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Radiation or Active Survelliance

My first biopsy was several years ago because my primary doc found a lump on my prostate. Nothing was found. A couple years later my PSA had jumped a little, although still under 4. Due to my age at the time, and a brother having been treated for prostate cancer, my urologist suggested an MRI. Nothing was found. Last fall my PSA came back 4.2, and I underwent another biopsy. Bingo, 3+3, 3+3 Group 1. I was then referred to an oncologist for radiation. I'm 70 and in good health, I wasn't convinced I shouldn't just do active surveillance. My oncologist suggested we do a Decipher test that might help me with my decision. The test came back exactly .50. Not much help there!
A childhood friend, who lives in another state, was diagnosed about a year before me. His PSA is 9 and our Gleason scores are almost identical. My dilemma comes from what his urologist told him. He was told, "guys with these kinds of scores are never going to develop a tumor." He will continue to test and have MRIs.
I've made the decision to continue active surveillance and will have my PSA tested every 4 months. If things change, I will undergo radiation for 8 weeks.
I find it hard to believe what my friend was told. How can his urologist possibly know there is not going to be further development. Although, I had two uncles with prostate cancer and they both lived to old age.
I welcome any suggestions, opinions any other's experiences.

  1. Despite your friend's urologist comment, "guys with these kinds of scores are never going to develop a tumor." To me; having a PSA score of 9, paired with his previous biopsy result seems to me like good reasons NOT to let his guard down.


    For a bit of perspective. I'm now 65, and 18 mo's. ago my PSA drifted up to 5.6 at which time I was biopsied with one core coming in with a gleason score of 9 (very high-risk), and only one core being cancer free. 14 months ago; Went thru the RPS, and the post-surgery margins all came back clear. definitelysurveillancesurveillance (aka ultra PSA tests)

    1. Meant to say: Post surgery margins were clear, however I also had a decipher sore of .9 (1.0 being the worst). For these reasons I'm definitely on-board with quarterly ultraPSA blood draws (latest one was .02)

      1. There are no easy answers. And so far no one I know can tell accurately the future just ask your local weatherman about predictions for starters 😀


        All we can do is make a decision based on the information we have at the time and hope it was the best one. Getting tested on a regular basis makes sense. I had a Gleason score of 9 a contained cancer and a PSA of 2.3. On a Decipher i was in the middle of the range --- I did surgery in 2013 and then needed follow radiation in 2018 - so far all is good.

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