What do you think about my case? Better to remove the prostate now or wait?
52 years old man. MRI PiRads 4 (10x11 mm pseudonodular lesion with ill-defined margins in Peripherical zone) Lesion located in the posterolateral segment of the lower third of the left peripheral lobe. PSA 5.33 ng/ml. Systematic biopsy and targeted (total 14 samples). 5 samples targeted to lession index (3 positives & 2 negatives). GLEASON 6 (3+3) Core with the greatest impact is 60%. 35% total involvement of all material sent for biopsy. Rest of prostate without evidence of malignancy.
I am completely devastated and terrified.
Comments
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I was a cpl years younger, similar pathology and did AS for about a year. Ended up getting surgery 2 yrs ago. So far all is good. If your volumes are high, then there is more chance if higher gleason missed by biopsy. Talk to your doctor about AS as well as treatments. Don't panic and rush anything. Get as much info as you can to make your most informed decisions.
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I have consulted several doctors from the private and public system. Private doctors push towards radical treatment and doctors from the public health system rely on European and American urological guidelines that say that active surveillance is the recommended option in low-risk tumors.
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You sound like you are in the middle of the AS realm, With your MRI and biopsy results results indicating low risk. Since your cancer appears to be localized, another alternative in between just monitoring and removing the prostate, is to pursue a focal therapy. In that case, they would just go after the lesion and leave the rest of the prostate there. When you meet with your urologist, you can ask about the different therapies available.
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They also told me that there is a 30% chance of recurrence in the treated area and in the untreated area that a new tumor will appear within 3-4 years and in addition an active surveillance protocol must be followed in any case, because We are leaving a prostate that in some patients is programmed to develop tumors.
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I just had a Focal IRE nanoknife procedure to address my 4+3 Tumor. Took me several months to decide and find a place and doctor I felt comfortable performing it. As you're probably aware, the main benefit of Focal is that the side effects typically associated with surgery or radiation are very much reduced. The downside is that the procedures are still deemed investigational. The medium term data is very encouraging, but there is not yet enough long term data for total acceptance by regulating bodies. Not everyone is a good candidate for Focal, but for those that are, I obviously believe it's worth the risk. Many of the Research centers of excellence are offering it. Sounds like you can likely Active Surveillance and take your time assessing the myriad of information about Pca and the associated treatments. Pca is typically a very slowly progressing disease. Ultimately, it will be your decision how to address your situation. It's not an easy one!
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So now we are at the point of deciding the following:
1. Treat it now immediately that the tumor is not very aggressive and small and begin to suffer now the possible side effects of the surgery.
2. Do active surveillance. Wait and risk the characteristics of the tumor changing and attack it at that moment in the hope of not having lost hope for a cure and gaining months/years of full quality of life without sequelae.
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Hi,
If it was me I would want to know how close the cancer was to the Prostate capsule edge. If the cancer is deep inside the Prostate then you have time for AS. If it’s close to the edge I would want to deal with it sooner than later. Surgery or radiation is something to be decided by you and your doctor team. A second opinion at this time might not be a bad thing before you decide. In my humble non medical opinion you don’t want the cancer to escape either to the Prostate bed or bladder. If you get all the facts a decision should be easy to make because you know what you are dealing with.
Dave 3+4
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Yes, it is a question that I sometimes ask myself about the proximity of the tumor to the prostate border. The MRI report says that it has already reached the prostatic margin. But by definition, prostate cancer almost always develops in the peripheral zone and therefore is almost always very close to the prostate capsule. The strange thing is that urological clinical guidelines, when they recommend AS, do not take this information into account.
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I am sorry you are dealing with this my friend. Agree with Old Salt, let your Gleason Group disease status and the guidelines direct what you do next. Other auxiliary tests like Decipher may add information to your risk category and curability with treatment.
It seems active surveillance would be reasonable although I do understand you have high core positivity in some of your biopsies. I would caution you on focal Therapy or any therapy that does not have long-term greater than 10 year data. At age 52 you have too many years left to live to choose a therapy that has a high risk of PSA recurrence multiple years later and requiring repeat intervention of some sort(possibly before you are even age 60), in my humble opinion.
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Hello friend, what you say is very true. In my case, I find it difficult to make the right decision or the one that is most likely to be right. one of my cylinders is affected with 60% of the tumor but it is quite relative because the report does not accurately indicate the length of the cylinder (5 samples are taken from the suspicious lesion that have a length between 0.4 cm and 1 cm) but This 60% does not indicate whether it corresponds to the 0.4 cm cylinder or the 1 cm cylinder). It also indicates that the percentage of total involvement of all samples of the suspicious lesion is 35%. On the other hand, the MRI report indicates that the lesion reaches the prostatic margin but that there is no deformity of the capsule or involvement of the periprostatic fat that shows extraprostatic extension. No guidelines or inclusion criteria in AS take into account the proximity or distance of the tumor to the edge of the capsule. This makes me feel confused.
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If I were in that situation, without knowing anything else, I would consider the timing and your state of mind. Are you going to spend every day worrying about this until you get something done? Or are you going to not worry about it and enjoy life? Consider maybe having a good summer, do the travel you always wanted, spend time with the family, etc. Then take action. And consider some counseling if it is troubling you.
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I try to lead a normal life but the shadow of cancer is very large. I'm obsessed with this. On the one hand I feel like I'm playing dice with my health and on the other hand I think I should make the decision that scares me the least. I have been diagnosed since November 2023 and I soon have to do a PSA test within the active surveillance program. I am quite anxious if there is a big jump between the last value of 5.33 ng/ml and what may appear next week
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When I was diagnosed in January via MRI and confirmed via biopsy in February, I too was obsessed and my life was on hold until I got clarity. The clarity was that my gleason was 3+4 and my Urologist said I was at a very early stage. And he gave me all the options that you have (AS, radiation and removal). But now with the reassurance of doctors and after I have finally made a decision, my stress level is almost totally gone. Removing ambiguity helped.
My decision…to have my prostate removed (July 11). My reasoning was manyfold.
- I just want it out and hopefuly not have to worry about this again (though will still need yearly PSA tests)
- Radiation is a good option for many, but I was concerned that if there is a reoccurance, surgery after radiation can be problematic.
- At 68, I am in relatively good health 5'11 1/2, 190 lbs, acitve. No meds, no underlying conditions. If I chose active surveillance, will I still be in good health to take surgery well, 4-5 years from now.
I do have some concerns about incontinence and ED, but its not like I have a choice to do nothing the rest of my life. I need to do something and there are some consequences. Though I am a pretty good candidate for these issues to be minimal.
And finally, I have talked with many doctors and survivors who said "you can live a long time with prostate cancer without issues. You likely die of something else first". So, to me that means if I don't die of something else first I will die from prostate cancer. LOL
So those are my reasonings for opting for surgery. But everyone is different.
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Hi,
Sounds like the cancer is very close to leaving the Prostate capsule(“reached the prostatic margin”). If it was me I would act now and not do AS because of the position of the cancer. Gets more complicated once the cancer leaves the Prostate.
Dave 3+4
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