Do I really need treatment?

Danfl: With your statistics and especially your relatively young age; I would say that treatment is indeed necessary. Listen to your doctor, there is a reason why they treat people!

Bill K. from NJ

age 58, PSA 3.3, free PSA 21% Gleason 3+4=7, 1/12 cores +, neg. DRE
RP (daVinci) 7/2011, downgraded to Gleason3+3=6, contained.
Now age 60, All PSA's <0.015, No ED, no urinary problems.

Danfl, welcome to our little corner of the ethernet.

With a Gleason 7, you're looking at an intermediate risk cancer. Also, there are 2 combinations of Gleason 7: a 3+4 or a 4+3. A 4+3 is considered higher risk than a 3+4, but either way I'd say you need to make a treatment decision. By any chance, did the biopsy report give you a percentage of cancer in each of the four positive samples?

While there are many here who would agree that sometimes doctors are too quick to recommend treatment, with a PSA of 8.5, a Gleason of 7 and one-third of the samples taken coming back as cancerous, I'd say you need to decide on a treatment soon.

If I had Gleason 7, I would go for treatment.

I enjoy a nice cold beer, an NFL game in the fall or walking through London, Paris or Rome. Don't think "enjoyment" was part of my education when I compared surgery to radiation and they're various potential side effects and cure rates. Necessary for sure, but nothing enjoyable about it.

no doubt :)

Hi Dan,

I replied to your same post in the cancerforums.net, where I am the moderator of the prostate cancer forum. I thought I would also paste it here so that you might see it sooner. Nothing new, though. It's pretty much what the others are telling you. I know it is terribly scary, but the reality is what it is. I would get this taken care of as soon as possible to give yourself the very best chance for a cure.

As one urologist told me a few years ago, "There is a small window of opportunity with these things." Consider our advice and don't wait until that window closes on you. Here is my post from the other forum:

Hi,

Sorry you need to be here, but happy you found us.

As Otago suggested, the idea of AS for you is not a good one unless that G7 somehow becomes a G6. And that could only happen if a second opinion on your biopsy slides says it was a G6 all along. So, you might consider having your ORIGINAL slides sent to a second lab to see what they come up with. If it SHOULD say you have no G7, you might consider a THIRD lab and let that lab's analysis be the tiebreaker.

In the meantime, you should never consider AS with a G7. AS is usually considered an option when there are three or fewer positive cores, if each of those positive cores is less than 50% involvement and if the PC is no higher than G6. Unfortunately, you have FOUR positive cores and that G7 indicated. Keep in mind that the average cancerous prostate has as many as 7 (and an average of 3-4) individual tumors, not just one.

Also be fully aware that the biopsy report is only an educated estimation of the full nature of the prostate cancer. As we so often tell people, between 20 and 28% of patients undergoing prostate removal find that their post-op pathology report UPGRADED their Gleason score to a higher level of aggressiveness. This is the risk one takes when choosing AS because we do not yet have a test to show if there is only a G6 in the prostate.

So you need to question, to yourself, just how much G7 (or perhaps even higher) might be in the prostate. One good thing is that, what they have found so far, is a 3+4 instead of a 4+3. That means the most aggressive cells (at least within that one positive core) were in the minority. But still, realize that that Gleason grade of 4, if combined with another 4, would give a Gleason 8, which is very aggressive.

Hate to say it, but you DO need some treatment -- and I would not waste too much more time in deciding what sort of treatment that would be among surgery, radiation, etc.

Take care,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

Hi Danfl, and welcome to our little corner of the world. You have come to a good place with immeasurable help and knowledge from those that have "been there, done that" with respect to being told we have PCa, learning about the beast, deciding on a treatment path and moving on.  Please keep in mind that with your statistics while I also believe you need treatment, you do have time - time to learn about PCa and the various treatment options - so don't panic! 

Others have already asked about getting a 2nd read on your biopsy slides yet, and I agree that should be one of your next steps. Labs such as Bostwick and Epstein are two of the best and a 2nd opinion is usually a good thing to add to your decision making tree.

Along with forums such as this where you can learn from people that have and are going through what you are, do as much internet research as you can. When I was at your point in my journey I encountered the "paralysis by analysis" syndrome as I was spending several hours a day doing all of the research and reading as much as I could - but that's o.k. as it will put you in a better place in terms of deciding your choice of treatment. 

There are a number of great books out there as well - Dr. Patrick Walsh's "Guide to Surviving Prostate Cancer" and Strum and Scholz' "Invasion of the Prostate Snatchers" are two that I found incredibly helpful during that part of my journey.

You will also want to talk to and if possible meet with as many of the medical experts in the different treatment approaches as you can.  When you do, be sure to ask for their specific outcomes post treatment - % regression free, continency (and have them define what "continent" means - to you and I it means NO issues, while others may qualify that with "only one pad per day" or "only when straining") - same goes with ED.  They all have these statistics and if they say they don't or are unwilling to share that would be a cause of concern for me.

At my young age and excellent health, and with no symptoms or issues - while curing the cancer was / is my top priority, at the same time preserving my quality of life ran a very close 2nd.  Be aware of this by doing your research and getting these statistics from the practitioners/treatment modalities you may be considering going with.  You only get one shot at this - one of the most important decisions we're likely to make in our lives. 

As part of my journey to learn about the various treatment options I downloaded, purchased, and copied a number of studies and results that I would also be happy to share with you, so again if you are interested shoot an e-mail my way and I'll reply right away.

We are all out here to help - my very best wishes to you in this journey.

Hello Danfl,

You have received lots of great advice. Bottom line is the decision is yours. My decision was mine and I always have been comfortable with what I decided. Your decision is yours and I wish you the same comfort after you make your decision as I have now.

Take care,

Pat

Hi Danfl,

Welcome and sorry you have to be there. At the risk of piling onto the already good info you've received, I would also say it makes sense to have treatment. It's that darn Gleason 7 that is pointing me there.

That said, I would definitely get a second read on your biopsy slides before you make any decision. I was shocked at how easy it is to get the best people in the world (Epstein in my case, but you could also use Bostwick) read your biopsy slides.

The good news in this is that I do think you have some time to make a decision and research various treatment options. And the even better news is your prognosis is excellent! Good luck and keep us posted!

Michael

Dan--You've gotten excellent advice from others to which I can add nothing. All the best on your decision about what to do next. Take care and hang in there.