Surgery with Gleason 6 and PSA 2.5?

mozach

First post here……I'm 50 years old and recently diagnosed. Half of the biopsy samples came back as a Gleason 6 and it's bilateral. I've had my PSA checked for the last 6-7 years and it was always around 1.5. At the last physical it jumped to 2.5. I decided to meet with a urologist and now here we are. The kicker for all of this is that my dad was diagnosed with prostate cancer at 53. He had never had his PSA checked until then and it was over 50. His cancer had already spread outside of his prostate. He's 83 now and well. But I've always been hyper aware of my PSA.

So now I'm weighing my decisions. I've met with a couple of different doctors and feel no pressure to do surgery anytime soon. But it seems it would be within my future in the next few years. Part of me just wants to get it over with and do it within the next 6 months or so. Anyone with a similar history who has opted for surgery "early"? Any regrets?

VascodaGama

Hi, welcome to the forum.

I was diagnosed with PCa in 2000, at the age of 50. It was the PSA 22.4 ng/ml that took me to additional tests and to the ultimate biopsy. The Gleason score was 6 in all the needles (voluminous case).

I had the opportunity in consulting radiotherapists and medical oncologists, as well as the urologist that in the end operated me. The fact is that Image studies at those times, were not as accurate as the ones of today which weighed on my decision in having a radical prostatectomy. it took me 4 months of studying the issues regarding the cancer and the treatments before I and my wife decided to advance with the treatment. I do not regret have done it.

In your shoes I would do more exams such as the 68Ga-PSMA PET (or similar) to verify the extent of your case, investigate the details and risks of each treatment, and look for a reliable institution and experts in PCa, before deciding.

Remember that each case thought similar is not the same. You can't compare yours with that of your father.

Treatments also have improved much along the years.

Best wishes and luck in your journey.

VGama

Rob.Ski

I was diagnosed at 49, did AS for about 1.5 yrs. PSA creeped up over 5 and biopsies showed progression in volume of gleason 6. Had surgery at Hopkins, post pathology was gleason 7. Pretty much continent at catheter removal, 100% continent now. Sexual function was good, right after surgery. Can get there without but, still use viagra. So far, so good. PSA undetectable 3.5 yrs later. No regrets.

Clevelandguy

Hi,

Glad your getting ahead of the curve and doing your homework now. I had robotic surgery back in 2014, Gleason 3+4, Psa 4.5. Still undetectable almost 11 yrs. later. Whether you do surgery or radiation is up to you and your doctor team. If choosing surgery I would look into the newer one incision surgery which seems to do less damage to the nerves that control sexual and bladder functions. Good luck with your research, who knows what new technique will be available when your ready to proceed.

Dave 3+4

mozach

I appreciate all the input. It's all super helpful. This is exactly what I've been looking for.

Wheel

mozach,

It’s always tough to hear you have “cancer”, but you are the definition of the watchful waiting candidate. As you have probably read their are current schools of thought amongst Physicians that a Gleason 6 should not even be classified as having cancer. I would not say it’s necessarily in your near future. I would enjoy my current quality of life for possibly years before jeopardizing it in a short time especially at your age. You are not anywhere near a surgery age cutoff. Treatment can carry consequential side effects affecting everyone differently. What is important is that you are on top of it and will monitor it closely.

Old Salt

Personally I would choose a carefully monitored Active Surveillance program. As Wheel already pointed out, there are outcomes with surgery that are less than desirable.

Surgery will remain a good option but five or ten years from now you will still be a good candidate (from the information you provided). Best wishes!

Rob.Ski

What are the volumes of cancer in the cores? I had like 6 of 12 positive gleason 6 with 70%, 100% in 2 of them for 2nd biopsy. At that time my AS doc encouraged treatment because of high volumes and young age. I did wait a few more months and my next PSA still climbing so I pulled the trigger. Post surgery 3+4. So, even at gleason 6 it depends on your situation. If my PSA wasn't moving I might have road it out longer. Turns out I'm glad I didn't. Not encouraging one way or another, just my story.

Wheel

Rob.Ski

I think you said it best. It depends on the person’s situation. You clearly were doing what you are supposed to be doing and monitoring your AS and a rising PSA to 5 would be disconcerting at the very least. Today with the advent of the genomic testing of biopsy tissue such as Decipher one can even determine whether a Gleason 6 is aggressive, however I doubt with the very expensive cost of that testing that insurance covers that testing with a Gleason 6 nor that it is certainly even done with that grade unless in some clinical trial setting. Their is another test mozach could look into to help guide his overall gathering of information regarding his status. It’s the non-invasive urine test called ExoDx ordered by a urologist. It determines a person’s risk of clinically significant prostate cancer. Even someone with a Gleason 7 , their cancer can be considered not clinically significant, as many even with a Gleason 7 remain on AS. Now certainly these genomic tests can help make a decision to pull the trigger on treatment during AS. The ExoDx analyses genomic markers that are expressed during cancer cell growth found in the urine. More info is better than less.

Steve1961

you have cancer cancer is a poison. It’s inside of you the best way to Get rid of it is to get it out of here. That’s just my opinion..I battled back-and-forth back-and-forth. I was diagnosed at 57 and I decided to do radiation. The radiation didn’t work and six Years later it was still contained to the a prostate. I ended up having salvage surgery and I’m doing good now I wish I would’ve done it in the first place. So if you have prostate cancer and your life expectancy is more than 10 years. The standard gold treatment is surgery. Look it up ….then if it happens to come back, you have a Plan B, which would be radiation and then if it happens to come back again . You have plan c hormone treatment .. I did it backwards so now if it comes back, I can only do hormone treatments and I’m scared to death. That’s going to happen to me i would remive it find a top surgeon who’s done 5000 of these surgeries get it done and don’t look back that’s just my opinion. Also, have you sent it out for decifer testing yet to make sure it’s not aggressive I waited about seven months seeing radiologist surgeons, but the one surgeon that I wanted to see was booked for six months and when I finally saw him, he nobody did the testing so he it out for the for testing and guess what Mine came back aggressive crib form so I would send it out for testing to make sure it’s not aggressive. If it is aggressive, you have no choice even if it’s not aggressive I would have it removed. Good luck with your decision.

Wheel

Steve1961,

You are certainly right about the 10 years and gold standard. You mention at 57 you were diagnosed and you decided on Radiation treatment, however with Radiation failure 6 years later you had salvage surgery with it still contained. Do you have any idea what your status might have been if you had just waited? Could it still have been contained? How aggressive was yours? Your Gleason? Age 50 is still a lot younger than 57 to accept the significant possible side effects versus waiting especially if quality of your love life is important and waiting won’t impact your outcome versus immediate treatment possibly destroying it many years earlier than necessary.

Clevelandguy

Hi,

Whether it’s AS, surgery, or radiation you have to make an informed decision based on your particular case. Great facilities +great doctors=the best results. All three forms of treatment or lack of it have benefits and drawbacks. The old adage that surgery will rob you of your sex life and bladder control seem to be lessened with the newer one surgical incision techniques. Newer radiation approaches are also reducing latent bladder and rectal issues. AS can be a pain with the repeated biopsies and scans. So know where your cancer is inside your Prostate, meet with the best doctors and facilities your allowed to by your medical plan and you should come to the proper decision for YOU. Also a good idea to have backup plan A & B ready if the first choice fails. Don’t look back and play the coulda,woulda,shoulda game it will drive you crazy.

Dave 3+4

Josephg

@Clevelandguy has said it all in a very succinct manner, and I fully concur.

Everybody has an opinion, and some are convinced that their opinion is the only relevant or correct opinion out there.

You've basically got 3 choices at this point, and don't let anyone tell you otherwise. Do your research and ask your medical providers any and all questions that you and your family can come up with regarding the next steps forward.

Then, when you feel that you've researched enough and received enough answers to your questions (you will never really feel this way, but you will know when you are close enough), you will have to opportunity to make your decision, and at the end of the day, this decision is your and yours alone to make.

And, probably the most important advice from above is that when you've made your decision, move forward and DON'T look back. Discussion boards are filled with folks who made a decision, and then whine about making the wrong decision, ad infinitum. This serves absolutely no positive purpose, and so moving forward, your focus should be on today and on tomorrow.

mozach

Some great advice here. I appreciate it. My dad has said the same thing in regards to moving forward and not looking back after I make a decision. The good news is I don't feel any pressure from anyone to get treatment anytime soon.

Old Salt

I deduce from your latest comment that you have chosen for an active surveillance program. They come in many flavors; some are more strict than others; something you may already have learned from traveling the internet. What will your parameters be?

Clandeboye1940

https://csn.cancer.org/discussion/329642/surgery-with-gleason-6-and-psa-2-5

Mozach Your dad is amazing . What wonder treatment did he receive ? For your case research NanoKnife .

centralPA

@mozach , do you have any BPH symptoms? What is the size of your prostate? When you had your MRI, did it detect a lesion? If so, were the biopsy samples into the lesion positive? What zone in the prostate were the positive lesions located?

mozach

https://csn.cancer.org/discussion/comment/1724431#Comment_1724431

Thanks. My dad did cryotherapy and hormone treatments. Undetectable PSA since.

mozach

No BPH. My prostate is actually small. The MRI came back with a lesion of PI-RADS 3. Biopsy in that region came back positive. That one was 40% of the core. 5 others cam back positive and all around the prostate. The percents were smaller. Around 10%

Old Salt

Your last post made me realize that your case is more serious than I originally thought (my fault, really). Whereas 10% sounds 'minor', please realize that a biopsy samples only a very small portion of your prostate. With six (!) areas 'all around the prostate' (that's a quote), I am seriously concerned. You haven't reported whether any of these are close to the periphery, but if so, that adds another layer of concern.

Clandeboye1940

Monach : First , I agree with your decision NOT to make an uninformed decision you may regret the rest of your life . Educate yourself on the Focal Therapy options available today . e.g. NanoKnife .

Purchase and study the book by Dr. Patrick Walsh: " Guide to Surviving Prostate Cancer " —— A must read .

Good Luck.