It means go home to you wife and children...there will be no hanging to night...or put another way..."sufficient unto the day is the evil thereof"...no worries...others will be along shortly and give less esoteric advice...but no less thought provoking...

What was the MRI PIRADS score?
PSA not unusual for 80 cc prostate volume.
Might consider continuing on AS with regular follow up.
Will be interesting to learn what urologist says.

After a casual read, it does look like there may be more involvement reported with this biopsy. Your first biopsy had cores with 35%, then one with 10%. Now this one has three cores positive, one with 10% and two with 50%. Am I reading your signature correctly? This certainly shows that there can be significant variability among biopsies.

It may just be that the third showing more involvement just found PCa that the first two missed. Or it could be that the cancer is growing and showing more involvement. With the PSA increase of 2.25, about a 40% increase, may indicate the latter. You do have a large prostate, but is the present size comparable to nearly four years ago? So is the increase in PSA due to a larger prostate? More PCa? Or some of each? Just don’t know.

Should you be more concerned? I don’t know how concerned you are to begin with. I certainly don’t think you should be worried as nothing indicates any real danger at this point. However, you do have some significant discussion points for your doctor. Maybe a 6 month course of Avodart and check PSA every four months to observe the trend? Should you be treated for the enlargement? Is it causing problems that may worsen with age? It does indicate that you must pay attention to the “Active” in AS, which it appears you are doing with three biopsies in the past 54 months.

The favorable takeaway I see is that no G4 was detected. As long as you stay G3, it is a matter at what point, if ever, does the growing cancer cause problems in the prostate area or you get tired of AS and decide to treat. G6 doesn’t metastasize and would not be life threatening. If a subsequent role of the dice comes up with a G4, then that helps you decide. I know two men that had long and slow PSA progression with G6 that finally each at age 76 decided to treat with radiation with excellent results. So time and treatment options should be on your side

For now, don’t worry….be happy……and give thanks.

The size increase could easily explain the increase in PSA. That is a lot of prostate…..certainly no walnut……more like a tennis ball. I would be getting proactive regarding the greatly increasing size before it really becomes a problem.

I'm new to this forum, so I'm not sure if this has been posted before, but there is a very well respected pathologist at Johns Hopkins, Dr Epstein and if you have your biopsy slides (all of them is preferable not just the ones with cancer detected by orig pathologist) he does a 2nd opinion on them (another pathology report). They will bill your insurance and usually it is covered but if it is not the cost I believe is around $300 out of pocket. Once Dr Epstein does the second opinion path report he will also speak to you on the phone as a complimentary service (no extra cost) usually during his drive home from work and you can ask him questions and his opinion on your pathology and if he feels AS is appropriate. He is very well known and many urologists suggest that one does this 2nd opinon. You can also contact your orig path lab directly and fax them the JHH's form and you don't necessarily need to wait on your doctor to do this. Johns Hopkins prefers your orig lab send them ALL your glass slides, the form (see website) and the original path report and a copy of your insurance card (if your going to have it billed via your insurance). Also my own little tip, on the JHH's form that you fill out there is a place at the bottom where you request/ write in Dr Epstein as the pathologist you want. Here is the link to the JHH website: https://pathology.jhu.edu/patient-care/second-opinions/send Also here is a great video where he goes over the ins and outs of qualifying for AS and grading of biopsies which he helped develop, the Q&A after his presentation is also very informative: https://www.youtube.com/watch?v=XLvTaqBaXAA

Post Edited (MaureenW) : 12/6/2021 8:32:54 PM (GMT-7)