Newly diagnosed age 58

I was diagnosed in April. 2 out of 12 cores showed trouble as i call it.. 3+3 3+4 Gleason scores.
Dr. said they showed low risk non aggressive T1c stage.
He said we can schedule appt to have prostrate removed. I said what other options are there?
We can Genomic testing. Ok i said. Received results back last week.
Results were 13 and 14 percent Right Apex and Right Mid
My GPS score was 19
My PSA score is 6.4

Alot of other numbers as well.

I said i want to try Active Surveillance
So that's is where I'm at. I will have my PSA checked every 3 months and the Dr said he will do a MRI in September.
My concern is does this make sense or am I just putting off a surgery that will have to happen.

Thanks all comments will be appreciated.

Thanks for your reply. The Dr. did mention radiation. He made it sound that radiation could damage the tissue making it worse for a radical prostectomy down the road. I would be up for the radiation treament.

Welcome, weak10!

Your instinct to explore active surveillance is spot-on. A number of forum members are/were in AS and know a ton about it, I'm sure they'll chime in soon.

Where are you located, if you don't mind saying? It would help us steer you to a cancer center that has a proper structured AS program, as well as to other specialists if needed.

Please read the sticky thread for the Newly Diagnosed carefully. It has lots of helpful basic information about making the right initial steps on the PCa journey.

Also, please consider sending your slides to Dr. Epstein at Johns Hopkins for a second reading. He reads only prostate biopsies, you can bank on his findings. It's important to make sure you have an accurate assessment of the extent of the PCa and the Gleason scores. It may have a bearing on whether AS is your best option. The cost ($250) is well worth it. Here's the url: pathology.jhu.edu/department/services/secondopinion.cfm

PCa is very slow growing. You have PLENTY of time. No decisions, please, at least until after you retest your PSA in three months.

As far as I can see there's no reason why you shouldn't try AS and see how it goes. You are in a fairly low risk category and there is not much danger of anything bad happening before a properly "active" active surveillance program catches it. You may be able to avoid treatment or at least delay it.

And you can use that extra time to look into your options if the surveillance does tell you it's time to take a more aggressive stance. You really ought to talk to a couple of radiation doctors to see how you like their stories. SBRT radiation has been showing some good follow-up results lately, the treatment requires fewer sessions, and the side effect story is pretty good.

What your urologist (a surgeon, by the way) told you about radiation is absolutely true. Prostate surgery after radiation is a mess. There are doctors who do it but the side effects are often unfortunate. Mostly, if it becomes apparent that some cancer was missed by primary radiation therapy then some other sort of salvage is considered -- sometimes you can do more radiation, or focal therapies like cryotherapy or high-intensity ultrasound, or seeds, or the like. There are salvage options after radiation -- they just aren't usually surgery. Urologists are surgeons and they think that surgery is kinda neat -- that's why they went to the trouble of learning to do it. This means that radiation makes them sad. But there's no particular reason for you to keep your urologist happy if radiation sounds like a good bet to you.

We have similar numbers. I had 4 G6 cores and one was upgraded to 3+4 but less than 5%. My Decipher score was less than positive. I considered AS for a brief time but also wrestled with am I just delaying the inevitable? I then pursed RP and fortunately found a great RO who explained in details the options.

In the end, for me, it was a bit of a gamble. Do I wait and see if there are more cores that the biopsy missed, or that the current cancer progresses? Or do I take action as early as possible to stop the disease hopefully? The second gamble was on the difficulty of the treatment and the possible SEs. In the end, I decided on treatment due to the G7, mainly and chose HDR BT due to the ease of the procedure and the minimal temporary SEs.

I took about six months to get to the treatment phase. I strongly suggest you fully explore all the options, in depth. If you want to hear about my treatment send me a message and I will share my phone number.

An OncotypeDX GPS of 19 is a good score. You seem to be a candidate for AS, from what we know at this point.

The "you can't have surgery if radiation fails" is a talking point used by urologists, and is misleading. There are several types of non-surgical treatments available for radiation recurrent cases.

You are receiving some great advice here. Just keep asking.

You have a lot of time, maybe forever, to make a TX decision. Seems to me , as long as a second opinion mirrors the first, that AS is the best present course to take. Make sure to learn everything you can about ALL TX options to include ALL forms of radiation. Then should you decide that you can't deal with the AS or if the PCa progresses you will be ready to make the big decision.

There are several TX options with great outcomes and very low to non existent SE's.

May you be well.

Roger