Considering End of AS

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tutor_paul
Regular Member


Date Joined Jan 2017
Total Posts : 53
   Posted 1/3/2018 1:00 PM (GMT -6)   
Hi,

My confirmatory biopsy at diagnosis+1year still shows 1/12 positive cores (in same location), but pathology upgrade to 3+4=7 @ 30% G4 (see updated sig).

I don't like that G4 and am strongly considering treatment. I know 1 core of 3+4 still makes me an AS candidate in many if not most circles, but after this Gleason upgrade it feels a bit like Russian roulette. It seems like treatment is inevitable at some point, so why not just get it done?

Appreciate any thoughts on the matter.

-Paul
Age: 54 at Diagnosis

12/2016: PSA=4.13; Free 11.9%
12/2016: BX#1 Pathology: 1/12 (Left mid) 3+3(Score=6); 10% of Tissue
12/2016: Oncotype DX Genomic Prostate Score = 5
02/2017: MpMRI... 1 lesion in vicinity of BX positive core; PI-RADS 3
02/2017: AS Decision Made
09/2017: PSA=3.56
01/2018: BX#2 Pathology: 1/12 (Left mid) 3+4(Score=7; G4=30%) in 1/15mm
DRE=Consistently NEG

island time
Veteran Member


Date Joined Dec 2014
Total Posts : 1438
   Posted 1/3/2018 1:44 PM (GMT -6)   
I understand things are progressing on the AS front in the medical community. But the thought of having cancer inside my body....that's proven to be a metastatic cancer.....is more than I can comfortably sleep with at night. That's me.

There's a chance (possibly a reasonable one)....that one could live for years with that path with no adverse effects.

I'm not that brave (or rational?). But...I can completely understand people doing it.
PSA 2010 thru 2014...4.0 +/- .7
Dx 12/14 @ 56 yo...2 cores G6 <5%, 1 core G6 20%, 1 core HGPIN.
RALP 11/25/15...3+4. 3 to 5 mm surgical margin 15% involvement pT2+
2/16-.01...4/16-.00...7/16-.00...10/16-.01...1/17-.01...4/17-.02...7/17-.02
10/17-.02

Hardlyrob
Regular Member


Date Joined Sep 2017
Total Posts : 73
   Posted 1/3/2018 1:45 PM (GMT -6)   
Tutor_Paul:

As someone who is about four months post RARP I would encourage you to wait. The recovery is unpleasant, but not horrible, and the side effects in my case are no fun.

I don't know what treatment you are considering, but they all have side effects and risks that vary from person to person. I wouldn't have gone down the path I did if AS was an option for me.

Talk to your Uro, talk to a RO and understand what they believe the best treatment options are for you. Take into consideration the recovery / side effects and make a decision - but take your time. If it is your style read and learn as much as you can about this disease and the different treatments.

The other argument is that treatments are getting better all the time and waiting probably gives you different treatment options in a few years.

Best of luck, and let us all know what you decide.

Cheers!

Rob
5/2017 PSA 34.2 age 53
6/2017 Dx by biopsy - 9 of 14 positive; Gleason 7 (4+3) 5% to 90% cancer
8/24/2017 RARP, Dr. Canes - Lahey Burlington (MA)
4/8 lymph nodes positive
Extraprostatic extension
Positive margin 5 MM
Seminal vesicle invasion
pT3b; pN1; M0
10/24/17 PSA 0.13
12/11/17 Started 18 months of Lupron

NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 1013
   Posted 1/3/2018 1:58 PM (GMT -6)   
Your first decision, which only you can make, is whether major decisions in your life are going to be data-driven or emotion-driven.

Post Edited (NKinney) : 1/3/2018 1:06:08 PM (GMT-7)


ddyss
Regular Member


Date Joined Apr 2017
Total Posts : 227
   Posted 1/3/2018 2:05 PM (GMT -6)   
I would get an MP-MRI to see if it progressed in the scan as well and if there are more than one lesion and if the pirads score also moved up.
DX@ 48 Yrs PSA 03/15 4.45 DRE: Firm Right Base
04/18 Biopsy Right: Base 4+3, Middle 3+4, Apex: HPIN
Left 6 cores : -ve
5/20 MRI: Pirads 5, ECE:+ve
RALP 05/26 Mt. Sinai Miami - Dr. A. Bhandari
Path:
Gleason downgraded to 3+4 !! Stage T2C
Prostrate Size: 49grams Tumor:20%
LN/SV/ECE: -ve PNI: +ve
Cath Removed : 6/1
Full continence: 7/4
PSA History :
7/7 <0.1
10/2 <0.006

George_
Regular Member


Date Joined Apr 2016
Total Posts : 486
   Posted 1/3/2018 2:19 PM (GMT -6)   
The gleason 4 cells were in the prostate a year ago already, the needles were just not placed to locate them.

A CTC Test will already show prostate cancer cells in your blood. Nowbody can tell if or when these will result in metastases.

I think you could still live for some time without side effects. You can decide for surgery or radiation any time.

George

island time
Veteran Member


Date Joined Dec 2014
Total Posts : 1438
   Posted 1/3/2018 2:40 PM (GMT -6)   
NKinney said...
Your first decision, which only you can make, is whether major decisions in your life are going to be data-driven or emotion-driven.


if data driven...never get married. Especially a second time. tongue

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4089
   Posted 1/3/2018 2:50 PM (GMT -6)   
Paul, before you leave AS — have you had the recent biopsy slide read by Dr. Epstein?

Jim
Forum Moderator-Prostate Cancer. Age 62 (71 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-9 yr: 1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1

tutor_paul
Regular Member


Date Joined Jan 2017
Total Posts : 53
   Posted 1/3/2018 3:02 PM (GMT -6)   
Rob: Thanks for the feedback on your experience
Island Time: Yes, the metastatic potential of G4 is really the concern
George_: Maybe/maybe not on the G7 last year... who really knows?
NKinney: Being an engineer, if anything I am probably overly-data driven
ddyss: Yes, the uro said another MP-MRI is the next step if I say on AS
Jim: The slides are supposedly on their way!
Age: 54 at Diagnosis

12/2016: PSA=4.13; Free 11.9%
12/2016: BX#1 Pathology: 1/12 (Left mid) 3+3(Score=6); 10% of Tissue
12/2016: Oncotype DX Genomic Prostate Score = 5
02/2017: MpMRI... 1 lesion in vicinity of BX positive core; PI-RADS 3
02/2017: AS Decision Made
09/2017: PSA=3.56
01/2018: BX#2 Pathology: 1/12 (Left mid) 3+4(Score=7; G4=30%) in 1/15mm
DRE=Consistently NEG

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 400
   Posted 1/3/2018 4:58 PM (GMT -6)   
paul I was considering AS but when one core was upgraded to 3+4, I choose to get treatment. I have the assumption that there is more there then less there. I wish you well. Denis
65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. decided on HDR BT, first treatment 1/26/18 Denis

Dreamerboy
Veteran Member


Date Joined Jul 2011
Total Posts : 591
   Posted 1/3/2018 6:10 PM (GMT -6)   
I followed AS for several years but I had a set of criteria when I would choose treatment. One of those criteria was if any G7 (3+4) showed up in the biopsy. The longevity stats are pretty good with G6 but not as good with G7. Almost 3 years out from surgery things appear to be pretty good with minimal side-effects.
B-year: 1959 PSA
4 years AS; following Ornish/Michael Milken-style diet
RARP March 2015 after biopsy showed tiny amount of G7

ASAdvocate
Veteran Member


Date Joined Feb 2015
Total Posts : 697
   Posted 1/3/2018 6:30 PM (GMT -6)   
Paul, a small percent of G4 would not cause me to leave AS.

But, 30 percent would. I would recommend, as Tudpock18 suggested, that you have the slides send to Dr. Epstein for his opinion. If he concurs with the 30 percent number, then I would take action, if I were you.

Types of radiation such as SBRT and HDRBT would be my first choices for treatment, but your choice will be your decision.
DOB: May 1944
In AS program at Johns Hopkins
Five biopsies from 2009 to 2014. The third and fourth biopsies were positive with one core and three cores <5% and G 3+3. Fifth biopsy was negative.
OncotypeDX: 86 percent chance of PCa remaining indolent
August 2015: tests are stable; no MRI or biopsy this year for my AS program
August 2016: MRI unchanged from 2/2014; PSA=3.9; FPSA= 26; PHI =28

tutor_paul
Regular Member


Date Joined Jan 2017
Total Posts : 53
   Posted 1/3/2018 6:33 PM (GMT -6)   
Denis - Thanks and good luck with your HDR in a few weeks.

Dreamer - Honestly, that was my criteria as well... If I get pathology confirmation from JHU, I will likely move forward. Glad things are going OK for you.
Age: 54 at Diagnosis

12/2016: PSA=4.13; Free 11.9%
12/2016: BX#1 Pathology: 1/12 (Left mid) 3+3(Score=6); 10% of Tissue
12/2016: Oncotype DX Genomic Prostate Score = 5
02/2017: MpMRI... 1 lesion in vicinity of BX positive core; PI-RADS 3
02/2017: AS Decision Made
09/2017: PSA=3.56
01/2018: BX#2 Pathology: 1/12 (Left mid) 3+4(Score=7; G4=30%) in 1/15mm
DRE=Consistently NEG
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