Recently diagnosed with prostate cancer .... what now?

Hi Joe and welcome to the forum. You may be a candidate for doing nothing...well more specifically, Active Surveillance. I’ll let those with more AS knowledge chime in. You’re already off to a good start by seeking opinions from specialists in their areas of expertise.

I’ve got to get going to work. Others will be along to give you more thorough comments. Weekends tend to slow here but more guys will be coming along.

Stick with us and good luck on your path!

Welcome to HW, sorry you need to be here.

You're right about seeing an RO. RT would be a good choice. SBRT, Brachy seeds or even plain old IMRT would work and could be curative. Surgery is a possibility too, but in general the older you get the less you want surgery. AS might be a possibility, but you should find a good AS program and get an evaluation if you're thinking of that route. With the small amount of G4 might knock you out of that plan.

It can be a tough call.

Let us know what the RO says,
Andrew

I'd like to recommend that you get a second opinion on your biopsy slides, which is both simple and inexpensive to do. Dr Epstein's lab at Johns Hopkins will do this for you (there's info on how to do this in the newly diagnosed sticky) and they are considered top of the class in reading PCa biopsy slides.

The reason why I encourage you to do this is that you only have one G7 core and that's the possible hang-up to doing Active Surveillance. If that were to be downgraded to a G6 that would alter your risk category. Is that likely to happen? No, it's not, but why not check it out as part of your due diligence? (BTW, one of your G6 cores could also get upgraded to G7 on a second opinion. That would also be helpful for making a treatment decision.)

Joe Kelly said...

...Trying to decide on a course of treatment with these parameters. Meeting with a Radiologist Oncologist to get another opinion soon. Any comments if this was you? Thanks for your input.

Hello Joe,

Well, if I were you, I would be really happy with those results compared to all the "less good" results you could have obtained. Seriously, the initial diagnosis crushes your spirit which takes a while to sort out mentally but you will find out you have a lot of "good" options for possibly a modest case of PCa based on the limited data you presented.

I agree with the second opinion from Johns Hopkins - Dr. Epstein being the first item of business: (http://pathology.jhu.edu/department/services/secondopinion.cfm). Have your urologist have whoever did the pathology send the slides and follow the instructions in the link. With such small percentages you listed, it is probably going to be a pretty subjective determination so you want to get that hammered down before considering any options.

Depending on the biopsy 2nd opinion, a high powered MRI should probably be done to see if anything can be observed. A standard 12 core biopsy can miss things as well as find things that are out of whack with the larger prostate condition. The MRI can be used to guide a second biopsy at some point if necessary.

Visiting the RO is probably a good idea but you may be getting ahead of yourself since there are other items you should probably address first as noted above. In fact, you may get better 2nd opinion information from another urologist or place noted for prostate cancer treatment like Hopkins, Mayo, etc. When and if treatment is required, you will want to visit RO's that offer all the treatments noted above which may be multiple RO's depending what is available locally for you.

If it helps any, my Dad is 91 and started watching his PSA go up around the same age as you, 74-75. 15 years ago, he had the low dose brachy seeding and had Lupron shots a couple of years ago since his PSA finally started to creep up again.

Good luck with your journey.

Joe, I have been on active surveillance for ten years, and am now slightly older than you.

My trigger for treatment would be two cores with more than 10 percent Gleason 4, or one core above 20 percent. You are below that threshold.

So, I would agree with all the above advice for getting a second opinion on your biopsy slides.
But, would also caution you not to rush into any treatment. Certainly, several types of radiation are attractive, but all treatments have some side effects.

Take your time. Learn, consult, and have more testing. As far as you know now, your cancer is not a short term danger to you.

Geta MRI guided biopsy. More complete and accurate. A random biopsy may have missed some spots. Get a second read. I was 75 and rushed into surgery. Excellent health. Lots of SEs, and regrets, to this day. +rising PSA anyway. Take your time and make surgery your last choice.

Thanks so much for the informative input. Seems most are encouraging a second opinion on the pathology (slides). Are there any threads on protocol to get that started?

Hi Joe and welcome. You've already received great advice and learned how to get your second opinion on the biopsy slides. Depending on what Dr. Epstein says, AS is probably still a reasonable option for you. After you get his opinion, if it's no worse that what you already have, visiting a center/doctor who has experience with AS patients is probably a good idea. Note that AS is not "doing nothing" or even "watching". The key is "active" and there is a protocol that needs to be followed to make sure the cancer doesn't get away.

If you don't do AS, the LDR Brachy, SBRT and HDR Brachy all seem like good options that should cure you.

Good luck.

Jim

Congratulations on your favorable-risk diagnosis.

Of course the "congratulations" are tongue-in-cheek, but PC is a ubiquitous disease, and the percentage likelihood of having PC is roughly equal to a man's age...a 70-year old is more than 70% likely to have PC, although the vast majority of cases are benign and never need treating (actually, most men never know they have it)...having PC in your family is therefore no surprise, in fact it largely means that you are more prone to testing, which will inevitably lead to a diagnosis. So, the "congratulations" is on having a case that needs no immediate action, only monitoring.

All I can say for you going forward is "choose wisely."