Questions for the Doctor
Soooo...
I'm 63 years old. March I had my annual PSA blood test and it shot up from 4 to 5.67 in a years time. Went to the urologist, found my prostate was enlarged and ordered an MRI. MRI "2.4 cm PI-RADS 5 lesion involving the transition zone of the right base to mid gland. The lesion abuts the anterior fibromuscular stroma, without definite evidence of extraprostatic extension"
So a biopsy was next at the end of April. The urologist did 16 cores which were all negative except for the ROI (region of interest) which showed:
G. PROSTATE BIOPSY, ROI:
Prostatic adenocarcinoma
Gleason score 3 + 3 = 6/10 (Grade Group 1)
Number of cores involved: 2 of 3
Percentage and length of cores involved: 25% (3 mm), 65% (4 mm); ~25% of the
total tissue submitted
Perineural invasion is: Not identified
News was probably as good as I could have hoped considering.
Week after next I am being set up be evaluated at MGH GU Oncology Multispecialy Clinic. I'll be evaluated by an Oncologist, a Urological Surgical Oncologist and a Radiation Oncologist, one after the other in a 3 hour block. They are all with Mass General and seem VERY good in their respective fields
Right now I'm not worried but have a case of information overload from reading message boards, hospital web sites, NIH papers etc.
My main question(s) are besides the obvious, what should I be asking these doctors when I see them? The obvious are side effects, cure rates, prognosis. What are some of the less obvious questions?
Sorry for the rambling....
Hi
. It is good that you are collecting information, but the information overload is completely understandable, so absolutely no reason for concern about rambling. A Gleason score of six is also very good news. In fact, there is some debate within the urinary oncologist community on whether a Gleason six is actually cancer. Given this fact, one question that jumps out for the doctors is about active surveillance. It is not for everyone, but is worth a conversation. If you are headed for treatment, given the low Gleason, basically every option is on the table, such as Cyberknife, proton therapy, or cryotherapy. You also have the luxury of time to weigh options and get opinions. Please feel free to keep us posted on how things are going. Wishing you the best. Richard (ProstateCancer.net Team) Thanks!
I thought about active surveillance and will run it past the doctors, however, the thought of multiple biopsies is a real turn off when the end result will in all probability be the same whether it's in 6 months, 1 year, 2 years etc. I really want closure. Just do it once and be done, whether it's surgery or radiation therapy. My PSA went from 2.42 to 2.87 to 4.13 to 5.67 in consecutive years. Coupled with the 2.4 cm lesion size makes me think I should take care of this in the near future.
All the best...
As Richard says, Gleason 6 is a good place to be.Remember all treatments have possible life long consequences of one kind or another. Check with the videos put out by Dr. Mark Scholz of the Prostate Cancer Research Institute, either on the PCRI(dot)org site or on Youtube for the most up to date and unbiased information on all forms of treatment.
As my urologist honestly stated, doctors too often are in marketing mode to pay for their robot surgery gear or radiation gear. Dr. Scholz is a medical oncologist and has nothing to market.
When you read comments and reports on the internet, be aware of the date they are published. Studies typically are showing results of treatments in use 10 years ago and may be outdated. This is especially true of radiation treatment.
Doctors typically will give you answers that are generic. Drill down on all responses to get information that applies to your unique individual situation. Ask whether there are alternatives to biopsies.
When you make a treatment decision you are deciding on the quality of life you will have to live with after treatment.
Guy B. Meredith, moderator.
By the way, ask your doctor about the Perineural invasion. I had this and it possibly caused me unneeded panic. The video below describes my situation an diagnosis.
Guy B. Meredith, moderator.
https://www.youtube.com/watch?v=UYaIiqYDsYgSo I had an evaluation with an MGH Oncologist, Surgeon and Radiation Oncologist. This is what I learned. I am paraphrasing a lot of this, so hopefully I'm not saying this wrong and misrepresenting what the doctors told me.
Oncologist- I am a candidate for watchful waiting/ active surveillance. However, based on the size, location and PRADS-5, she recommends that I initiate some sort of treatment. In her experience, lesions of this size carry the risk of being something other than Gleason 3+3. Also in her experience, there is a good chance that I would need treatment in the future anyway. And the thought possible more biopsies isNOT appealing. So active treatment it is.
Next was the Urological Surgeon-I am a good candidate for nerve sparing robotic surgery. He is very experienced having done more than 1000 of them. We discussed the risks , side effects, ED, Incontinence, both short and long term. He was very up front about the best case and worst case scenarios.
Last was Radiation Oncologist. Based on my age, good health and the size and location of the lesion I am a excellent candidate for radiation therapy. He explained that the long term survival rates for surgery and radiation in my case are statistically equal. SBRT and moderately Hypofractionated radiation were discussed. He also mentioned that using SpaceOAR rectal spacers and seed markers lower the side even further. We discussed long and short term side effects, ED, incontinence, additional cancer risks etc.
Based on my discussions with the 3 doctors, I am going with Radiation Therapy. I think there will be fewer side effects (both long and short term), the long term survival rates are equal and my quality of life appears will be better
