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I just got back from my second cross-country visit to Dr. Bahn and, while the good news is that there is no evidence of progression since my last visit, the bad news continues to be that I have a small tumor right up against the prostate wall near my left neurovascular bundle (which is a common pathway out of the gland). This tumor was detected only by the biopsy that he performed last year. This time around, the Dr. chose not to do a repeat biopsy. However, in his review of my visit, he pointed out that I could have a stage T3a malignancy in that the small unseen tumor could have penetrated the prostate wall. Ironically, another biopsy is really the only way to determine if that has, in fact, happened. So, I'm a little surprised that he chose not to do another one. Apparently, he felt that since the larger tumor was not progressing, then it was likely that the smaller tumor (which may, in fact, be a part of the larger one) was not either. (Also taken into consideration was the important fact that I am a Gleason 6 and that I have a consistently low PSA, which averages about 1.4). Of course, I could always choose to get another TRUS biopsy locally, but I've had four to date and I feel that my prostate has been beat up enough, (which is something my urologist agreed with on my last visit just about a year ago). Also, I am someone who believes in the possibility of "needle tracking", and I don't want that needle to help the cancer leave the gland through that neurovascular bundle.
So, my worst case scenario question is this: If the cancer escapes the gland, how many good years can I be expected to live in light of today's varied treatments? I ask this because I am a daily reader of the YANA forum and I am encouraged by the seemingly positive information on the various HT treatments and the like. Frankly, at this point in time, more and more I see myself waiting for evidence that the cancer has penetrated the gland before I actually do anything in the way of treatments. Still, I wonder where the cancer would likely go once it leaves the gland and how long it will take to spread to the point where these treatments will have minimal or no effect. For the record, I am 56.
P.S. I know that some well-meaning people will think that this is a dangerous strategy, but, while I appreciate and respect their opinions, I don't need people to try to talk me into having surgery or RT. The bottom line is that I've just not been able to pull the trigger on either one largely because of my "true" Gleason score as determined by Dr. Bahn's scan/biopsy in February of 2012. So, like Joe Friday says in “Dragnet”, just the facts. That's what I'm looking for, the worst case scenario facts from people who are living with cancer that has escaped the gland. Thank you.
I was Gleason 6 prior to surgery. Doctor was sure it was confined. Surgery proved cancer had escaped into fatty tissue. Gleason raised to 7. PSA .001 post surgery. 6 months later PSA started rising. At .036 I elected to have salvage radiation and hormone therapy. One year later all is well. Still have PSA anxiety. No opinions just the facts. Good Luck
You definitely are not in the worst case scenario. I think the doctor chose not to do another biopsy because it would not necessarily have told him anything new. A biopsy would not normally show if the cancer had escaped the prostate capsule. It usually takes a surgical pathology to determine this.
As far as your question, I am fully aware of the situation you are asking about. I was diagnosed in 2009 at age 54. My Gleason was a 3+4=7 based on the biopsy and the PSA was only 6.2. The surgeon was sure that the cancer was fully contained so we went ahead with the surgery. Unfortunately, he couldn't have been more wrong. There was a large positive margin, both seminal vesicles were about 40% filled with cancer and they found a small amount in the lymph nodes. Since then I have had 40 days of radiation and was on ADT for 2 years.
Its now been 4 years since I was diagnosed and my PSA is still undetectable. I know I have a higher than average chance of recurrence within 10 years based on statistics. However, I feel that the aggressive treatments I chose have given me a higher chance of exceeding the average. Time will tell. I feel fine and look forward to many more productive years.
Everyone's situation is different and it depends on how aggressive your cancer is. If you don't want to have treatment now, I'd definitely monitor your situation through regular PSA tests. The only way know for certain if the cancer has escaped is through surgery. If it has, its still not the end of the world, but you may have to pursue other treatments such as radiation on ADT.
In over 17,000 surgeries of G6 cancers there has been zero incidence of metastasis. G6 cancer rarely metastasize, although they can grow through the wall and affect the rectum and bladder. The mortality rate of untreated G6 cancer is about 5% in 20 years; so that's your worst case scenario.
