low PSA and gleason - what's next?

hopeful and optimistic said:

active surveillance with delayed treatment
What prompted a biopsy? DRE? PSA rise?

Strongly recommend that you get a second independent opinion on your pathology from a world class pathologist so that you are not over or under treated.

Become educated, read research, attend support groups

I am on Active Surveillance, double click my name to see what I have been doing, and studies about Active Surveillance.

It appears that you have indolent cancer, that is not likely to spread.......that you are an ideal candidate for AS

Go on with your life

Enjoy the moments

Gleason score 5; a rare case
Chew

Welcome to the board.

You are the second person I “found” with a Gs 5 (2+3). The first is me, diagnosed in 2000. We are supposed to be rare cases, and many pathologists, nowadays, just do “abolish” the Gs5 moving it up to a score of 6 (3+3). It seems that in the US and Europe there are very few classifications of grades 1 and 2. These grades can easily be misinterpreted in the analysis.

The “experts” say this;
“…The lowest Gleason score assigned today to a man who is found to have cancer cells in his prostate on biopsy is 6 (3 + 3). There are complex technical reasons for this, and patients diagnosed before 2002 may have been assigned lower Gleason scores (e.g. 3 + 2 = 5). However, if you are a patient diagnosed today by prostate biopsy there is a very, very high probability that your Gleason score with be 6.”

In any case, Gleason score 5 (or 6) are made up by grades low in aggressiveness for spread. Many tumors are indolent and never bother one’s normal ways of living, “letting” the patient to die from other causes. Prostate cancer (Pca) is also a sluggish growing type that permits (some) “time for thoughts”.
However, there are several types of prostate cancer and in some rare cases low Gleason scores can be related to very active tumors multiplying fast. This is regarded as the initiation of micrometastases.

I absolutely agree with Hopeful recommendation that you should get a second opinion on the biopsy samples. Only one positive core out of 24 represents a very small portion, but the PSA is high at 4.2, which does not correspond to common cases of Gs5 (or 6) in terms of cancer volume.
The pathologist report (you should get a copy) may indicate other factors that you are not sharing in this post. Is there any finding of existing hyperplasia? What was the size of the prostate?

Proper diagnosis will lead you to a better decision on what to do next. In any case, you should be aware of the pitfalls that prostate cancer entails particularly with the treatments.
There is no perfect “silver bullet” yet that kills cancer, and treatments are sort of primitive assuring more a defect than a cure. There is a lot of guessing and one must decide looking upon the most effective with the lesser side effects. Quality of life is important when considering particularly to guys at younger age, that may never father a child again.
Radicals (surgery and radiation) are common to cause a certain degree of these conditions; incontinence, erection dysfunction, bowel impairment, permanent fatigue, etc., added to the risks that may involve the treatment (fistula, infection, organ damage, etc).

In low aggressive cases Active Surveillance (watchful waiting) is recommended because it allows deferred treatment to a later occasion which may never happen (in indolent type of cancers). Hopeful is an "expert" on the matter. This way of constant vigilance (periodical check on lipids, DRE, image studies and biopsies) would permit full control on any development out of the natural.
The problem is that one needs the nerves to live with the “culprit” alive inside one's body.

We are not equal so that what may have worked well for some may not do the same in others.
The important is to be confident when choosing, and such can only be achieved by education on the disease.

Here are some books that I would recommend you to read;
A “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (second edition June 2007); which may help you understanding options between surgery and radiation.

“100 Questions & Answers about Prostate Cancer”, by Alan J. Wein and Pamela Ellsworth.
This can help you in preparing your own list of questions to take to your doctor/s when going around.

Another example;
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

In PCa, outcomes seem to be better if the case is handled by experienced team of physicians and at modern renowned facilities.

Wishing you peace of mind.

VGama

chewbydo said:

low PSA and gleason - what's next?
PSA had doubled in 5 years; went up .5 in 3 months. Did get 2nd pathology opinion; reported gleason 3+3; involving 1 of 12 cores & less than 1% of total tissue in right prostate; in left prostate- all 12 cores were benign tissue; Have seen 4 urologists-- all mention active surveillance; but all recommend radical prostatectomy. Urologist with most experience (published 100's of articles) said 15% are what path report showed while 85% are worse. Did not elaborate on severity of being worse.

suggest that you consult with a specialist in AS
at a major medical center of excellence such as Johns Hopkins. Where do you live?

At the Sloan Kettering web site there is a nonogram that measure rate of psa change and doubling time

Five year doubling time is not considered aggressive.

I know that you probably know, but sex, bike riding, even a hard stool before the psa test elevates the number.

Fact of life; there are self serving doctors with profit in mind who are out there.They know the things to say in order to make the sale.

Approximately 70 percent of of low risk cancers will never progress; of the 30 percent of the cancers that are wolf in sheeps clothes studies indicate that if a man is monitored he can stil treat with the same active treatment option as he would initially picks if there is indication that the cancer has progressed ..

I am not an expert about active surveillance; I am a lay person who is informed.