Welcome new member Paul T: New dx Gs 7 hoping for AS

Hello Paul,

Welcome to the forum. Sorry you find yourself here but glad you found us. We'll try to help.

The first thing we always say to newly diagnosed guys is to calm down, take a breath, and know that prostate cancer usually moves slowly and you will have time to educate yourself and make a rational decision, even if you are not a candidate for Active Surveillance.

As a Gleason 7 you are at the top of the risk category for which most active surveillance programs will consider you. There are a few AS programs that take some Gleason 7 guys but all the other factors that might affect the risk have to line up. Thus, a few questions.

Do you have access to your pathology report from your biopsy? If you do we'll want to know about your Gleason 7 score. The 7 is the sum of two factors -- almost always Gleason type 3 and 4 -- and it makes a difference which order they are written. If you are a Gleason 7(3+4) you might be an AS candidate, if you are a Gleason 7(4+3) then probably not. In GS7(4+3) the more aggressive type 4 cells predominate and treatment is usually recommended.

We'd also like to know how many of the biopsy cores were positive and what percentage of each core was involved. They will often give a Gleason score for each core.

So, tell us more about yourself so we can help you worry...

As Peter said, it depends on many things, including if it is 3 or if it is 4 that is the primary pattern. If the predominant pattern is 4 AS is not likely to be offered, again as Peter said, g7 with primary pattern of 4 is more aggressive than that which the primary pattern is 3.

Also like he said, it also depends on the number of cores positive, and to a lesser extent, the percentage of cancer present in those positive cores (ie, core A is 40% composed of adenocarcinoma). DRE results may factor in as well, if the doctor felt lumps, bumps, and/or firmness, AS probably wouldn't be advised/offered.

Have you had imaging tests done, bone scans? If not, your doctor will likely advise you to do it, particularly if the primary pattern is 4.

I know you don't like the idea of treatment and noone likes having to have treatment for cancer of any time, but if it is determined AS absolutely isnt an option for you, then the sooner you get treated, the better. If you do have imaging scans done, the results will ultimately be a big factor into what treatment(s) will be available to you, and you and your doctor can then decide what venue to pursue.

If it is revealed that the cancer is confined to the prostate gland, imaging tests (if done) are negative for possible spread, then surgery will be the treatment your doctor will advise, especially at your young age. But you can look into other treatments before deciding on one.

If there is evidence of cancer breaking through the gland, radiation+ hormone therapy would likely be the treatment modality of choice. Hormone treatment is supposed to make cancer cells more vulnerable to radiation, and it can slow the growth of these cells.

As for advanced/distant spread, let's think positive for now and approach it like if is no more than locally advanced unless proven otherwise.

Locally advance prostate cancer is that which has penetrated through the gland, but has not spread to lymphnodes or distant parts of the body. It has a pretty food cure/success rate when treated appropriately, this is considered stage 3a which is considered curable with aggressive treatment.

Your PSA being under 10 is a positive factor in your favor, this would suggest at prostate confined disease, which is a lot better than extra prostatic extension. Let us know how everything goes, we are here for you.