Active Surveillance Update

Looks as though I still only have G6 in the prostate and still a candidate for AS. I expected the worst this time and spent a great deal of time studying treatment options. I have included below a summary table of my last two biopsies. (I hope you can understand it as the format is not too good) These were only about 15 months apart from the same place. It makes me wonder about the precision of these biopsies. My 2017 and 2018 biopsies indicated G6 at two different locations from the 2021 and 2023 results??? A comparison of all 4 of the biopsies makes me wonder if they use the same volume location designations. Or do I have G6 all over the place or is the grading too subjective?

location 2021 2023
Right Apex Benign Benign
Right Mid Benign Benign
Right Base Benign Benign 2017 G6 35%
Right Lateral Apex G6-50% Benign
Right Lateral Mid G6-50% Benign
Right Lateral Base Benign Benign
Left Apex Benign G6 - 5%
Left Mid Benign Benign
Left Base Benign Benign 2018 G6 10%
Left Lateral Apex Benign Benign
Left Lateral Mid G6 - 10% G6 - 10%
Left Lateral base Benign G6-20%
Fusion Lesion Benign Benign

PSA 7.6 9.8
Volume GM/ML 47 65
PSAD 0.15

In 2017, Right Base had G6-35%, all other cores clear (2021 and 2023 benign)
In 2018, Left Base G6 - 10%, all other cores clear (2021 and 2023 benign)

It sure looks like eventually you will need to undergo treatment, with that steady climb in PSA and PIRADS. I’m glad it’s been all G6 so far.

Good point on Right vs Left

Good news on staying a Gleason 6. Undoubtedly some of your PSA is due to that very large prostate (95cc). In addition to PCa treatment options you may follow the path of CentralPAdude and consider HoLEP or one of the other BPH treatments. Slimming down that prostate now may improve any urinary issues you may have and simplify PCa treatment later. I’m a fan of early treatment so I wouldn’t wait too long. Glad you’re seeking information. Terry

HTownman, some questions...

What was the last volume calc of the prostate from the most recent MRI? Still growing?

Where is the PiRad 4 lesion located? Peripheral, transition, or central zone?

How bad are your urinary issues (if bad at all)?

I did find my previous MRI. Volume then was 145cc and I seem to remember the latest was 160 cc.

As far as location, the report states ".9cm area of mild restricted diffusion without suspicious enhancement at the right peripheral zone mid gland. - Prostatomegaly

I had my visit with my urologist yesterday and thought I would share a summary of the visit.

The MRI showed my prostate volume to be 123 cc a little less than I had stated in my posts.
The Dr. had no concerns with me staying on AS. The number of cores with G6 is somewhat of a concern but with 4 biopsies to date not showing any G7 it was lessened somewhat.
The different locations of G6 from the 4 previous biopsies was not a problem for him as well. To him it seemed to be more of the inconsistency of the grading than locations as he use to perform that work. He stated I had very low volume of G6 but possibly in many areas of the prostate.
He seemed to lean toward G6 not being cancer but something to watch.
He noted that the 8 cores of the lesion found in the MRI were all benign. Stated that the PIRAD grading was quite subjective and not a concern after the two biopsies.
HoLEP is considered out of date technology and TURP is now the gold standard if I needed to shrink the prostate for BPH or preparation.
If I wanted treatment of the prostate, he would recommend radiation and not necessarily reduce the size of the prostate before the treatment, but it may be recommended by the ecologist. He sees less side effects or damage from radiation these days as opposed to RALP.

I am going to stay on AS for at least one more cycle of PSA/biopsy.

Htownman said...

HoLEP is considered out of date technology and TURP is now the gold standard if I needed to shrink the prostate for BPH or preparation.

TURP has been around a long time while HoLEP is the relatively new kid on the block, so you may have that switched.

https://pubmed.ncbi.nlm.nih.gov/34453422/

HoLEP is also harder to get trained in, though, so harder to find an experienced practitioner.

Best of luck with your AS protocol. Right there with you.

Post Edited (centralPAdude) : 2/17/2023 9:21:24 AM (GMT-8)

Thanks again for the replies.

As far as my urologist and HoLEP, it seemed like he did not pick up on HoLEP as he asked what it was. He did pick up on laser and it being a focal therapy. Possibly other laser treatments are not new?

Glen must be a mind reader, as my exact words to my urologist was "I will continue on AS for at least one more cycle" Hopefully, that will be at least 3 years if my PSA behaves..

Also, based on my research, if I were to treat my prostate, I would reduce its size based on my urologist recommendation and then SBRT. I am sorry to hear about the side effects of SBRT.