Before you make a final decision, make sure you get a second opinion on the biopsy from a highly respected prostate pathologist like Epstein at Johns Hopkins. I would also advise you get your prostate imaged with a multi-parametric 3T MRI to be more certain that there is not more significant cancer lurking in the prostate. Also useful is a PCA3 urine test. If it is below 25, the chances of a higher Gleason score tumor are lower.
Finally, if these precautionary steps still leave you with a low volume Gleason 6, then Active Surveillance is definitely worth using. As you can see from my numbers below, I did all of the above, and these steps gave me the confidence to use AS instead of more aggressive treatment.
By the way, the first surgeon I consulted strongly recommended surgery. When I went to a second urologist, he agreed with the first. When I continued to resist this advice my family accused me of "shopping around" for an opinion that would agree with what I wanted.
If his situation at Mayo is like mine was, he will automatically have a second opinion from the Mayo pathology lab. When I went there for my second opinion, they would not give me an appointment in urology until I provided them with the original slides from my biopsy.
I think this was because Mayo will probably not offer an opinion based on some other lab's "eyes and ears" and would want to examine the slides for themselves.
So hopefully he will be providing Mayo with his original slides so they can make their own clinical analysis.
Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain painlessly removed morning after surgery.
Catheter painlessly out in 7 days. No incontinence, occasional minor dripping. 100% continent after 3 weeks.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Brief, firm erections on occasion, still hoping for more improvement.
Post Edited (HighlanderCFH) : 3/4/2014 10:15:16 PM (GMT-7)