High PSA + Gleason 6

High PSA 8.51 + Gleason 6, AS, UTSW, appointment on 3/01, any thoughts? Thank you very much...

Age 69, T1c, Symptoms some increased frequency to urinate. PSA 8.51 2/26/2019
DX 10/11, 54 gm, 32 bx, 2, 2%, G6, PSA 5.49, AS. DRE OK
DX 06/13, ? gm, 12 bx, 2, 2%, G6, PSA 6.31, AS,
MP MRI 6/17, 14 mm Lesion, PIRADS 4, EPE 3, 78 cc, abutting capsule mildly irregular margins.
Fusion BX, 12/17 8 core, no PC, 2 HGPIN, 1 ASAP,

09/11 5.49 19.67 %
10/12 5.44 14.71 %
12/13 6.31
06/14 6.01 13.64%
03/16 6.88
02/17 6.80
08/18 7.67
02/19 8.51

Post Edited (suttersmill) : 2/27/2019 5:13:07 PM (GMT-7)

NOTE: your dates are a little difficult to decipher because they appear to be out of sequence and don't include the year. Is this (line copied/pasted from below) your most recent biopsy result? DX 10/11, 54 gm, 32 bx, 2, 2%, G6, PSA 5.49, AS. DRE OK. I interpret this to mean that you had a biopsy in October 2018 (appears to be your most recent of 2), size was 54 gm, 32 samples drawn, 2 samples positive, 2% cancer in the positive sample, 3+3, PSA just prior to biopsy was 5.49 ng/mL, currently on AS, DRE was negative...is this right?


PSA density is 0.15 which pretty much puts you at the border line between LOW RISK and VERY LOW RISK.

PSAD has some marginal value and is never used as the sole measurement, but in your case it helps reveal that your elevated PSA is largely the result of your enlarged prostate...keeping in mind that prostates (and therefore PSAs) continue to grow (increase) throughout life. Your PSA is still above the age-adjusted PSA upper normal threshold.

PSAD = (8.5 ng/mL) / (54 cc) = 0.15 PSA/volume (PSAD)


I agree with what MG0351 meant to say...which is that you (and everyone having a prostate biopsy) should always have their slides read (or re-read; 2nd opinion of biopsy) by a prostate cancer pathology expert...someone like Dr Jon Epstein...because of the high rates of correction/adjustment (both up and down) when read by the "community" pathologist. Important to have the very best input for this critical metric.

Post Edited (Blackjack) : 2/28/2019 10:08:37 AM (GMT-7)

Somebody said...
...you [are]at the border line between LOW RISK and VERY LOW RISK.

That's a good place to be...especially if you want to make decisions based on mostly data and less on emotion.

suttersmill, I would recommend this article in MedPage Today by fellow AS-follower Howard Wolinsky about life on AS. PCI has just started a live virtual support group for men on AS (the link is embedded in the article) which you may be interested in joining...most other prostate cancer support groups are (in my direct experience) focused at the other end of the spectrum.

Great quote by Howard in the article, reflecting on PC overtreatment recently past:

Howard Wolinsky said...
You have cancer? Let's cure it. It was an all-American response to cancer.

Personally I would be a bit worried about AS. Certainly get the 2nd opinion. Really consider SBRT as it can do a good job on the "irregular" pattern that RP has trouble with.

Roger

three 5's and a jack said...
Personally I would be a bit worried about AS. Certainly get the 2nd opinion. Really consider SBRT as it can do a good job on the "irregular" pattern that RP has trouble with.

Roger

From what I can see, a fusion biopsy was done on the "irregular" lesion and no cancer was found there.