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Second opinion from JH came in today..

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Prostate Cancer
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Posted 8/2/2022 5:38 AM (GMT 0)
Hello.

I posted about 4 weeks ago with my diagnosis from a prostate biopsy of Gleason 3+3 prostate cancer. 67 yo with elevated psa levels for 5 years ( at highest point was 9.4) I was shocked at first with diagnosis of course but then my family thought a second opinion was a must & thankfully someone on this forum recommended dr Epstein at Johns Hopkins. The results came back today and the good news is he has confirmed 3+3=6 Gleason score. I am now still torn on what direction to take. I have a prostate mri in September and another psa level check as well. As much as I want to just have it removed to get the cancer out of my body, I am worried about urine incontinance, having to take viagra, so many possible outcomes, the unknown of how it will effect me long term. Does it make more sense to ‘watch and wait’ every 6 months, that is what the drs think. I’m so torn.
Posted 8/2/2022 6:05 AM (GMT 0)
so you won't consider radiation?
Posted 8/2/2022 12:25 PM (GMT 0)
If your docs think you are a good candidate for active surveillance (AS), you have one and possible two decisions in front of you, but fortunately you have time to make them.

Not all men whose cancer profile is suitable for AS are good psychological fits and choose to treat. That's your first decision. If you choose AS, you can treat either at any point if you decide you no longer want AS or if your docs tell you that your cancer profile has changed and you should seek treatment.

The second decision would the type of primary treatment you want, if and when you decide to treat. The choice between surgery and radiation can be a difficult one for the reason that for many men either is a valid choice. For some men the treatment choice is easier, because they eliminate on or the other for various reasons.

Take time and read up on AS, surgery and radiation. Ask questions. We are here for you.

Djin
Posted 8/2/2022 12:29 PM (GMT 0)
With a G6 score, active surveillance (not watch and wait) is an excellent choice. A quality AS program includes the following:

Regular PSA readings (at least every 6 months)
A follow up MRI or other scan to look for hot spots
A follow up biopsy following the scan, focusing on the hot spots
Regular visits with your urologist

Up to half the men with a low level G6 can remain on AS for years. That is the ideal course of action--if you can handle the emotional strain of knowing it's in there. If it changes, if it grows, then the follow up exams and biopsy will find it, and you can deal with it then.

So, make sure you ask your urologist if you're a candidate for Active Surveillance. If they say no, ask why. Then, ask for a referral to a radiation oncologist.
Posted 8/2/2022 2:35 PM (GMT 0)
Maddixone, what is your prostate size? Did you have an MRI? If really big, that high PSA may not result in a high density.

Also, you can get your biopsy genomically analyzed to help stratify (figure out) your risk. No reason not to, other than it costs some money.

Do you have any urinary issues? Low flow, etc.?
Posted 8/2/2022 4:38 PM (GMT 0)
I've been on active surveillance for several years now.

Somehow, on my last biopsy the doc said he found no cancer cells.
I've heard the analogy of the muffin and the raisins but wonder if this has happened to others here?

My PCP used a different facility for my last blood test and my PSA had risen more than usual.
I wonder if some labs get different results than others.

I do have a quite large prostate that may have skewed things, but I don't know.
Posted 8/2/2022 5:33 PM (GMT 0)
Maddixon, Glad you got the second opinion. Unfortunately there’s no easy or best treatment option for every guy in your situation. The best we can do is make an informed decision based on our unique situation. If you are not comfortable with active surveillance as a treatment option there are a number of radiation options that are extremely effective, safe and have very low risks of side effects. With information I gained on this forum I chose to be treated using SBRT and have no regrets and only very minor, temporary side effects. Plenty of low risk guys here have been treated with radiation as a monotherapy with great results.
Posted 8/2/2022 10:41 PM (GMT 0)
Perhaps it would be a good idea to take it slow. In your position, there is no need to take quick action with respect to treatment. Do all you can to ascertain what you're dealing with. If after that it seems that you really have a 3+3 situation, embark on AS and wait to see how well you can handle the uncertainty. It is good to avoid treatment if you can.
Posted 8/3/2022 7:54 AM (GMT 0)
Not many here would do AS with your numbers maddixone. (I’m not saying not any, just not many). Not many docs would recommend it.

I think you know. You’re not striking me as a guy that will ever get comfortable with this. (Which is understandable with 8 cores and a high PSA).

But time will tell (which you have).

Take care madd.
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