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Restored1
Posts: 11
Joined: May 2019

I have a Gleason 6 diagnosis with 7 positive cores, I’ll like to know from this forum if I can safely participate in active surveillance or undergo da Vinci surgery? I am really concerned about the possible side effects of surger.

Georges Calvez
Posts: 242
Joined: Sep 2018

Hi there,

Do you have the results of multiple PSA tests and the dates?
It is not that reliable but it does give an indication of the rate of growth of the cancer.
How many cores did they take?
Seven cores positive tends to suggest that the cancer is quite extensive.
You have a lot of time in hand to think about it with that pathology.

Best wishes,

Georges

VascodaGama's picture
VascodaGama
Posts: 2987
Joined: Nov 2010

The word"safely" is ambiguous regarding the choice of options. Treatments for prostate cancer follow principles based on the status of the disease. You should get a clinical stage from your doctor firstly. Do you have any image study result? What is your age?

How much (% of cancer was identified in each core?

Typically surgery is chosen when the cancer is contained. If spread is thought to exist then radiation may be the best approach. Try getting more information on your status and get a second opinion from another specialist.

Best

VG

lighterwood67's picture
lighterwood67
Posts: 202
Joined: Feb 2018

What do the doctors taking care of you say?  At a Gleason 6, I would say that you have time to ask questions and then ground any decision that you make on the facts presnetd and the doctors' recommendations.  Active Surveillance maybe your best option at this time.  This is your decision.  You have time to become very familiar with the side effects of surgery or radiation.  A Johns Hopkins study of men on Active Surveillance found that, 15 years later, less than 1% of men developed metastatic disease. This is important because treatments used for localized prostate cancer—surgery and radiation—have side effects that can alter a person’s quality of life.  The key to these successful numbers is making sure you are monitored regularly for signs of progression. A PSA blood test and digital rectal exam (DRE) are usually done once or twice per year by your urologist, with a repeat biopsy of the prostate every 1 to 5 years. If there is evidence that the cancer is progressing, treatment may be warranted.  Good luck on your journey.

Restored1
Posts: 11
Joined: May 2019

Thanks for your responses to my question. Some needed more information and here it is. I am 54 years old. This is my recent fusion bipsy report. My doctors are advising me to do surgery due to too many positive cores but I am confused because I have read in some medical journals that Gleason 6 does not have the potential of escaping the prostate. Please advice needed on what to do.

 
FINAL PATHOLOGIC DIAGNOSIS
 
C, PROSTATE, LEFT LATERAL APEX, NEEDLE BIOPSY:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 3 = 6 (GRADE GROUP
1), INVOLVING 1 OF 1 CORES (TUMOR MEASURES 0.5 MM, 6% OF CORE).
 
M, PROSTATE, TARGETED CORES, RO#1, NEEDLE BIOPSY:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 3 = 6 (GRADE GROUP
1), INVOLVING 4 OF 4 CORES (TUMOR MEASURES 3 MM, 35% OF CORE; TUMOR
MEASURES 2.5 MM, 36% OF CORE; TUMOR MEASURES 2 MM, 20% OF CORE;
TUMOR MEASURES 0.5 MM, 10% OF CORE)
 
N, PROSTATE, TARGETED CORES, RO#2, NEEDLE BIOPSY:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 3 = 6 (GRADE GROUP
1), INVOLVING 4 OF 5 CORES (TUMOR MEASURES 1 MM, 11% OF CORE; TUMOR
MEASURES 1 MM, 12% OF CORE; TUMOR MEASURES 0.5 MM, 5% OF CORE;
TUMOR MEASURES 0.5 MM, 5% OF CORE)
 
A,B,D,E,F,G,H,I,J,K,L, PROSTATE, NEEDLE BIOPSY:
- BENIGN PROSTATE TISSUE. 


This case has been reviewed by another pathologist with
concurrence.
 
 
Clinical History
DIAGNOSIS/CLINICAL IMPRESSION:
Total cores: 20
 
(33-mL prostate)
 
PSA, CANCER MONITORING      5.3   03/14/2019
PSA                         4.5   10/25/2018
PSA                         3.7   03/27/2018
PSA                         6.7   11/14/2017
 
1:  Left lateral base - 1 core
2:  Left lateral mid - 1 core
3:  Left lateral apex -  1 core
 
4:  Left base -  1 core
5:  Left mid  1 core
6:  Left apex -  1 core
 
7. Right lateral base 1 core
8. Right lateral mid 1 core
9. Right lateral apex 1 core
 
10. Right base 1 core
11. Right mid 1 core
12. Right apex  1 core
 
13. Targeted cores - ROI#1 (R PZ) - 4 cores
14. Targeted cores - ROI#2 (L TZ) -4 cores
Number of Containers->14

VascodaGama's picture
VascodaGama
Posts: 2987
Joined: Nov 2010

I understand the reason for you to be concerned about the surgery side effects. You are too young to lose the present quality of life. The two main consequences from surgery is incontinence and erection dysfunction. These issues in many guy reverse after several years (never fully but acceptable) but in some they become nightmares. I think that your wish is (question above) to follow AS as a substitute to treatment, which may not be advisable for the number of positive cores (9 positive out of 20). Surely you got another option that would involve treatment with radiation. This also got side effects linked to cases of proctitis and cystitis. Radiation treatment is not recommend to guys with ulcerative colitis. One needs to check firstly with a colonoscopy.

Thought the cores all are Gleason score 6 (confirmed by a second pathologist) the high percentage found at the peripheral zone and the high PSA (in normal size gland) may suggest your case not to be indolent. 4 positive cores found cancer at the transition zone which is the inner area surrounding the urethra but there are no positive cores at the base of the prostate (under the bladder) which case could be dealt with radiation therapy avoiding the sphincter that involves most of incontinence casualties. 

In the report there is no comment on cancer found close to “shell”. I wonder what does the MRI report indicate. 

In your shoes I would get a second opinion on suggested treatment. You can consult a radiotherapist to gather more information on the matter. I also suggest you to research on the risks of treatments. You got time before making a final decision. Your family should help and support with opinions too.

Here are links regarding the location/division of the biopsy drilling in the prostate;

https://www.cancer.ca/en/cancer-information/cancer-type/prostate/prostate-cancer/the-prostate/?region=on

https://www.researchgate.net/figure/Location-of-prostate-biopsy-schemes-A-Right-base-lateral-B-Right-middle-lateral-C_fig1_262071105

Best

VG

Restored1
Posts: 11
Joined: May 2019

Thanks VascoDagama for your informed insight and links you shared, they are really helpful.

Clevelandguy
Posts: 440
Joined: Jun 2015

Hi Restored,

Good advice from the folks, it’s really up to you.  Some people on this forum have been doing AS for years, others surgery, others radiation. In my opinion at your young age you will eventually have to do either surgery or radiation. The cancer is not going to go away but you do have time to study,study,study and pick the best treatment plan for you. I think Davinchi robotic surgery and Cyberkife are two of the better choices out there today.  Both methods have had results from fantastic to ugly I feel due to the doctors and facilities that use these “tools”.  Pick the best doctors & best facilities you can to optimize your results. Once you do your homework you should feel comfortable with you choice and the possible side effects.

Dave 3+4

Restored1
Posts: 11
Joined: May 2019

Thanks Cleveland Guy for your advice, it is well taken.

greenteaguy
Posts: 34
Joined: Feb 2019

If the OncotypeDX genetic test is covered on your health insurance plan, I would certainly get one.  Get all the information and results from the best possible testing before making a final decision.  I have 4 positive cores Gleason 6 and one Gleason 3+4 all on one side and have been on AS for about one year.  I have chosen to make significant changes in my lifestyle and am comfortable with my decision.

Restored1
Posts: 11
Joined: May 2019

Thanks Greeteaguy, I will definitely ask my doctor for an OncotypeDX test and decide thereafter.

Georges Calvez
Posts: 242
Joined: Sep 2018

Hi there,

For a man of your age the incontinence is highly likely to go away quite quickly.
About 90% will go back to only losing the odd drop.
I lose a few if I pick up a 25kg bag of sand or spuds or an 11kg watering can, etc.
It is acceptable as I am not lifting heavy objects all day, every day, but if I had to it would be impossible for me.
Lots of Kegel exercises are good, I think they help with penile rehabilitation as well.
I cannot get an erection for the moment as my nerves were removed and I am on ADT but my penis looks normal and increases in size under physical stimulation, so I am hopeful for the future!
Erections are a black box, the nerves are fragile and very close to the prostate, sometimes they just seem to get stunned and never recover.
Experienced surgeons do have better results but it is not guaranteed, the average recovery rate for your age group is around 60%.
This 60% hides a lot of variation from men who are pretty much normal to a close to complete loss of potency.
Some men have OK orgasms after the operation but for some it becomes close to a none event.
One thing for sure, a prostatectomy will not improve your sex life and it might kill it close to stone dead.
The results of prostatectomy today are fantastic compared with the past but it has got downsides.

Best wishes,

Georges

Restored1
Posts: 11
Joined: May 2019

Thanks for this insightful info George 

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