologist ordered an MRI.

The MRI came back with a lesion on each side grade 3 and 4.

This prompted a Biopsy & Cysto which I had on Monday.

I get the results on this Monday evening of the Biopsy... But I am guessing with the 2 lesions and a rising PSA of 27 at age 51 there is little doubt.

Been reading a ton on the treatment options, but I guess the first question I have to get answered is if it would be nerve sparing? Being only 51 I guess also raises more questions... /sigh

Rob.Ski

I'm your age, just had RP in Feb. Biopsy is the info you are after, it confirms if you do have PCA. Doesn't really confirm you don't with certainty. If you dig around on this site, I think you can find cases where MRI lesions are benign so, need to wait and see on Monday.

Florida51

HI Rob,

Thanks for the reply. That is my hope also, but with a PSA of 27 and rising 2 points in 2 months, I am bracing myself...

VascodaGama

Hi,

Welcome to the board. I agree with the opinion of Rob. You haven't been diagnosed with cancer yet. The PSA is high but it doesn't diagnose cancer.

Surely the high psa is a matter for concern and you are doing well in trying to educate on the matter. The biopsy will confirm the case and provide you with information on the type of cells composing those lesions.

The doctor will then give you a clinical stage from which you decide in your next step.

Best of luck.

MK1965

Florida,

wait for biopsy results but don’t be surprised if you get cancer diagnosis. PSA is fairy high for someone of your age. Don’t panic!

I was same age as you 51, when I was diagnosed in 2016. Life is going on.

It will never be what it was before Prostate Ca if you’re diagnosed.

i wish you good luck and hopefully favorable results.

MK

MK1965

Florida51

https://csn.cancer.org/discussion/comment/1696351#Comment_1696351

7 hours...

Florida51

Gleason 6 in 2 cores but because of high PSA still considered high risk,

Rob.Ski

What were the volumes? Not a doctor so, not familiar with PSA that high with low grade cancer. Possible there is higher grade missed by biopsy or something else causing PSA rise. Was your doc recommending treatment? If so, might want some second opinions. Can also get second opinion on pathology.

Florida51

Doctor wants to do surgery in 4 weeks. 20% in each sample T1. It would be AS if not for my 27 PSA.

Clevelandguy

Hi,

What was your Gleason score on your biopsy? If you do surgery just make sure your cancer is contained inside the Prostate. You can confirm this via different scans(MRI,PET,Bone). If the cancer has escaped the Prostate capsule then there are other treatments you should look into, mostly external based radiation.

Don’t let your doctors rush you into surgery, do you homework first so you know it’s the right option for your particular cancer diagnosis. Might not hurt to contact a Oncologist for review and have them on your team.

Dave 3+4

Florida51

https://csn.cancer.org/discussion/comment/1696374#Comment_1696374

3+3 on the biopsy, but because of PSA they still classify me high risk. I am absolutely meeting with an RO also, this seemed to really rub my urologist the wrong way but whatever.

MK1965

https://csn.cancer.org/discussion/comment/1696373#Comment_1696373

Looks like you are perfect case for AS. Think twice about surgery. Surgery is very disruptive to man’s body. You will never be the same. Why risk QoL for the rest of your life. Dealing with RP side effects is very depressing especially ending being 100% impotent for year or two or for high numbers of patients dealing with it for the rest of life.

I was 51 in great health, great physical shape, not on any meds, non smoker, non drinker, very healthy eater, and I never tried Cialis or Viagra before RP.

Uhhh! If I could be in your place to reverse my decision.......

MK

Clevelandguy

Hi,

Unlike MK I don’t feel surgery if very depressing but in-fact liberating. Hopefully got rid of my cancer with very livable side effects that don't effect quality of life in any way. But MK is right you could be a candidate for AS as long as your doctors agree. Might want to get a second opinion from a different hospital network if that’s possible. In the end its your decision to go AS, surgery or radiation route, its your body. Educate yourself on all the treatment plans, know the upside & downside. Great doctors + great facilities = great results. At 3+3 you have time to do your homework……….

Dave 3+4

J69

Seems your Uro is jumping the gun before all the facts are in. Your MRI was two lesions 3 and 4. Your biopsy was 3+3. He immediately wants to go to surgery? He downplays seeing a RO? Many send off their slides for a second opinion. This could result in a downgrade or upgrade of your Gleason result. You are wise to see the RO for another opinion. Also, as Clevelandguy said, there are more test to see if you have a prostate contained or not situation. If contained then surgery and RA can both be in the mix. If not contained then most likely RA would be the answer. I am surprised with your PSA climbing hormone therapy wasn’t discussed. With a GL-6 you have time to research and make the best decision that is right for you. I hope for the best outcome whatever you choose.

Old Salt

I agree with the consensus that more info is needed and that your urologist is jumping the gun. As already stated in the other posts, there's no need for immediate action.

Do send the biopsy samples (including the 'negative' ones) to Johns Hopkins for a second opinion; they are the experts.

An explanation for the high PSA is needed. Is your prostate very big? Do you have prostatitis?

Good luck with evaluating ALL possibilities and making a choice.

centralPA

Florida51, can you post your full biopsy results? Were the lesions specifically sampled?

I would pump the brakes on surgery. Tons more info to be gathered. Second opinion on biopsy from Hopkins, genomic test, consult with RO for any of IMRT, SBRT, LDR brachytherapy, HDR brachytherapy, proton beam,…. You get the idea. Even if all the other info confirms surgery is the best choice, is your Uro the best surgeon?

The decision will ultimately be made with lots of grey area uncertainty, but you want to understand the decision before you make it.

lighterwood67

Obviously, you need a second opinion. For sure, you need to do your homework on surgery (gut) or radiation (nuke) or Active Surveillance. Appears you have time. My background: diagnosed PC 2018; gleason 4+3=7; RP 2018. Status: recent PSA .004; fully continent; intimate with wife. I try to keep Quality of Life in front of me. Please understand, surgery will change you. Your seminal vesicles will be removed (you will not ejaculate sperm anymore); your urethra will be shortened (this may limit the range of your penis during an erection or not); some surgeons remove lymph nodes for biopsy (checking for spread); it is my understanding that the internal sphincter is removed from the bladder (so now you only have one external sphincter); it is possible you may develop a hernia due to the RP (I did, but it was a year or so later). With me, my surgery was performed at Levine Cancer Center, Charlotte, NC. The surgeon that performed the RP was over the Urology Center at one time (very experienced). Then went back to surgery. Over his career, I think he said he had performed over 2000 RP's. So, think it over. Keep QoL in front of you. And weigh out what path you want to take based on the data provided. Surgery, Radiation, Active Surveillance. All the folks on this site have a story to tell. Good luck on your journey.

Old Salt

OK; AFAIK we did not go to med school, (I certainly didn't); therefore, it's useful to see what the American Urological Association 'recommends'.

First of all, you are in the 'High Risk' category because of your high PSA.

Here is a copy of their recommendations:

High-Risk Disease

High Risk: PSA >20 ng/ml OR Grade Group 4-5 OR clinical stage >T3

Guideline Statement 22

Clinicians should stage high-risk localized prostate cancer patients with cross sectional imaging (CT or MRI) and bone scan. (Clinical Principle)

Discussion

Guideline Statement 23

Clinicians should recommend radical prostatectomy or radiotherapy plus androgen deprivation therapy as standard treatment options for patients with high-risk localized prostate cancer. (Strong Recommendation; Evidence Level: Grade A)

Discussion

Guideline Statement 24

Clinicians should not recommend active surveillance for patients with high-risk localized prostate cancer. Watchful waiting should only be considered in asymptomatic men with limited life expectancy (≤5 years). (Moderate Recommendation; Evidence Level: Grade C)

Discussion

Guideline Statement 25

Cryosurgery, focal therapy and HIFU treatments are not recommended for men with high-risk localized prostate cancer outside of a clinical trial. (Expert Opinion)

Discussion

Guideline Statement 26

Clinicians should not recommend primary ADT for patients with high-risk localized prostate cancer unless the patient has both limited life expectancy and local symptoms. (Strong Recommendation; Evidence Level: Grade A)

Discussion

Guideline Statement 27

Clinicians may consider referral for genetic counseling for patients (and their families) with high-risk localized prostate cancer and a strong family history of specific cancers (e.g., breast, ovarian, pancreatic, other gastrointestinal tumors, lymphoma). (Expert Opinion)

Discussion

TomThorn62

you can have aggressive cancer and low PSA

Old Salt

https://csn.cancer.org/discussion/comment/1696489#Comment_1696489

True, but irrelevant to this thread