Newly diagnosed

Pre-surgery stages are defined by how your PCa was discovered, and what observations can be made as a result. Post-surgery stages depend on analysis of the gland, and can be very different.

You would also need to include what your DRE found, and where the two positive cores were located. I had two doctors that disagreed on what to call mine, but post-surgery, they were both wrong.

This is from http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient/page2

Stage I

In stage I, cancer is found in the prostate only. The cancer:

is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Gleason score is 6 or lower; or
is found in one-half or less of one lobe of the prostate. The PSA level is lower than 10 and the Gleason score is 6 or lower; or
cannot be felt during a digital rectal exam and cannot be seen in imaging tests. Cancer is found in one-half or less of one lobe of the prostate. The PSA level and the Gleason score are not known.
Stage II

In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. Stage II is divided into stages IIA and IIB.

In stage IIA, cancer:

is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 20 and the Gleason score is 7; or
is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is at least 10 but lower than 20 and the Gleason score is 6 or lower; or
is found in one-half or less of one lobe of the prostate. The PSA level is at least 10 but lower than 20 and the Gleason score is 6 or lower; or
is found in one-half or less of one lobe of the prostate. The PSA level is lower than 20 and the Gleason score is 7; or
is found in more than one-half of one lobe of the prostate.
In stage IIB, cancer:

is found in opposite sides of the prostate. The PSA can be any level and the Gleason score can range from 2 to 10; or
cannot be felt during a digital rectal exam and cannot be seen in imaging tests. The PSA level is 20 or higher and the Gleason score can range from 2 to 10; or
cannot be felt during a digital rectal exam and cannot be seen in imaging tests. The PSA can be any level and the Gleason score is 8 or higher.
Stage III

In stage III, cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles. The PSA can be any level and the Gleason score can range from 2 to 10.

Stage IV

In stage IV, the PSA can be any level and the Gleason score can range from 2 to 10. Also, cancer:

has spread beyond the seminal vesicles to nearby tissue or organs, such as the rectum, bladder, or pelvic wall; or
may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes; or
has spread to distant parts of the body, which may include lymph nodes or bones. Prostate cancer often spreads to the bones.

Based on what your wrote, you are a Gleason 7. The highest score found is usually how a prostate cancer case is treated. The good news, only 2 positive cores found, and a very minimal amount of cancer found. Your prostate is a bit on the large size, but that can come with age.

What has your doctor suggested you do at this point?

With 21 cores taken (that's quite a few) and only two positive found, and being <5% positive, its possible you could qualify for AS, instead of needing immediate treatment. That would keep you having a safe eye on the small amount of cancer, without subjecting yourself to any invasive treatments, and the possibility of dealing with ED, incontinence, or both.

David

Thanks for all the advice. The cancer is in the right lobe at the apex and base.

My doctor recommended either AS or surgery. He doesn't think I am a good candidate for radiation given the large size of my prostate. But, he is a surgeon and I am going to get a second opinion from a radiation oncologist. I read about a new type of surgery that is more targeted and will investigate that (stereotactic body radiation therapy). Does anyone have experience with this?
Thanks again.
Eric

There are some focal therapies with laser, ultrasound (not in US), nanoknife (radiofreqeuncy) and radiation. (cyberknife for one) There is at least one member who has done the focal thing but I cannot recall who it is. Maybe he will chime in.

Best of luck to you.
Don

Hello Eric and welcome to HW. Re your question about SBRT, we have several members who have used that treatment with great curative success and little in the way of side effects. I suspect one or more of them will chime in. We also have one member, Ziggy9, who has done targeted focal therapy. He chimed in with a recent thread about his success so you might want to go back and look that over...and contact him if you are interested as he can tell you tons about it.

Also, may I suggest that you get a second reading on your biopsy slides from one of the pathology experts such as Dr. Epstein at JHU or Dr. Bostwick at Bostwick Labs. You want to make sure of your pathology before you commit to any treatment.

Some have mentioned AS; that is something you might want to consider.

For your reading pleasure I can also recommend that you check out the sticky thread at the top of our forum that is designed specifically for newly diagnosed patients.

Good luck and please let us know how we can help.

Jim

Sailorman,
Clinical stages are only based on the DRE and any imaging you may have had done afterwards. It's not based on the biopsy. If your doctor didn't feel anything, you are stage T1c. If he felt a small lump on one side, you are stage T2a, etc. The only way to know what stage you are is to ask your doctor. If your stage was T1-T2, you would be classified as "favorable intermediate risk" because of the GS3+4. I would want a second opinion on that, as you have been advised.

AS may be a good option if you have access to multiparametric MRI or CDUS-guided biopsies. You're a great candidate for focal therapy. You asked if anyone has had SBRT - I have and strongly recommend it.

Sailor,
At 74 you should be very cautious about treatment. There is no survival benefits for treatment of low risk cancer for those over 65. Prostate cancer is very slow growing and take decades to cause death.