Just diagnosed

Your post used both "I" and "his", so were you diagnosed, or somebody else? 

In any event, having six positive cores, bilaterally, at age 50, would usually require treatment, even if the Gleason scores were all (3+3).

But, PCa is usually slow growing, so you/he have the time now to get educated on the treatments and their side effects. The worst mistake a patient can make is to rush into surgery or another treatment without having consulted multiple doctors offering different specialties. Don't be afraid to ask and question all that you can.

Take you time and consult all options . Being 50 is young for this so study and take slides to have looked at again

My psa was only 2.97 at 60 years old but biospy showed 2 cores positive 25% left apex gleason 6. still deciding on treatment

at this time or active survellance. Any advice also appreciated.

As I understand your Gleason is 3+3=6.

In one core, there is a 30% involvement, and in another there is 10% involvement, that is 30% and 10% of each of these cores are cancerous.

Now are there any other cores out of the twelve that were taken,  that are cancerous? and if so what is the involvement of each? 

willie49 said:

Hi,

Hi,

This is from the report:

Right apex - 10% occupied
Right base - 30% occupied
Left base - 10% occupied

Greatest percentage of tumor in a core = 50%

So, as I understand six of twelve cores were postive within the areas that you mentioned. Do you have the information for each of the cores that were positive and the involvement of each?

Sorry to be a pain, but were three cores positive or were there six cores positive? There is a difference in available treatments depending on this answer.

Determining Gleason scores are subjective; there is a difference among the skills of pathologists and available facilities, so I recommend that you receive a second opinion of the pathology from a world class organization that specializes in prostate cancer. Johns Hopkins is one of these organizations. The results of your pathology is the primary source to determine treatment. If your insurance does not cover the cost of the second opinion, it will be approximately $250 out of pocket. Simply call your doctors office and ask that the slides be sent to Johns Hopkins

Basically even with with a low 3+3=6 when there is an abundant amount of cancer located, you would not be a candidate for Active Surveillance (monitoring), unless you are an older man where the critieria is relaxed,  since there is a good chance that a 3+4=7 can be found.......so consider a second opinion by an expert organization that you can trust, and you will know where you stand.    .

My husband’s doctor neglected to tell him about a PSA of 9 in summer 2016. A recent routine test indicates his PSA is now over 30. The only information so far is that he has cancer. I will accompany him to urologist on Wednesday December 20. I’m trying to not get too anxious before we have more info. However, I did read that a man presenting with a >20 PSA is more likrly to have advanced cancer. Can anyone comment to that?

Mostly what I’m seeking is advice on what questions to be asking at the urologist appointment. What information is most important at this time? My spouse is 65 with chronic hypertension and Type 2 diabetes. Thank you in advance.

Willie,

I was diagnosed in August 2013.  My PSA was 69 when found, I had no symptoms.  It was found purely by accident, because of an internal bleed.  At the time, I was 67 years old at the time.  I had biopsy done, and my Gleason was 3 + 4 --7.  As has been stated in another reply here, I wanted the cancer gone.  My Urologist / Surgeon suggested Robotic Surgery or Radiation. He suggested surgery, because "Of my Youth, and physical condition".  I laughed at that, but he was totally serious. I was a road cyclist and out riding with the University Cycling Team practicing Drafting and such things. So, at your young age, that has to be a consideration.   I was ready to jump at the surgery right away.  However Dr. "M" would not do the surgery until I went to Radation Oncology first, and talked to the Oncologists.  Then I thought I'd do the radioactive seed thing.  However I decided to go with the surgery, instead, after I read many articles about the side effects of all the treatments available.  It was a good thing that I decided to do the surgery.  As they were working on my surgery, They discovered that my Bladder was adhered to my prostate, and they had to do other work , put an incision in my bladder, etc to get the prostate removed.  They found that using the radiation seeds would not have worked because they coudn't have gotten all the seeds where they needed to be.  Also, because of Hernia mesh from an Abdominal Hernia, my robotic surgey that was supposed to take about 3 hours ended up taking 5 1/2 hours.  Post Op Pathology showed 40% involvement of the prostate, and there was one very tiny spot in one lymph node.  That spot was so small that it hadn't shown up in my MRI's. There was no other spread of the cancer.   Thus I was listed as a Stage pT3bN1.  Because of that pathology, I had to do 38 follow up Radiation Treatments.   28 regular and 10 treatments  they called "Boost" to the Prostate Cavity.  This was done to catch any cells that might have been missed.  I was also on Lupron for two full years.  They started me on the Lupron first, to weaken any cancer cells that might have been left during the surgery. My surgery was on December 10, 2013.   I am now  four full years and 7 days past my surgery.  My PSA dropped to <0.010 with in about 2 months, and stayed there for three years.  I've been off Lupron for over a year now, and my testosterone has come back up into normal range.  They had my testosterone down to 17.  Normal Total Testosterone Level range is 250 - 1100.  I am now at a Total Testerone level of 380. Normal Free Testosterone Levels are 30.0 - 135.0.  My Free Testoaterone is now back to 41.8.  As of my last check up my PSA was at 0.147. It had come up, but the last tests showed the rate of increase has been cut in half.   My Radiation Oncologist, My Chemo Oncologist and My Urologist / Surgeon are pleased.  However they say there are still cells somewhere, and we must keep close watch on the PSA Numbers.  If we come up to around 2, the I will probably have to go back on Lupron or some other form of treatment.  My doctors keep it real.  This is and will be a constant on going fight for the rest of my life.  

So, as far as advice----->.   Read, study, read, study, and then repeat.  Make sure you understand all the options and all of the side effects of all types of treatment.  I am not a doctor and thus would never make suggestions.  Only that you should study hard.   Ask as many question as you can think of.  Ask your doctors, and also ask us here on this site.  We can share our experiences with you.  You will have to make the decisions for yourself.  That's how my doctors were with me.  So far, I'm glad I followed the path I did.  My doctors are talking types of treatment options we have, if needed, for 10+ years and beyond, as of right now.  My wife has been my biggest help, support and "Cheer Leader".  Enjoy the simple things in life.  Being together and out side.  Sunsets, Rain and thunder storms, lazy snow falls,  wild life in the yard  (for us, that's Birds, an occasional Bear, Deer, and even a Coyote), etc.  Sunny Day Drives just looking at the scenery.  All this has gotten us through this up to this point.  

Know that you are in my Thoughts and Prayers.  Best of luck and sucess with your journey.

Love, Peace and God Bless

Will