I'm sorry about
your diagnosis at such a young age. That must be all the more shocking. My advice: Read the sticky for the newly diagnosed, and have your biopsy slides sent to Bostwick or Epstein for a second opinion, and then commit yourself to taking your time before making any decisions:www.healingwell.com/community/default.aspx?f=35&m=2652250
I also want to tell you that according to current NCCN guidelines and specialists, you are a great candidate for Active Surveillance. The fact that you apparently have access to an mpMRI improves your chances of detection and treatment before there can be any serious progression. MSK has an excellent Active Surveillance program.
I'll try to address your questions as best I can:
1. Am I reading the literature correctly that cells cannot move up in Gleason score and that the areas that have been identified will remain Gleason 3s?
That is not correct. The areas where there is GS6 now may remain that way forever, or a long time, or for a longish time. Higher grades possibly emerge from a common ancestor, or there may be clonal progression, or both. If it progresses, it typically progresses slowly. Even with an mpMRI, there's a (small) chance they missed some higher grade stuff.
2. Am I reading the literature correctly that Gleason 6 (3+3) cannot metastasize?
There seems to be little doubt about
it. But that doesn't mean that it will necessarily remain entirely innocuous. It can sometimes eat into healthy tissue without metastasizing.
3. Does the Detroit study show that 29% of men in their 40s have Gleason 6 and I'm just one of three?
I don't know the study, but it is rare to be diagnosed at such a young age. That doesn't mean that guys in their 40s don't have it -- they may have it but it may go undiagnosed for many years. It is most often indolent at younger ages.
4. Can someone here recommend a non-surgeon urologist/oncologist (in NYC) that I could get a second opinion on? My feeling is that surgeons have a base setting and I'm wondering if there is someone else that is equally an expert in prostate cancer that might have a different view.
You are lucky to be in NYC where there are so many good ones to choose from. Here's my "favorites" list for NYC:
• for surgery: Ash Tewari, Mt. Sinai, NY (he's the only surgeon who intra-operatively monitors penile oxygenation and does torsionless nerve sparing)
• for SBRT: Alan Katz, Flushing NY - he's done the most of these (see link in my signature)
• for HDR brachy monotherapy: I think Josh Yamada at MSK does it.
• for LDR brachy monotherapy: Michael Zelefsky, MSK
5. Could I do Focal Ablation (or is there something better), then wait and see with some degree of confidence?
Yes. Dr. Jonathan Coleman at MSK has protocols for using something called irreversible electroporation (NanoKnife) and for using focal brachytherapy. I like these because they are non-thermal - less apt to affect surrounding tissue. As long as you have the attitude (which you seem to have) that this may only be slowing things down while providing good quality of life, I think this may be a good choice for you.
5. If RP is the way to go:
open vs Robotic?
It doesn't matter. Pick the surgeon with lots of experience in whichever he prefers. With equally experienced surgeons, the outcomes are about
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 6 year results
treated 10/2010 at age 57 at UCLA
•PSA since treatment:
1/11:3.9 5/11:3.0 8/11:3.7 5/12:1.2 9/12:1.3 5/13:0.4 6/14:0.5
• SEs of treatment:
after 2 wks: mild urinary & rectal - last 1 wk
1 yr after: mild urinary - last 2 months