Anyone on active surveillance with Gleason 7?

If that were me, I would take their advice and do AS as long as possible. Take the time to make all the necessary diet, exercise, and lifestyle changes. You might want to look at Dr. Myers work with AS patients on low dose Avodart who show no signs of PCa after 1 year.

Just keep on top of it. Good luck!

Hi LeftyW,

I know a couple of guys with small amounts of GS3+4 who are on AS. In both cases, they are being monitored with sophisticated imaging (CDUS and mpMRI). Since you seem to have access to mpMRI at MD Anderson, it seems to me to be a safe way to proceed.

I would, however, get a second opinion on your biopsy slides from Epstein or Bostwick. If they upgrade, you wouldn't want to stay on AS. If they confirm or downgrade, it will add to your assurance.

Another route to consider, if you haven't, is a clinical trial for focal therapy. You seem to be a perfect candidate, with your "favorable intermediate risk," single core involvement and low % cancer. The upside is that treating the "index lesion" may be curative or keep it in check for a very long time, without incurring the side effects of whole gland treatment. The downside is that it effectively keeps you on Active Surveillance anyway, but perhaps with fewer biopsies. I like some of the new non-thermal ablation therapies, especially if the index lesion is anywhere near critical structures.

- Allen

Because I am contrary I went looking for a study I had seen that warns that a single positive core on a standard sextant biopsy is not always that good an indication of the grade of the cancer for men considering AS. I found it and I am glad to be able to report that it doesn't seem to apply here for several reasons.

The study looks at men who would have qualified for AS based, among other factors, on having only one positive core in their biopsy, but who decided to go ahead and have a RP. Among such men there were a surprisingly large number who turned out to have significant disease that the biopsy did not indicate.

The primary reason it probably doesn't apply to you, Lefty, that they only observed the high rate of missed grading in men with prostates larger than 50 grams or PSA scores over 10. I don't remember you mentioning the size of your prostate but your PSA wasn't in their danger zone.

The other reason it doesn't apply is that the study was retrospective and it was made in Brazil where the technology is probably somewhat behind the times. MDA has a much more advanced AS program and the Brazillian experience probably doesn't apply.

For the curious: Can single positive core prostate cancer at biopsy be considered a low-risk disease after radical prostatectomy? (Int Braz J Urol. 2013 Nov-Dec;)

PDA, the other difference is that Lefty has had a 3T T2 MRI, while the Brazilians only had a 10 core TRUS biopsy without benefit of advanced imaging.

Lefty, in the last 2 months, 2 of the men in my PC Support Group were downgraded by a reading from Epstein. Both of them had their slides read originally at UCLA, a major tertiary care facility. For one man, who was downgraded from several 3+4s to only 3+3s, it meant staying on active surveillance. For the other man, who was downgraded from a 3+5 to a 3+4, it meant changing his treatment plan from combo therapy (IMRT with a HDR brachy boost) to a far simpler SBRT plan. Of course, it could just as easily have gone the other way.

- Allen

Lefty, with SBRT there has never been shown to be any benefit to adding hormone therapy to it (that is true for any form of hypofractionated radiation). Hormone therapy adds side effects without adding to the cure rate. Check the link in my signature - Dr. Katz did it both ways and then completely stopped adding hormone therapy, with no loss in results.

Ancient Mariner,

The AlDaTross that throttles you
And stops your getting harder
Will be replaced by a sweeter bird
Whom you will thrill with ardor

- Wedding Guest