biopsy results gleason 6

randyp
randyp Member Posts: 6 Member
in Prostate Cancer #1

just got the news. im 69yrs old 6 out of 12 positive all on left side. PSA is 5.8 but have been taking Dut for bph, Psd is .19, gleason 6, T1c, grade 1 ,Dre was normal. im trying to get a quick education in this area. My urologist spent 10 minutes with me , asked me if i was still sexually active and made an appointment to see a radiation oncologist in his group for next week. In my very short internet education i think my results are less scary than i first thought. My Dr. never mentioned active surveillance. When i asked about cyberknife from the tv ads he said he's not in favor of it. he seems to be pushing the longer multi week treatments. I'm a self employed farmer who's not in a great financial situation with a medicare hmo. I don't know if it is just in my head but i feel alittle bit like a cash cow. Not sure how to proceed. My wife wants the cancer gone. I'm scared of losing my life style but more scared of making a huge mistake. Any help from you more experienced guys would be greatly appreciated.

Comments

  • TKDMASTER
    TKDMASTER Member Posts: 5 Member
    #2

    start here

    https://www.youtube.com/watch?v=nb-PFvn9rzA
  • jc5549
    jc5549 Member Posts: 71 Member
    #3

    hi there, sorry about your news. Many men on this site advocate getting more than one urologist opinion. If you felt that yours did not spend time with you, it sounds like he did not, then there are typically many others that would talk to you about all options, including active surveillance.

    Tell us what city and state you are in and I’ll bet you get lots of suggestions for people to see.

    Finally, it’s not unreasonable to ask the urologist if he has a business interest in the Radiation Oncology group that he’s referring you to. It may be a good and reasonable business for a urologist to do so, but he should be upfront about this relationship and explain why it is he feels CyberKnife is inferior to the other type of intervention he’s offering.

    jc

  • randyp
    randyp Member Posts: 6 Member
    #4

    thanks that really was helpful!

  • Wheel
    Wheel Member Posts: 194 Member
    #5

    you absolutely right that your diagnosis details appear very less scary than you initially thought. Most Gleason 6 are Active Surveillance eligible and there are circles where straight Gleason 6 is not considered cancerous yet. Take your time on decision, even if you decided treatment, studies show a delay in treatment approaches of 6 months to treatment does not change outcomes. Your urologist seems pretty focused in directing you to Radiation treatment. Even with Radiation there are protocols that can be as short as 5 sessions of SBRT. Engage second opinion

  • Clevelandguy
    Clevelandguy Member Posts: 1,265 Member
    #6

    Hi,

    It sounds like you have three options, kick the can down the road(AS), surgery or radiation. If your tumor is not close to escaping the Prostate then AS might be a good selection. Based on the time your Urologist spent with you I would be seeking a second opinion with different doctors and a different hospital network. If you do decide on surgery or radiation get the best doctors & facilities within your reach to get the best results. I had surgery over 10 yrs ago and don’t regret it. There are no guarantees with either surgery or radiation so get the best team available to give you the chance of success.

    Dave 3+4

  • centralPA
    centralPA Member Posts: 379 Member
    #7
    https://csn.cancer.org/discussion/329022/biopsy-results-gleason-6

    Hi there @randyp

    Because you have 6 of 12 biopsy samples positive, that kicks you into Unfavorable Intermediate Risk by the NCCN standards, and AS is not recommended for that case. You should also be T2b by my reckoning, but I am not a urologist. Here’s the NCCN guidelines in doctor speak.

    https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf

    And for normal people. Requires a free sign up. Worth it.

    https://www.nccn.org/patients/guidelines/content/PDF/prostate-early-patient.pdf

    If I was doing radiation for an intermediate risk case, I’d do brachytherapy from a hospital with skills in that technique. Better radiation control, just one procedure, should be cheaper, etc. Give it a look.

  • randyp
    randyp Member Posts: 6 Member
    #8

    thanks centralpa for the info . i read your profile it seems like you been at this a long time. i appreciate your experience and help. i'm a little bummed out with the risk group info. i was hoping for better news. i've procrastinated most of my life i thought active surveillance had my name on it. I hope everything goes your way in the future.

  • Old Salt
    Old Salt Member Posts: 1,585 Member
    #9

    Just one comment on the mode of radiation:

    IMRT (many treatments) is more profitable to the radiologist than SBRT (CyberKnife is just an instrument). THe latter can be done in five sessions and there are a lot of published data that indicate SBRT is just as effective as IMRT.

    As has been pointed out by others, the experience of the staff who will treat you is paramount.

  • jc5549
    jc5549 Member Posts: 71 Member
    #10

    RandyP,

    You have time. You have months before you have to make a decision. Let us know if you would like suggestions on centers of excellence near you.

    jc

  • centralPA
    centralPA Member Posts: 379 Member
    edited February 20 #11

    Did you have an MRI yet? If so, what was the result? Also, how big is your prostate?

    How bad is your BPH?

    Here’s a trial ongoing in Kansas worth giving a look. Could get some free high quality care out of it.

    https://www.cancer.gov/research/participate/clinical-trials-search/v?id=NCI-2022-04174

    Agree with @jc5549 , be patient and fully educate yourself before acting. There’s lots to learn, and plenty of time to learn it. As per @Old Salt , Cyberknife in studies does just as well, but makes less money for the treatment facility. Etc.

  • randyp
    randyp Member Posts: 6 Member
    #12
  • randyp
    randyp Member Posts: 6 Member
    #13

    Centralpa, ultrasound says the prosate is 30.5 ml. that seems small to me after reading your results. My urologist never mentioned mri to me before the biopsy or after. It's only since i've been reading that i see it's a common tool that could shed more light on my situation. The dr. never mentioned any genetic or molecular testing either. At this point i'm losing confidence in my urologist. My BPH at this point is annoying . I have all the classic symptoms but i can still pee. I'm in central NJ ,any recomendations on better care choices? I think i need to look into changing my insurance . I'M with Humana gold medicare hmo. Not many in network choices. Their PPO looks better but would be paying 30%.of care bill. That scares me almost as much as the cancer. All this is new to me. I'M Definitely over my head. I will look into the clinical trial link. Thanks again for everyones help!

  • centralPA
    centralPA Member Posts: 379 Member
    #14

    I think your prostate is normal size? Mine wasn't so not a good comparison.

    I would move on from your urologist to a site that can provide full Standard of Care. Your urologist isn't.

    As you note, standard of care now is an MRI first, followed by biopsy. There are a ton of reasons to do it in that order, and no good ones not too, really, other than maybe cost? But you should get an MRI now. It can indicate if there is a lesion, and if it is extending beyond the prostate boundary. It can see other stuff too. All of that can affect your treatment choice.

    Some folks here will advocate for a PSMA PET exam.

    Same for the molecular testing, just no good reason not to do it (other than cost).

    I know across the river in Pennsylvania there's Fox Chase, U Penn, and Jefferson that all have top notch programs. Finding a hospital that is also an NCCN Cancer Center is a safe bet. I am sure New Jersey has some good ones, and of course NYC.

    Hopefully some folks from that part of the world will jump in here. I know @swl1956 is seen at Fox Chase.

    Be patient and keep learning!

  • swl1956
    swl1956 Member Posts: 194 Member
    #15

    randyp

    I could not agree more with the above recommendations. NCCN Cancer Center such as Sloan Kettering, U Penn, Jefferson, MD Anderson, Fox Chase, John Hopkins, and others all would be excellent choices. I chose Fox Chase just because it's the most convenient NCCN center closest to me. Fox Chase does have a facility in Voorhees, NJ. They also have one in East Norriton, Pa. There is a doctor there David Chen who has a world class reputation and I would recommend him for an opinion. I've been seeing Dr. Andres Correa who's office is near the North East Philly Main Hospital location which whom I am happy with.

    In my opinion MRI is a must. Should have been done prior to a biopsy. If lesions are found with an MRI, then a targeted biopsy will give more accurate indications of one's situation. You likely have time to wait a bit, but I wouldn't recommend procrastinating too long. The stress of procrastinating and not knowing what's going on is worse than knowing what's going on even if it's not good news. Ask me how I know this. Lols!

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