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New Member with Recent Diagnosis

Hi everyone! I'm 53 years old. In August of 2019 at my annual physical, my PSA test came back as a 5.6. Another PSA test immediately after came back as a 4.3.

My doctor arranged for a biopsy, which was mostly clear, but did indicate a "suspicious" area (PROSTATE BIOPSY, LEFT APEX (S-19-44584-6A-1, 6A-2; 12/5/2019): Atypical small acinar proliferation suspicious for adenocarcinoma). My insurance company referred me to Mass. General, where an MRI was performed, with the following findings: (PROSTATE VOLUME Measurement via DynaCad gland segmentation: 29 cc. PROSTATE: A 0.8 cm T2 hypointense focus is seen in the right anterior transition zone on image 13 of series 8 in the mid to apical gland. There is associated restricted diffusion without definite enhancement. There is no surrounding capsule. No disruption of the prostate capsule. IMPRESSION: Index lesion (highest PI-RADS assessment category): Location: Right anterior transition zone in the mid to apical gland Size: 0.8 cm PI-RADS Score: 4).

I was encouraged to have another biopsy, but at Mass. General this time, with the following results: (PROSTATE BIOPSY, TARGET ROI ONE: Prostatic adenocarcinoma Gleason score 3 + 3 = 6/10 (Grade Group 1) Number of cores involved: 2 of 3 Percentage and length of cores involved: 50%, 6 mm on each core).

I am currently in Active Surveillance, with my first follow-up appointment scheduled for the end of this month. My prostate is enlarged, and I feel the need to void my bladder much more often than normal. Often 2 minutes or so after voiding, I need to urinate again. A

ny thoughts on whether Active Surveillance is the best approach in my case? I am married and enjoy frequent sexual activity, but wish I didn't have to urinate so often. Thanks!

  1. One of the more challenging questions all men face in dealing with prostate cancer is,"what should I do next?"

    Rest assured you are not alone with your question. While I can not offer medical advice or direction I can tell you what I know based on personal experience.

    A Gleason of 6 or less is typically considered low risk. In my case I had a Gleason of 9 but fortunately it was contained. I opted for surgery. Several years later the cancer returned so my next choice was to undergo radiation and hormone therapy . So far so good. PSA is now 0.02

    Active Surveillance (AS) gives you and the MD an opportunity to keep an eye on things along with time to evaluate status, progression (if any) and your options.

    At the same time AS often requires additional biopsies as you move forward. Some men are comfortable with undergoing repeat biopsies while others are not.

    Some men are comfortable knowing they are living with untreated cancer, others are not. It will be up to you to decide your comfort level. That said at any point you can change direction.

    The real key is to stay on top of this, do not ignore the situation. Worse still is to just drift away from Active Surveillance as many men do.

    Prostate cancer grows slowly. That gives you time to explore options and perhaps even a second or third opinion.

    The same holds true for sexual activity. Again no one knows how someone will react to a treatment -- surgery or radiation or ??? An enlarged prostate can be treated in a variety of way if frequent urination is an issue.

    At this point get as much info as possible for medical professionals and make a decision based on that research.

    None of this is easy! Just know ...what ever decision you make it was correct one for you at the time based on the information available.

    Hope this long answer helps a bit 😀

    ... Dennis (prostate Team)

    1. Thanks Dennis for your response! Even though I am only a Gleason 6, I am giving consideration to having the prostate removed completely, as I don't like the idea of having additional expensive MRI's or biopsies, and would like to be able to avoid urinating as often as I do now. Financially, since I've met my deductible for this year already, it would be more cost effective to have the removal procedure done this year, as opposed to waiting until some time in the future. I know that this decision should not exclusively be a financial one, but it is a big factor for me. If it were easier to predict how my body would respond to the surgical approach, it would be an easier decision to opt for this choice. I appreciate the advice--I'll continue to research my options and discuss them with my doctor!

    2. Glad to be of help - Again it is only my personal experience - With a Gleason 6 you have some breathing space - Following surgery I have had NO issues with emptying my bladder now and the flow is like a teenager 😀 Please keep us in the loop as your journey continues 😀

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