Good Prolaris Score, Seeking Advice

Earl

Hopefully, others who comprehend Prolaris better than I do can respond.

In my case I had fewer cores with indications, but one was a GL 7.

Also had Prolaris with a similar finding to yours. In the end I wasn't sure how much credence to give to the Prolaris and I elected to have treatment.

When I had a favorable result on my OncotypeDX test, my oncologist was not about to lessen my future testing. He said that such tests were useful in suggesting intervention if the results were pessimistic, but favorable results would not change the surveillance.

You would not be eligible for the AS program at Johns Hopkins due to your cancer being bilateral. That criterion was added by Dr. Epstein in 2014, who determined a higher risk if both sides were involved.

Just another opinion and facet of information for you to process. But, with only Gleason 6 found, you have very favorable prospects for outliving PCa.

Thank you all very much for responding.

Works Out and Sr Sailor;

Actually, the doctors at both NYU and MSKCC do seem to give a fair amount of credence to the Prolaris scores. Certainly, it is one data point among a number of parameters, but yes, my impression was that this is relatively new technology and it is increasingly being considered in the overall decision-making process for an increasing number of patients.

ASAdvocate and Tall Allen;

Yes, I have discussed active surveillance as well as all radical PCa therapies. And Allen, you raise a number of very interesting questions regarding one's psychological makeup and the "right" therapy for each individual. And I think when I consider my present overall situation, I'm leaning towards AS.

I guess my biggest question(s) at this point are what/how would/could change my "low risk" diagnosis? How accurate is the mpMRI targeted biopsy? Can G6's change into something more aggressive? And what is typically involved with AS?

Any additional information and/or help would be most appreciated.

Thanks again, in advance.

Earl96, you asked a couple questions at the end of your last post which I can address.   What could change your status from “low risk” is the future growth of new cancer cells with Gleason pattern 5, or a lot of Gleason pattern 4 cells.   That could happen, but you already have consistently verified “low risk” PC and that definitely tends to be slow moving…so the “active” part of AS is meant to keep monitoring your case—more closely at first, and probably with less frequency as time successfully goes by—so that you would move into successful treatment if and when such changes occur.   3+3 doesn’t metastasize or grow into something more aggressive, but as I said you might some day in the future grow a more aggressive version of PC.   Of course, you might also get hit by a Mack Truck tomorrow, too, if you get what I mean…   mpMRIs are accurate at identifying aggressive PC, and they are not sensitive to non-aggressive PC patterns.   mpMRIs are now commonly used in conjunction with AS programs for ongoing monitoring, especially as they are becoming more widely available.   Lastly, you asked:  What’s typically involved with AS?….hmmm, where to start…?   There has been some good threads about AS written here at HW.   Here’s something at JackH recently posted which I’ll simply copy/paste (that thread topic was a little different, but good info nonetheless):   ACTIVE SURVEILLANCE FUNDAMENTAL #1:   AS is only for well-selected men diagnosed with PC.   This is why “Step #1” for newly diagnosed men is to understand your risk category (see “Newly diagnosed…” thread). AS is not for men with high risk cases. Intermediate risk…maybe. This category has been split into two groups: 4+3 unfavorable intermediate risk cases, and 3+4 favorable intermediate risk cases, with other case characteristics also weighing-in. A number of AS programs have been including favorable intermediate risk cases. Low risk cases are the obvious candidates, and Johns Hopkins has had strict guidelines (although they have relaxed their AS criteria a couple years ago). AS FUNDAMENTAL #2: Despite the limitation of being "well-selected" in #1, above,   a huge percentage of newly diagnosed men are suitable for Active Surveillance as a first-line management strategy.   Some AS programs are more restrictive than others, and there is currently no universally accepted formal protocol for AS entry, monitoring, or exit. Clinicians individually tailor a program of care to each individual case but based on common foundations. Using contemporary data of newly diagnosed cases in the US, somewhere between 40% and 67% of new PC cases are likely eligible for Active Surveillance, based on more and less restrictive program criteria. AS FUNDAMENTAL #3:   Some men who originally qualify for AS end up moving onward at a later date to a deferred treatment if signs indicate degradation in case characteristics.   These men with deferred treatment are also “AS success stories!” (Please study and understand this PC Infolink article if you are confused by that statement: prostatecancerinfolink.net/2010/10/19/understanding-your-clinicians-mindset-about -active-surveillance/) The program worked for them, too, by showing them if and when treatment was appropriate. Complementary research has demonstrated that men on AS who move to deferred treatments have essentially the same outcome as those who sought immediate treatment.   AS FUNDAMENTAL #4:   Ongoing monitoring is important to the continued success of AS programs and men enrolled in AS programs.   Annual PSA blood tests are the norm. In the past, on-going AS cases have follow-up biopsies (after the 2nd, confirmatory biopsy) on an every 18-24 month basis (typically), depending on the program. In the current decade, mp-MRIs have been found to be superior to the old standard ultrasonic-guided needle biopsy, and most AS programs now at least intersperse mp-MRIs with needle biopsies.