Recently diagnosed - PSA 15.1 with only 1 core positive @ 3+3. At 44yrs old - any thoughts?

Hello ZZarth, Welcome to the forum. Glad you found us but sorry you found yourself needing to look for us. Hope we can help.

You might want to read through the first thread on the Prostate Cancer forum. It's a "sticky" thread because it stays at the top of the page even if there are newer postings. Here's a link: Newly diagnosed with PC? – read this thread first.

One of the things it will talk about is "Active Surveillance" -- a program where men with the sort of disease that is unlikely to be particularly aggressive can simply watch it closely and, in many cases, delay treatment for years (while treatments improve) or even avoid it altogether. AS isn't for everybody but, even if it isn't for you, the fact that the sort of cancer you appear to have can be watched for years in many cases should help you understand that you have time to educate yourself and make an un-rushed decision.

Hi Zzarth-

Sorry you got this diagnosis at such a young age.

I hope you will follow the recommendation in the sticky to get your biopsy samples re-read by Bostwick or Epstein, rather than some random lab of your urologist's choosing. The reason we recommended only those two is because they have highly trained staff that only read prostate biopsy slides. Other pathologists have to be able to read any kind of tissue or fluid samples and don't specialize.

Also please read the following:

Can a man be too young for active surveillance?

Just being young is absolutely not a valid reason to have immediate surgery. In fact, as you will learn, a better case can be made for immediate radiation. But best of all is active surveillance.

As you will learn, the first doctor you talk to, typically a urologist who advocates surgery, is not necessarily a good source of info about other treatments. You have to take it upon yourself in seeking out experts in each specialty.In addition to specialists in active surveillance (and there are many different protocols), those specialties may include focal ablation, SBRT, HDR brachytherapy, and LDR brachytherapy. I talked to 6 specialists before deciding. Take your time!

You also deserve a better answer to the question of why your PSA is so high. It is much higher than one would expect from your biopsy results. Do you have some kind of urinary obstruction? I would guess you are showing some kind of urinary symptoms for a man your age to get a PSA test. Maybe it's prostatitis or possibly even BPH. Whatever it is, you should investigate and treat it if possible. It may be that you have some other cancer in the prostate that wasn't found. If so, that's the value of active surveillance - within a year, you will have another biopsy, possibly mp-MRI-targeted or a saturation biopsy that will pick up whatever the first one may have missed.

Hi Zzarth. Welcome and sorry. I can't really add anything further, and I agree with what's been said so far. PSA at 15...yikes! That doesn't seem to match your Bx results.
As the others have said, there is more to do to sort out the details.

Take the time to research your options, but DO NOT take your time in getting down to the facts surrounding your PSA and gleason. In my mind, there is a missing piece of the puzzle.

Hi Zzarth, welcome to HW, sorry you have to be here. You got some great advice already so not much for me to add. I wish you luck on your journey. Keep us posted. Take care! -JR

You haven't said, and I can't imagine, what you need imaging right now for. Based on what you wrote, you don't need a CT scan or an MRI, and you should not have any imaging unless you are clear as to its purpose. I mentioned a multiparametric-MRI a year from now to target a follow-up biopsy only if you decide on active surveillance. If you decide on, say, radiation, then a radiation oncologist will specify the kind of imaging he needs to create the plan. Depending on the therapy you choose, the specialist may specify a special kind of imaging - I would wait for that.

The most prevalent kind of focal ablation (the "focal"part is very important) is focal cryotherapy (BTW, a specialist I have met, Duke Bahn, uses a completely different kind of imaging, called color doppler ultrasound.) There are several kinds of focal ablation available in the US now in clinical trials or registries - cryotherapy, HIFU, laser, IRE, or photodynamic therapy (in Mexico). There are many outstanding unresolved issues and very little long term data, but I encourage you to meet with specialists to learn more. If you're interested in understanding more about this and the issues, you might want to read the following article about IRE:

NanoKnife or irreversible electroporation treatment as a potential focal ablation therapy

- Allen

Hi Zzarth,

You asked whether anyone has seen a mistake, in reference to your Gleason of 6. The answer is yes, in a sense. Your G6 is a subjective opinion from a pathologist who examined the biopsy tissue under a microscope. The idea of a mistake is maybe more a possible difference of opinion of the slide. Your biopsy may not be considered even a G6 by an expert reader, but it may be considered above a G6. This is why you're doing the right thing by getting a second opinion/reading of the biopsy. Epstein's group at Johns Hopkins is considered highly accurate in reading biopsies by various evaluations, and thus they've become basically the prostate biopsy standard-bearers.

Regarding pro/con charts about treatment options, there's plenty of data sources. There are as many opinions here as to what to make of those charts, so you'll need to come to your own conclusions as you explore them. My own focus was to emphasize the treatments with the greatest chances for non-recurrence of cancer at the level I was at, and then what were the tradeoffs in terms of likely side effects.

As to a similar experience to yours, I'm in the same ballpark, but please be wary of making individual comparisons with anyone. EVERY situation is unique. In my case, at age 57 I'd had a negative TRUS biopsy and a negative mpMRI by the time my PSA reached 12.7. Five months later, another mpMRI noted a suspicious lesion that turned out to be a small G6. Soon after my PSA was 16.8. I faced your same question, and I wanted to head to a world-class AS Program. The tiny tumor shouldn't be generating such high PSA, so I also continued efforts to eliminate non-cancer causes of the high PSA and also get more scans to look for possible additional tumors. My original urologist ultimately was right when he said, "Oh you've definitely got significant cancer, it just hasn't been found yet." Eight months later, my G6 tumor was re-biopsied as a G4+3, confirmed by Epstein, and it was time to end AS and act.

Our brother Halbert gives great advice, "Go big or go home." You've got 40+ years of living to get to, so get the best input you can on this, including as many specialists running Active Surveillance, and surgeons and radiologists as feels right to you. In my experience as a G6, most all will tell you that you're perfect for their treatment. But the real question is whether their treatment is best for you, and only you can answer that.

Keep in mind that most everyone is happy to go in more detailed off-line emails with you, if you prefer. I owe huge thanks to many here who have coached me through my situation.

Best wishes,
Jim

Zzart, I am not sure if anyone mentioned but you can have the one positive core gene tested for aggressiveness. You can Google "Polaris prostate cancer gene test" for more information.

Zzarth,

I partially agree with Tall Allan. Your psa of 15 is unusual and not at all consistent with your biopsy results. Before you make any kind of a treatment decision you must determine the cause of the psa discrepancy. It could be prostititis or it could be a more serious cancer that was missed. It happened to me and I was lucky to find a good oncologist that said we are not going to make any decisions until we find out what is causing the high psa. Everyone else wanted to operate immediately, which would have been a major mistake. My experience was similar to Jim Bears experience where it took 10 years to find a more serious cancer that was reflected in my psa, but not my biopsies.
I would seriously think about getting a multi P MRI or a color doppler from an expert RO. Somethings causing your psa to be 15, which is about 11 points or three times what your stats show it should be. It's a red flag that needs looking into.

Am a little concerned about your age. That said, I have G6 condition, my story below may be of value.
_____________________________________________________________________
JULY 2016: Bone Scan (NEGATIVE)
JUNE 2016: PSA 2.7
APRIL 2016: PSA 3.7

OCTOBER 2015
Age: 59
PSA: 3.0 elevated to 3.5 in (6) months
3T-MRI: (1) lesion identified
Fusion Biopsy Results: Lesion cores benign, additional (12) cores = (1)5%
Pathology Summary: Grade Group 1 (G6:3+3), 2nd pathology verification
Clinical Stage: T1c

Genetic DNA Profile: Above average risk for Aggressive PC (Genetics Test)
Existing Cancer DNA Profile: DNA risk unknown (Oncotype DX test cannot be performed, <1mm)
High Grade Biological Score: 27% aggressive risk (Mi-Prostate Score)
Other Health Conditions: Diabetes Type II (DX 2000), on meds & insulin

PCa Treatment: "Active Surveillance"
Risk: Undetected Cancer Progression
Risk Likelihood: LOW

My Story: https://www.healingwell.com/community/default.aspx?f=35&m=3528051

Nice work Zz, always push for the biology science info. You can base your decisions on facts, in lieu of emotion.
________________________________________________________________
JULY 2016: Bone Scan (NEGATIVE)
JUNE 2016: PSA 2.7
APRIL 2016: PSA 3.7

OCTOBER 2015
Age: 59
PSA: 3.0 elevated to 3.5 in (6) months
3T-MRI: (1) lesion identified
Fusion Biopsy Results: Lesion cores benign, additional (12) cores = (1)5%
Pathology Summary: Grade Group 1 (G6:3+3), 2nd pathology verification
Clinical Stage: T1c

Genetic DNA Profile: Above average risk for Aggressive PC (Genetics Test)
Existing Cancer DNA Profile: DNA risk unknown (Oncotype DX test cannot be performed, <1mm)
High Grade Biological Score: 27% aggressive risk (Mi-Prostate Score)
Other Health Conditions: Diabetes Type II (DX 2000), on meds & insulin

PCa Treatment: "Active Surveillance"
Risk: Undetected Cancer Progression
Risk Likelihood: LOW

My Story: https://www.healingwell.com/community/default.aspx?f=35&m=3528051

Hey all, well I just had my 1st meeting with the oncologist.

He had my consult results from John Hopkins ... and

:(

Unfortunately it was upgraded from RLA 3+3=6, 4mm, 30% of tissue

to

to 3+4=7 (Grade Group 2) discontinuously involving 70%, 1 core (10% Gleason pattern 4)

I'm assuming the labs report % of tissue differently, the 1st being 30% of the tissue and the 2nd being 70% not of the tissue? ... hmm

Anyways, obviously not the news I wanted to hear.

When it came to a recommended course of action, he highly recommended surgery.

He said given my PSA was a 15.1, and the new G3+4, that I fell into the *HIGH* risk level of cancer.

Does that make sense? ... I feel like I went from Low, jumped over moderate and to High.

Anyways, he said that the IMRT radiation solutions he offered would not be a good option, and that if I did go down the Radiation path, that then switching to surgery later was not a good option, because radiation damages the areas that need to be cut, so it's not as effective.

He said that IMRT is just like SBRT types of Radiation (Cyberknife) ... only it took a lot longer, and the theory in his view was that because SBRT took longer, it was more effective, because it allowed the cells to heal during sessions. (that part of the discussion felt funny to me)

When I brought up Focal Ablation, he said that since I'm 44yr, why screw around with unproven options, and he highly recommended I stick to what he called the "gold standard", aka, surgery.

When I left the office I called Cyberknife to setup a appointment down here in Austin ... I'll be interested to hear their pitch on IMRT vs. SBRT.

Also, the doctor said that my type of Prostate cancer can be trickier because it's APEX ... the RLA. And if it happens to get out, it's got more mobility to expand. Anyone have cancer in the RLA to help shed light on this comment?

Your doctor was making arguments that have been disproven years ago.
Over 50% of all surgical margins occur in the apex, because it is a difficult area to get totally clean and also there is a greater risk of incontinence.
The arguments about surgery after radiation is a red herring that has been discussed numerous times on the forum.
Review all of your options, especially the side effects associated with them.