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Re: Active Surveillance or Radical Prostatectomy?

Sounds like low grade cancer. The radical will pretty well get rid of the cancer, but it 'may' impact your sex life. Tough trade off. Like the others say, it's early for you it would seem.

Re: Active Surveillance or Radical Prostatectomy?

I replied previously, but it appears not to have gone through. I'll Try again.

I'm a physician survivor, diagnosed with a Gleason 9 in 2009. In the course of 50+ hours of medical library research I learned a great deal about prostate cancer. A Gleason 9 was highly motivating.

A one core Gleason 6 generally qualifies for wait and watch. About 70% of these tumors will just sit there for the rest of your life and do nothing. About 30% will eventually go bad, which is why you need to keep an eye on them. Why treat something which MIGHT need treatment later?

And it seems that your urologist failed to mention radiation (they usually do). For low risk tumors surgery has about as about the same cure rate as radiation, though the adverse effects are very different. If you do decide to treat it, I recommend that you consult a radiation oncologist, preferably at a university hospital, before making any decision.

Brooke Jennings, MD

Re: Active Surveillance or Radical Prostatectomy?

P.S. See my Survivor Story for my experience with surgeons. I had a very bad experience at UCLA (not detailed in my Story). Do not trust them without talking with a rad onc first.

Re: Active Surveillance or Radical Prostatectomy?

Active Surveillance.

What you have should be called pre-cancerous. A lot of research is going on with the best way to manage active surveillance, like how to do away with the biopsies, genomic studies and when to get treatment. The prostate cancer center I was treated at (one of the top ones in the world) will even put some low intermediate cases on AS.

Re: Active Surveillance or Radical Prostatectomy?

Frank,

Thank you for your recent reply but my condition has now changed.

Spoke to UCLA this morning and their pathologist looked at the slides from USC ( 1 core positive <10% gleason 6) and have upgraded to 4 cores positive. Here is the breakdown:

Core 1 - <10% gleason 3+3

Core 2 - < 5% gleason 3+3

Core 3 - < 15% gleason 3+3

Core 4 - < 25% gleason 3+3

Very concerned about these results. UCLA said I was still a candidate for Active Surveillance but this doesn't seem right to me.

--------------------------------------------------------------------------------

PSA

Jan 2013 - 2.76

Mar 2014 - 3.12

May 2014 - 3.4

Jul 2014 - 3.5

1/30/2015- 3.46

Color Doppler Biopsy 2/12/15 - 12 cores. 1 core Gleason 3+3 <10

Re: Active Surveillance or Radical Prostatectomy?

You've got low PSA and a Gleason 6. You are still a prime candidate for active Surveillance. The longer you can wait the better the treatment will be when/if you need it.

The fact that one pathologist is calling it Gleason 6 and another is saying the cells are not quite cancer yet also tells you that so far the cancer is not getting aggressive and you are at the low end of Gleason 6.

Re: Active Surveillance or Radical Prostatectomy?

Frank,

Thanks for your reassuring response. I would prefer to stay in the active surveillance protocol and hopefully still can. I spoke to my urologist tonight and he sort of echoed what you are saying. That it is still gleason 6 and that I'm still a candidate for AS. I have a multiplanar MRI Artemis with targeted biopsy scheduled in June to confirm biopsy from USC. Wanted one sooner but do wants my previous biopsy to heal.

Re: Active Surveillance or Radical Prostatectomy?

If it's not too much trouble could you share the name of the surgeon at UCLA?

Re: Active Surveillance or Radical Prostatectomy?

Robert,

Our circumstances and experiences are somewhat alike. So, if you want to read about 7 years on AS that started at age 51, including my experience with 4 cores, CDU and MRI scans, etc., then look up Alan Murphy under Survivor Stories.

Best wishes,
Alan M in the USA

Re: Active Surveillance or Radical Prostatectomy?

Alan,

I read your story and it inspires me to continue thinking that AS is a good option for me. I made an appointment with Dr. Leonard Marks at UCLA on 3/3/15 and he assured me that AS was a good option for me too. I also gave him the biopsy slides for a 2nd opinion. The UCLA path's opinion is that there are 4 cores from 5-25%. How does that happen when USC said only 1? Anyway Dr. Marks called me to talk to me about the 2nd opinion on the pathology and still said I am a good candidate for AS. Talking to him made me feel better about AS.

I noticed you had a CDU which I had at USC and the uro didn't find anything to be concerned about just like you. Wondering about the MRI with endorectal coil though? Not sure what this is. UCLA is going to do a multiplanar MRI on me in June. Is this the same thing?

Thanks

Re: Active Surveillance or Radical Prostatectomy?

Hi Robert,

I am glad that my story was of some use to you. Also, I am writing to answer your questions. First of all, you asked "How does that (meaning a four core finding) happen when USC said only one?" I am not sure if you meant the question to be rhetorical; so, I will go ahead and answer it this way: To a certain degree, the grading of your cancer cells is subjective, in that the opinion of one pathologist may differ from another (which is why it is always good to have your slides checked by another lab). After all, one pathologist could determine that you are a Gleason 3+3, and another could find that you are a 3+4 or worse. In determining whether or not your circumstances make you a good candidate for AS, a Gleason 3+4 finding would be a game changer for someone your age. That being said, I agree with Frank when he said: “The fact that one pathologist is calling it Gleason 6 and another is saying the cells are not quite cancer yet also tells you that so far the cancer is not getting aggressive and you are at the low end of Gleason 6.” Therefore, I further agree with Frank, and Dr. Marks, in believing that AS is a good option for you.

As far as your other question is concerned, unfortunately I do not have an answer. I googled ‘multiplanar MRI vs. MRI with endorectal coil’ for information, and I came away with no easy to understand answer. So, whether or not they are the same thing is an excellent question to ask your doctor when you go in for the scan, and I (along with, I am sure, others on this forum) would appreciate knowing what he has to say.

Lastly, when you said that my CDU doctor did not find anything to be concerned about, that is only partially true. The scan did detect a tumor, and the targeted biopsy revealed it to be a Gleason 6. So, you are right when you say that the Dr. wasn't concerned…about that. However, I asked him to also biopsy the common pathways out of the gland, and what he found disturbed him; enough for him to qualify his support for my AS decision. In fact, I have been back twice and each time he has brought up the risk involved in that finding.

I wish you all the best on your journey and if, anywhere along the line, you want to talk, then go back to my story to find my e-mail address.

Be well,
Alan M in the USA

Re: Active Surveillance or Radical Prostatectomy?

Robert,

I agree with all of Alan M's comments. I believe a multiplanar MRI is simply 3 views, sagital, coronal, and oblique. I would suggest you try to get a 3T multi parametric MRI if one is near you. This is probably the best imaging of the prostate that is available.

I would suspect that the mpMRI will not find the low gleason, low volume tumors that your biopsy has identified. That is normal and should not be of concern. The mpMRI can find more aggressive tumors that the CDU may have missed. If your mpMRI is unremarkable, you should feel confident that you can safely go on active surveillance.

Fred

Re: Active Surveillance or Radical Prostatectomy?

Fred,
I am having an MP MRI Artemis at UCLA under the direction of Dr. Leonard Marks. My thought was that the MP MRI would find those spots that were identified in my biopsy using CDU and they would be targeted again.

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