How Long is Taking Too Long to Decide on Treatment?

Several folks wrote back on my original post, thanks very much.  Most everybody mentioned that I've got plenty of time to research, consult, decide on a treatment path and move forward.  My question - how long is too long to wait to actually get the treatment? 

 

Biopsied in mid-September, so nothing doing until November.  Was initially planning on waiting till the end of January (work reasons) to actually get whatever treatment done.

 

Am I just playing with fire?  I think I'm fortunate that everything came back as Gleason 6, but given 6 of 12 random cores (mostly left, one of the right) were positive, and the trigger event for all of this was a palpable nodule (albeit small) on the left side, pretty far over... it's got me thinking, esp. in terms of the likelihood of recurrence post-treatment.

 

Working on getting a second opinion, too.... but assuming worst case, would an "upgrade" on some scores to Gleason 7 make a delay until late January any riskier?

PC is generally a slow growing cancer. In you place, I'd decide on a treatment soon - a couple of months, time to get the second opinions and do your research.

Have you asked about doing active surveillance rather than treating now?

If something does come back as G7 on a re-read, I'd think you're still fine to wait for January. Also, remember if you pick something like IMRT or brachy, your time off work is a bit less than surgery. Likely you'll need a good 3-4 weeks off work to recover.

Andrew

My husband was originally diagnosed with 7 out of 12 cores of G6. When his slides were reevaluated one core was upgraded to G7 (3+4). His percentages of cancer were higher than yours - they ranged from 5% to a high of 70% in one core. His PSA was also higher. The urologist who found his cancer told him to get treated quickly.

I came to this forum for advice when my husband was diagnosed. Everyone told me to take time and not rush into treatment. My husband met with both surgeons and radiation oncologists, and decided on surgery. One surgeon told him to get treated within 6 months and the other (the one he used) told him to get treated quickly.

My husband had work commitments so scheduled his surgery about 2 months and 3 weeks after diagnosis. Although he had an MRI that showed no extra-capsular extension, during the surgery the surgeon found that the cancer had escaped the capsule. The final pathology showed extra-prostatic extension but clear margins. The surgeon had to remove about 25% of my husband's nerves.

When we received the pathology report I asked the surgeon if the few weeks that my husband had postponed his surgery (he was originally scheduled for 2 months after diagnosis) could have made any difference. He said that a few weeks would not make a difference, but a few months could make a difference.

I don't believe that anyone should rush into treatment without enough research (consulting with doctors) and being sure of what direction they want to go in. However, although this forum has been helpful to me, in the end the medical advice that my husband receives from his doctors usually turns out to be accurate. We live in the NYC area so my husband has access to excellent physicians. In this case the advice from the urologist who diagnosed him to get treated quickly was the right advice.

This is exactly what one does on Active Surveillance. One has a follow-up biopsy, preferably mpMRI-targeted, and monitors PSA at least 2-4x per year, and a DRE. If there is any progression, you will have plenty of time to act curatively. After 5 years, most men have not seen any significant progression, so as long as you monitor it, you will probably have years to decide, rather than months.

- Allen

Definitely get a second reading of the biopsy slides by Epsein at John Hopkins. If it's still Gl 6, you have plenty of time and AS is an option. This disease takes many years to be detectable. You've already spent those years. Now You're getting close to a decision point.. Psa doubling time is the most crucial indicator of aggressiveness. You're young and have pretty high volume. I'd get something done as soon as you get the second reading.
Bob

Just for another reference point, I was on AS for 18 months following a biopsy in early 2012 with 2/12 sites (5%, 20%) G6. Then, a follow up biopsy in Nov13 showed progression .. 2 sites G6, and 5 sites G7 (3+4). I decided on surgery intervention, but all of my Docs (3 urologists, oncologist) agreed that there would be no great risk in delay until Fall in my case.

I had prostatectomy on 9/8, and final pathology confirmed G7 (3+4)... margins clear, and fully contained. So, no issue in my case with waiting 9 months. If biopsy shows G8+, then I think this would be a MUCH different story, with much more urgency. G6 and G7 (3+4, not 4+3) can be less worrisome and some delay is not a big challenge?