Surgery with Gleason 6 and PSA 2.5?

Clandeboye1940

https://csn.cancer.org/discussion/comment/1724453#Comment_1724453

Mozach : As is highly recommended : Did you get a 2nd or 3rd opinion to confirm your Biopsy Results - Gleason Score ? I did , they changed . My 1st Biopsy was negative . My 2nd Gleason 3+3 = 6 , a 2nd & 3rd opinion changed my treatment options . Read page 112 and 113 Dr. Patrick Walsh's " Guide to Surviving Prostate Cancer " .

p.s. Dr. Walsh is the worlds foremost authority on prostate cancer . A distinguuished Professor Emeritus ; John Hopkins Baltimore, Maryland .

Goood Luck.

swl1956

https://csn.cancer.org/discussion/comment/1724452#Comment_1724452

Hi Mozach,

I'm curious about your dad's treatment. I think cryotherapy with hormone treatments is very unusual. How long has it been since he had this? Where was this done? Was the hormone treatments administered for prophylactic reasons? I opted for a focal therapy (IRE Nanoknife) but there was never any discussion as to adding hormone therapy along with it. My cancer eventually metastasized to the pelvic lymph nodes within 6 months after the focal procedure which then required radiation and ADT. No fun, but at least for now seems to be controlling the bandit. I know of others having had focal procedures which have been successful, but I'm sure you're aware they are only recommended if you are deemed a good candidate after staging usually with one lesion and ideally located. Lots of options with no guarantees with any of them. Make the most educated decision you can, and like your dad says don't look back.

Clandeboye1940

swl1956 What was your Gleason Score when you had your NanoKnife and did you confirm it by a 2nd or 3rd opinion ? See pages 112 & 113 of Dr. Patrick Walshs book " Guide to Surviving Prostatee Cancer .

How many cores ? And I assume contained within the prostate or the procedure would never have been performed .

Thanks.

p.s. I never heard of ADT with Cryotherapy eithher .

swl1956

https://csn.cancer.org/discussion/comment/1724469#Comment_1724469

Clandeboye1940

Long story short, with a PSA over 4 at local hospital one lesion detected on MRI PI-RADS 4 right mid gland of the peripheral zone. 1st transrectal fusion biopsy indicating 3 cores positive out of 17, The worst being a Gleason 4+3 involving 33% of that core. Urologist sent me for NM bone scan which was negative. Also sent sample for Prolaris genetic test which indicated single mode of treatment with only a 4.5% chance of metastasis within 10 years. I wasn't liking what I was hearing about surgery or radiation so I went to Fox Chase Cancer Center for a second opinion and was interested in Focal therapy that I had been reading about. Some time had passed so the FCCC doctor insisted on a 2nd biopsy. This time trans perineal targeted biopsy which confirmed the first biopsy. Surgeon thought I was a good candidate for Focal. I insisted on a PSMA-PET scan which also indicated no metastasis. So after several months of stressing, I pulled the trigger and had the IRE Nanoknife procedure May 2024 which was relatively easy with the exception of a bout of urinary retention after the catheter was removed. (not fun!) Anyhow, at three months PSA dropped by only one point down from a 5.7. About six months after Nanoknife another MRI was ordered which showed everything clear. A few days later I had a 3rd biopsy also indicating everything was clear and the ablation procedure was successful. Three months later my PSA rose to 9 which another PSMA-PET scan was done immediately indicating activity in some pelvic lymph nodes. Radiation and ADT was recommended. (also not fun) Lols! They claim that likely I have an aggressive sort of Pca which likely micro metastasized to the lymph nodes which was not detectable by even the PSMA-PET scan.

Clandeboye1940

swl1956 Makes sense . PC is Multifocal and MRI & PSMA PET Scans cannot pick up the minute cancer lesions which can grow over time . Plus some cancers are not PSMA sensitive .

Good Luck .