Hi TBugg, and welcome to the HW/PC site. So glad you have joined, and hopefully you can also share some of your 8-years of experience on AS with others while you are here...we have a lot of men coming here every day who are "hesitant" (scared) to ignore their emotions, and so they jump into treatment even though their case is similar to yours. If and when you ever do go into treatment, you will definitely benefit for the 8+ years of advancements and improvements which have taken place over the past decade! Congratulation for being where you are...!
Several people here have already voiced concern over your rising PSA...this is decade-or-older thinking (and still readily accessible to Googlers). PSA kinetics (changes; increases)
used to be a trigger for intervention in the early days of AS. No longer. The old thought was based on the simplistic observation that most patients with advanced PC had an elevated PSA, and therefore, a stable PSA likely implied stable disease and vice versa. Until the multiparametric MRI became available, men on AS with PSA doubling time <3 years were typically recommended for treatment. Frankly, it's been the high prevalence of prostatatis (inflammation which causes transient PSA) which severely limits the reliability of PSA kinetics as an AS trigger. We are smarter today than in the early days.
As you probably understand (after all, you've got an "advanced" 8-year education in AS & PC!), the question of true "progression" is not clear. Higher grade cells were found this time using "targeting" tools (so largely unsurprising), but you already had some up-and-down experiences which were likely the result of the pure "randomness" of a random, blind biopsy procedure. Regardless (or because of this), "progression" from 3+3 to 3+4 is not necessarily a trigger either...not in the longest running AS program in North America. You are undoubtedly familiar with Klotz's work...right?
HERE is a link to his recent article
"Defining 'progression' and triggers for curative intervention during active surveillance."[You've probably already done this, but just as a point-of-reference, your PSADT (doubling time) is 5.5 years...which is a point of discussion in the article. Do you know your PSA density?]
You also asked about
genomic testing. I
do think that one of these main tests could help you make a data-driven decision by helping identify the nature of your tumor aggression/indolence since you are in a gray-zone.
If I were in your shoes, this is what I would do next. Best wishes...
Norm
Post Edited (NKinney) : 2/9/2018 3:57:39 PM (GMT-7)