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Posted 3/9/2015 4:29 PM (GMT -5)
My Mri came back, my doctor wanted a biopsys. I have a gleason score of 3+3 stage tc-1 positive scores 1,negitive 11. the cancer is only in the prostate. He said the best thing is to have my prostate removed. Does anyone have some advice on this
Posted 3/9/2015 4:40 PM (GMT -5)
Joey, welcome to the club. With 1 of 12 positive cores at at G3+3, you're a great candidate for AS, even by the most conservative criteria.
Posted 3/9/2015 4:46 PM (GMT -5)
Sorry to hear about your diagnosis. But...you are very, very low risk with that diagnosis.

Pretty much any treatment--surgery or different kinds of radiation would cure you. But with your extreme low level of cancer, I would very seriously consider Active Surveillance in which they closely monitor your cancer. If it there's a change, then you could always treat it then. And if it stays as low level as this, you may not have to do anything and you won't have the SEs of treatment.

Check out the sticky at the top of the page that has good info for newly diagnosed folks. Good luck to you!
Posted 3/9/2015 4:48 PM (GMT -5)
My advice - get a second opinion. Talk to a radiation oncologist.

With those numbers you have a whole range of options:
AS - active surveillance (no treatment now, monitor and treat when really needed).
Surgery - might be a bit extreme in your case. Lots of tissue removed for not much cancer.
Beam Radiation - zap that sucker. Less physical trauma than surgery and likely to be as effective
Brachy - radiation seed implant. Simple procedure, very effective for cases like yours

The thing that is going to drive you nuts is that all treatment modes will likely work just fine. Do some research into your options and don't rush into anything - you've got time to make an informed decision.

Andrew
Posted 3/9/2015 5:08 PM (GMT -5)
That's a surprising recommendation given the small amount of low grade cancer. With what you've mentioned, you would seem to be a candidate for active surveillance, if you chose that path.

Maybe some additional information would be helpful. Did you have a positive DRE? What is your psa? How old are you? What is your family history? Did they see a bulging at the margins on the MRI?

Definitely, get more professional opinions.
Posted 3/9/2015 6:03 PM (GMT -5)
Joey, welcome to the forum. You've gotten some good points of view here. I would add three comments
1. Have your slides sent to a Prostate cell expert for a second opinion. GLeason grading is very subjective and it would help to get a second set of eyes, either Dr Epstein at JohnsHopkins, or David Bostwick, at Bostwick Labs. You want to be as sure as possible that your Cancer is really a GLeason 6
2. Consider your emotional makeup. Clinically you are def a great candidate based on the data you have. But emotionally not everyone is cut out for a structured monitoring program, which is in my opinion, the only way you should do AS.
3. Be aware that in 20-40% of cases (depending on whom you talk to), GLeason score gets upstaged after surgery, because the pathologist has had an opportunity to look at the entire Prostate

With all this said, it looks from the biopsy results, like the odds are high that you don't have much to worry about long term, and any of the three options you have, will make the issue of PC a thing of the past for you in short order.
Posted 3/9/2015 6:20 PM (GMT -5)
My advice is:
1. Get a second opinion on your biopsy slides from Bostwick or Epstein
2. Find a new urologist - anyone who tells you that your best option is to cut out your prostate when all you had was one GS6 core has agendas of his own.
3. Find a good AS program.
4. Take your time to learn about your other options - surgery, SBRT, LDR brachy (seeds), HDR brachy (seeds) and focal ablation.
Posted 3/9/2015 6:44 PM (GMT -5)
I agree with number 2. Not that surgerybis a bad option. But that it's not necessarily the best one . Maybe , maybe not, depending on the individual.

Seriously dumb advice for a urologist to give, in your situation.
Posted 3/9/2015 6:49 PM (GMT -5)
I agree with Allen's four points, even in the exact same order.

Time to slow things down, real slow and think through this.

The 2nd opinion will make it easier to move forward, especially if it confers with the first opinion, then you will pretty well know for sure what you are dealing with.

David
Posted 3/9/2015 7:41 PM (GMT -5)
My doctor the head urologist at GW in DC he is too a prostate cancer patient. I have a ostomy so the 3 of the 5 options are not possible,my anus is gone. His theory is I am 57 prostate cancer runs all through my family. If I get this surgery then its done and I move on. I'm seeing that there are adverse affects to this surgery. May I thank all of you for your advise.
Posted 3/10/2015 5:22 AM (GMT -5)
Joey, let me suggest you create a signature in your profile that outlines your history, look at some of the others, so we can get a grip on the whole picture. Having an existing ostomy and extensive family history changes things for you. I'd still agree with the suggestion that you get a second opinion on your slides.
Posted 3/10/2015 6:32 AM (GMT -5)
Joey, Sorry you have to be here, but you've found a great bunch of guys. You have time to think this through in my opinion. As has been said already, it doesn't hurt to get another opinion from a radiation oncologist. I don't know your whole story, but it does seem your uro wants to jump to surgery pretty quickley. Maybe he has his reasons. Take a little time to investigate options yourself and feel comfortable with your decision. Good luck and let us know how we can help.

Mike
Posted 3/11/2015 7:43 AM (GMT -5)
I meet with a group at the end of the month at GW the whole team along with the surgeon will talk with me. My doctor wants me to do this so i can explore all my option as i said i really only have surgury or radaition due to my ostomy. I will complete my profile today. This forum is God sent.
Posted 3/11/2015 9:08 AM (GMT -5)
Glad to hear you're going to meet with the whole team. I was able to do that and it really helped to get a clear picture of my options and risks.

Andrew
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