Here’s a couple points I noted as I read through your original post…
Your original biopsy, which you need to keep in mind was a totally “blind & random” biopsy found just one core positive in the roughly 5% of prostate tissue which was sampled. This is an incredibly common and expected for any man in his 50’s…nothing special here. You then had an MRI which helped the urologist “see” where the image darker spots were, and that allowed him to plan and execute a more “targeted” re-biopsy with more cores specifically aimed at the suspect area in the prostate. More cores came back positive…again, no surprise and this is exactly the expected result. If I read right, 3 of 19 of the more extensive biopsy were positive cores (15%); in fact in a post-MRI biopsy some might have expected more positive cores.
The cores this time were 3+4 rather than 3+3. Again, not a surprise…very common result. Many men with low volume 3+4 PC are still candidates for starting or remaining on many of the best AS programs in the country. Pulling the trigger for treatment at this point is absolutely a choice for you; your case characteristics, including your age (life expectancy) and general health, should be taken into consideration. Big picture main point...you don't need to rush into anything.
PSA Doubling Time (PSADT) is not
a meaningful measurement for you or anyone pre-treatment because there are too frequently other assignable causes of PSA in the blood for untreated men. PSADT is
a meaningful metric for men post-treatment (very meaningful!)—and especially for men who have surgery, but also for those who have RT, because those “other” causes have mostly been eliminated. The importance of PSADT in untreated men is low
; the earlier comment about
your PSADT which seemed to indicate it was important/meaningful was a poor input. Your up-and-down results confirm
that there is something else affecting your PSA besides PC. Bigger picture, your PSA is just now into the 4-10 ng/mL "grey zone"...yet another indication not to rush.
Your PI-RADS score says a “clinically significant” PC is likely present; your 2nd biopsy (which followed and used the data from the MRI) confirmed that. Keep in mind that PI-RADS has nothing to do with the aggressiveness of your PC; only the presence of something greater than 3+3.
In very general terms, RT is more widely used by older men or younger men who cannot withstand the rigors of surgery or have medical counter-indications preventing surgery, due primarily to the “late-term side effects” which RT brings upon some (not all) men with more life expectancy...this point is widely available in the contemporary literature, but we also see this in real life with men here at this site with RT practitioners who have steered younger men away from RT because of their age. In general, the side effect profile for RT and surgery are opposite; that is, for most (not all) men the data shows that RT side effects (mostly urinary and bowel) increase over time while for surgery the side effects are immediate and for most (not all) the recover/improvement takes place over time…so somewhere down the road (several years post-treatment) the “quality of life” scores for RT and surgery patients actually meet (and cross). I'll add my own personal note: I'm completely agnostic about
treatments because in the big picture the cancer control is (for cases like yours and mine) the same, and different treatments are good/less good for different individual
cases; I had surgery for a case similar to yours, but if I was 10 years older when I was treated I would have had RT.
I hope that these interpretations are helpful.
Post Edited (Blackjack) : 7/26/2019 10:31:01 AM (GMT-6)