Another newbie

Welcome Fred.. Welcome to the club.. Fortunately you have the best pathology report available to this dreaded disease.. Know that you have pretty much all the time in the world to make decisions.

I chose Da Vinci robotic RP.. I wanted to rid my body and mind of this cancer.. I'm continent 4mo post RP.. Still ED and was told it can take up to two yrs for those nerves to heal.. Wife is on board.. So all is good.. My PSA is undetectable for last 6 mos. That's a win in my book.. Doc said my treatment would be a "cure".. Without the long term side effects of radiation..

Everyone is different.. As are treatments and side effects.. You need to do your own research and decide without influence what is best for you.. I don't sway decisions but some may.. Not sure why except maybe to justify their own treatment choice..

In the end you need to discuss with family .. When you feel good about your decision it will be the right one.. Only you will know.

God speed..

Sorry, I probably didn't explain the diagnosis path well (and I will eventually punch this all into my signature line):

- baseline psa in 2011: 0.89
- July 2014: abnormal dre, single nodule felt on left side
- July 2014: psa of 1.2
- August 2015: psa of 1.23 (different lab)
- August 2014: mri of prostate and surrounding areas (I think it was a 3T machine, but not 100%) indicates all clear except one suspicious lesion 5mm x 3mm x 1mm on left side of prostate
- September 2014: Mri-image fused with ultrasound guided biopsy, 12 cores plus 3 extra on the suspicious lesion
- last week: results back with 6 of 12 standard cores positive (5 on left side, 1 at the right base) plus 3 of 3 on the suspicious lesion positive. All Gleason 3+3. No mention on PNI, one way or the other.

Sorry to hear about your Dx, especially at such a young age.

I had a very similar biopsy report to yours - lots of positive GS 6 cores, but none that were mostly cancerous. You are also a very good candidate for active surveillance. There is a lot for you to know, several doctors you ought to talk to, and lots of self-assessment to do before making your decision. Fortunately, GS6 is usually very slow, so you have plenty of time.

A second opinion on the biopsy slides from Bostwick or Epstein is always a good idea.

I don't understand what it is that you don't trust. Some kinds of MRIs are very good at finding larger, higher grade lesions, but not so good at finding smaller, lower grade ones. That's why they take random samples in addition to the ones in the suspicious area. That's also why you had so many positive cores - if you had just had a normal TRUS-GUIDED biopsy, it may have found far fewer.

It's my understanding that MRI's usually don't detect small cancers Gleason 6 unless they're at least 5mm. This "limitation" can be useful for a man who has reason(s) to think he might have PC, but does not want his biopsy to be a fishing expedition. Random biopsies don't discriminate and often find clinically insignificant cancers. Taking 12 random samples in addition to the suspicious lesion found by the MRI defeats the purpose, it seems to me. The purpose being to identify more serious cancers that present an immediate danger.

It could be that many urologists are not willing to rely on MRI completely to identify all serious cancers so they believe they have an obligation to extend the biopsy to other random areas as a precaution. Unfortunately, in some cases, the very thing that is hoped to be avoided, i.e., the finding of indolent cancer, is presented to the patient and forces upon them very difficult decisions. In your case, however, the MRI did identify a suspicious lesion and it was confirmed by biopsy, so you still would have had a confirmed diagnosis of cancer even if he had not done the random biopsy.

Fortunately your cancer is Gleason 6. Have this confirmed by one of the experts Tall Allen suggested and you will see from your reading that you have many treatment options and every reason to be hopeful.

I had my open RP in 2008, both nerve bundles spared, had salvage radiation in early 2011. As of my last psa in April it was 0.01. full continence and natural erections. Mine erections started to return almost immediately but needed Cialis till they all healed. Get some opinions before you decide. A great surgeon can do wonders. I know. Best of luck to you.

Young means u can bounce back.

I would definitely dig into the research. See the best in your area screw the drs feelings go with the best.

You are in no rush but doing nothing (AS) is not a path I would take. Not like it is going to heal itself.

I had a biopsy in early 2012 that showed 2/12 sites of G6, at 5% and 20%. I was 56 at the time. After MUCH deliberation, we (spouse and I) decided to pursue Active Surveillance, and I continued with AS for 18 months. There seems to be a growing consensus that G6 could be active and progress, or it could be indolent and never turn into anything. There is just no good way to determine what will happen on case by case basis.

There are new genetic testing options, Prolaris is one, that purport to define future progression. There seems to be growing evidence around efficacy, but this is still new.

I had a multiparametric MRI (3T) as part of my evaluation process last spring, but my tumor was spread out and not localized, and MRI didn't show anything. I've since been advised that this is not unusual with G6 and G7 .. MRI is much better at visualizing G8+.

If you choose AS, I suggest it would be best to work with an institution (hospital or Dr) that has a real protocol for you to follow while on AS. I got quarterly PSA, exams with DRE every 6 mos, and a repeat biopsy after 18 mos. Find a program that manages your status with you .. vs. trying to do it yourself. In my case the repeat biopsy indicated progression with 5/12 sites now at G7 (3+4), which I independently confirmed.

We then decided that progression would most likely continue, and at my current age of 58 and health I would tolerate surgery well for recovery, and I completed Da Vinci RALP last month.

AS worked as it should in my case .. monitor, and understand progression so that you can make good choices. I would still be on AS, if biopsy would have indicated continuing G6. I had close to 2 years of NO impact or side effects from treatment while on AS.

Follow up comments for surgery, investigate very carefully for surgeons. I chose a surgeon who I determined was a robotic expert (does 120 - 150/yr with 7 year history) and he had a good day. I am one of the very fortunate 10-20%, that is dry from catheter removal .. although I'm only 4 weeks in at this point. Mine was nerve sparing, but I don't yet know about ED .. too soon. Surgery doesn't have to be a risky choice, you can improve your outcome if you choose surgeon carefully. No question, this is the hard part of the process.

Good luck with your decisions, and please keep us posted.