Options for Gleason 6
I'm wondering what others have had for options for a similar situation to mine. I have a history of approximately 30 years of prostatitis. I am 51 years old.
Last December I had my PSA run and it was 20. I went to the urologist and was put on a 2 week course of antibiotics and the next PSA only lowered to 19.
Next was an MRI which found one PIRADS-3 lesion of 8mm. This necessitated a targeted biopsy which found 6 cores had 10-25% involvement with all Gleason 3+3. The one area of interest that was sampled separately was the 8mm lesion which was 50% Gleason 3+3. There were no Gleason 3+4 or 4+3 findings in any of the samples.
I am a bit confused about my exact risk status as the Gleason 3+3 would indicate low risk, but the findings in 6/12 cores and the higher PSA would suggest a more intermediate risk. I have a CT scan scheduled next to check for any spread but no extracapsular findings came from the MRI, nor any bone, nerve, bladder, or seminal vesicle involvement.
So, my questions:
1. Is the CT scan scheduled routinely for most people or would this be as a result of some of my particular test results?
2. What treatment options were others offered in a similar situation? I'm guessing active surveillance is out of the question with this many nodes positive.
3. Anyone else have a PSA that elevated partially due to prostatitis while also partially elevated due to cancer?
I'd like to have some sort of idea what I'm looking at before I talk to the doctor in a couple of weeks to get his opinion.
Thanks!
You can find staging calculators on the internet. IIRC, psa >10 puts you at intermediate? There may be other factors to push you up.
Standard biopsy is 12 pins. Thats not many. Makes you wonder what else could be there?
Also, at biopsy, they probably took a volume measurement of your prostate. They say big prostates make more PSA. You could maybe take your volume and back that out of the 20 and see whats left for the PCa.
Then look up Dr. Peter Grimm and his charts. They will show you probabilities of long term survival vs your major treatment optionsI have a similar experience. It has been a 4 year journey, which in my case started with a bladder infection. PSA was measured at that time, and considered elevated (5.6), on latter thought, a normal situation with a UTI (bladder infection) of course. This was merely caused by a BPH, or the enlarged prostate. The UTI however caused the prostatis (or the other way around?), and it put me on alert. During this time I found relief with Bearberry (Arctostaphylos Uva Ursi-google it), and made me change my diet (Sulforaphane, high levels of Vit D, Zinc and Fishoil). Nevertheless it kept me worried, so I went for a PSMA-Pet Scan after 2 years, just to be sure. Nothing found, so relief, eventhough my PSA was 8.6 now. So after 1.5 years (too long I admit), I checked PSA again, it was now 16. So time for action. Meanwhile I never had biopsies done, I am working in the cattle business, and one thing I do know; never stick a probe in an infection (which I knew I likely had in the form of prostatitis) But in my search I came across Nanoknife (Google Irreversable Electroporation). Since I had problems relieving, it seems plausible to help me with this issue, as well as take out the lesion they have seen on my MRI (never had a biopsy). We agreed they would take samples of the lesion during the procedure, and indeed Gleason Score was 7 in one core and 6 in the other. With Nanoknife they insert via a matrix, up to 5 electrodes around the tumor, via your pereneal area; the electoporation will kill the tumor.
My PSA is below 4 now, my prostate is a lot smaller and I have no more prostatitis.
Consider yourself lucky, an early detection like yours is a life safer.
Hi
. It is definitely a good sign that all of your samples are Gleason 6. It does open many options. Whether active surveillance is one of those options depends on many factors. One thing that might help is something like the Prolaris test which "is a genomic test that analyzes changes in 46 genes in prostate biopsy tissue. It generates a risk score to help predict the likelihood of disease progression in men with localized prostate cancer:" https://www.aafp.org/pubs/afp/issues/2019/0901/p311.html#:~:text=Prolaris%20is%20a%20genomic%20test,men%20with%20localized%20prostate%20cancer. Making sure the cancer is contained to the prostate or escaped is essential, so testing for this is standard. Cancer volume, age, physical condition, and several other things can play a role in determining best options. It sounds like your doctors have a plan to proceed and, hopefully, you should have more information soon. Please feel free to keep us posted and to ask additional questions. Best, Richard (ProstateCancer.net Team)
