Active Surveillance for 3+4=7 Gleason - What's Your Experience?
Hi - my first post here.
I was recently diagnosed with prostate cancer. I am 57 years old, in otherwise decent health. PSA had been trending upwards over a couple of years, then jumped from a 4 to 7.93, and a later test was a 7.0. A 10 core biopsy identified 3 cancerous lesions, two 3+3 6 located in left apex, and left lateral apex. These comprised 5% and 20% of the samples. The third was a 3+4 7. 25% of that sample was cancerous, with the 4 making up 10% of the tumor.
I was referred to the University of Michigan for a follow-up. An MRI they did identify a 4th tumor located in the posterior lateral base and was a PI-Rads 4 (I think I described all that correctly!). The U of M surgeon initially focused all discussion on surgery as the best option, with only passing mention of AS or radiation. After the MRI, he seemed to focus all discussion on AS, with only passing mention of surgery or radiation.
Everything I have found online seems to say a 6 is the cut off for AS, with a few mentions of favorable risk 7 being ok in some cases. I really do find the AS appealing, but am reluctant given that I am most often, seeing 6 as the highest suitable for AS. Has anyone with a 7, followed AS? How were your outcomes?
I should also mention that Bone, CT and MRI scans indicated the cancer was contained in the prostate - no mets.
Hi KTMMike. First, let me say that it is good that your PCa has been caught early and that a discussion of active surveillance is possible. I want to share with you this article from our contributor Will on his experience with active surveillance: https://prostatecancer.net/living/active-surveillance-wrinkle. His circumstances were different in that his Gleason was a 6, but think his story may still be helpful. I also want to share this article on active surveillance from Johns Hopkins, which notes that "According to the American Society of Clinical Oncology, patients with low-risk, low-grade disease (a Gleason score of 6) can consider active surveillance. It may also be an option for patients with a Gleason score of 7. Patients within these categories may choose to postpone prostate cancer treatment because of its associated risks and side effects:" https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/active-surveillance-for-prostate-cancer#:~:text=This%20involves%20monitoring%20prostate%20cancer,6)%20can%20consider%20active%20surveillance. Each individual's circumstance is different and the final decision on treatment belongs to the patient. Please know that this community is here for you and feel free to keep us posted on how you are doing. Best, Richard (ProstateCancer.net Team)
Thanks Richard. Long story short, I've decided to go with a radical prostatectomy. With relatively near term plans for semi retirement and travel (3 to 5 years) I didn't want to have the eventual likelihood of progression and surgery to mean scrapping those plans in order to make sure I had good health insurance in place (ie needing a job). I'd rather get it addressed now and have it behind me. Surgery will be mid to late September.
