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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.
