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Gleason 6, AS or immediate treatment?

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User

Posted 22 May 2024 at 15:52

Yes positive cores in the 4 quadrants = T2c and a cribiform histology (even being Gleason 6)
not is for AS and radical treatment must be applied.

Originally Posted by: Online Community Member

@Adrian56 Totally agree. Its what set off alarm bells....after London MDT review two options were recommended....AS or RARP. My ex is a researcher in this field so our pillow talk used to be cell pathology, angiogenesis and cribriform cell structures :D

Knowing my PCa was at least T2c I engaged for a second opinion with the Prof Whocannotbenamedonhere as thats seemed like the minimum due diligence. The prof mentioned there was a ~60% chance there would be cribriform gland cells (>=grade 4) on final histology and he was spot on. Acting fast was prudent it would seem as the Prof had to resect additional tissue around the bladder neck and the cancer was extremely close to breaking out of the prostatic capsule.

I count my lucky starts I didnt defer for a couple of months over the xmas period which would have taken me into the covid crisis.

Happy days thus far....

User

Posted 22 May 2024 at 16:39

Will ping him an email later today as he's probably in surgery now.

Yes, surgery wasnt anymore involved for me than having tonsils out. Catheter was annoying but you get used to it and the associated management.

My mind was exploding after diagnosis so know how you feel.

I would find a surgeon who is at least high volume. The general accepted classification for high volume in the UK is >100 RARPs a year. I think my prof was 3-4x this number.

Retzius sparing is apparantly a more complex approach but it tries to avoid disturbing the nerves which control urinary management. I think fundamentally it means faster continence post surgery. Longer term there isn't much difference I think with conventional (anterior) robotic surgery in terms of continence stats.

NeuroSAFE is see as a no brainer as it basically means a rapid pathology is done to check if cancer cells are on the anterior of the prostate while the patient in open on the surgical table. In the UK is started to be rolled out on the NHS as add a superb level of near real time visibility and hopefully extra reassurances that no cancer is accidently less behind and nerves removed that could be spared.

A few of asked about best prostate cancer clinics in Europe...apparantly the Martini-Klinik Clinic in Germany is very well regarded if you can't locate a top surgeon closer to home.

Edited by member 22 May 2024 at 17:35 | Reason: Not specified

User

Posted 22 May 2024 at 20:30

Originally Posted by: Online Community Member

There are studies that support that the metastatic capacity of 3+3 is close to zero,

This is true; "pure" G3+3 cancer is extremely unlikely to metastasise. The main problem is that a biopsy is a random sampling process, and the fact that only G3 cells were found in the samples extracted from your prostate does not mean that G3 cells are all that's actually there. That's why the important word in "active surveillance" is "active"; it's important to have regular scans and PSA tests.

Best wishes,

Chris

User

Posted 22 May 2024 at 21:56

@quique no luck unfortunately with names of surgeons in Spain.

if you decide to go abroad for treatment maybe drop me a line let me know.

I think the single port Da Vinci robot is now being used at London Guys Cancer Centre.

Cheers

simon

Edited by member 22 May 2024 at 22:11 | Reason: Not specified

User

Posted 22 May 2024 at 22:39

Hello Chris, I completely agree.
Unfortunately, diagnostic tests do not have 100% reliability.In my case, 5 shots have been taken on the suspicious lesion
in which 3 of them say that there is G3+3 and 2 of them say that there is nothing malignant.
In the rest of the prostate, 9 samples have been taken because there are
no visible lesions on the MRI.
In this particular case, do we remove the prostate now or do we wait to find a G7 or greater?
That is the question

Originally Posted by: Online Community Member

There are studies that support that the metastatic capacity of 3+3 is close to zero,

Chris

User

Posted 04 Jun 2024 at 16:02

Hello again, reviewing my MRI reports I have been able to read that my gleason 6 lesion reaches the prostatic margin... but there is no deformity of the surrounding fat or evidence of extraprostatic extension...
It is surprising that the urological clinical guidelines and inclusion criteria in AS do not take this into account as a critical element when making an accelerated decision about radical treatment or surveillance.

B.R.

Edited by member 04 Jun 2024 at 16:29 | Reason: Not specified

User

Posted 12 Jun 2024 at 22:11

hello i have new PSA result today (5.85 ng/ml) from AS and Gleason 6. 10x11 milimeters. Pirads 4. 52 yrs old men.

30/05/2022: 4.14 ng/ml

25/09/2023: 5.33 ng/ml

12/06/2024: 5.85 ng/ml

PSA rising 0.5 ng/ml in 8 months. Next week i have appointment with the urologist.

I have a bad body and my nerves are stuck in my stomach and I want to cry. Big sh*** all this.

B.R.

User

Posted 13 Jun 2024 at 01:26

Good luck with your urologist, hopefully he will help you come to the right decision for you.

User

Posted 13 Jun 2024 at 11:20

I have followed your thoughts about the the best choice to make and after affects.I was PSA 2.19 Gleason 3+4=7

at the age of 70 with 5 cores out of 20 positive and was offered Robotic surgery or Brachytherapy and took Brachytherapy as i felt that the side affects may be better.

I am 8 years on in September and think i have had a very good result with no real side affects.

There are no guarantees in any option but if you do go for AS please keep on top of it as a few on here left it to long before making a decision and regretted it.

If you click on my Avatar you can see my Journey and i am happy to answer any questions about it, but i am no professional so can only give my side.

Good luck. John.

Edited by member 13 Jun 2024 at 11:21 | Reason: Not specified

User

Posted 13 Jun 2024 at 17:16

Originally Posted by: Online Community Member

hello i have new PSA result today (5.85 ng/ml) from AS and Gleason 6. 10x11 milimeters. Pirads 4. 52 yrs old men.

30/05/2022: 4.14 ng/ml
25/09/2023: 5.33 ng/ml
12/06/2024: 5.85 ng/ml

PSA rising 0.5 ng/ml in 8 months. Next week i have appointment with the urologist.
I have a bad body and my nerves are stuck in my stomach and I want to cry. Big s*** all this.

B.R.

That demonstrates that the cancer is not developing very fast - personally I wouldn’t be concerned about that ATM. However, at sometime development will speed up and you’ll need to make a decision. Have they suggested HT to slow down the development?

User

Posted 18 Jun 2024 at 18:26

Hello for now only AS is recommended.

User

Posted 22 Jun 2024 at 12:50

I was diagnosed gleason 6 about 3 weeks ago. Prior to my diagnosis I had pretty much decided on AS, if I was Gleason 6. On a fact finding visit to the Radiotherapy Team this week I was told a mistake had been made and I was actually Gleason 7 (3+4), which was (another) shock. However, I was pleasantly surprised when the most likely side effects (for my personal situation) were properly explained. I have BPH (66cc) and psa 5.5, so 3 months hormone treatment followed by 4 weeks IMRT/IGRT, 2 more months hormone treatment has been suggested. I'm weighing things up, but this potential exit strategy from AS has made me more relaxed and less anxious. Based on my experience alone, I'd suggest a chat about RT with a professional. I also have a prearranged meeting with a surgeon next week to discuss removal and staying on AS. Trying to keep an open mind till then, but as I say I felt much better after talking to the Radiotherapy Team.

User

Posted 22 Jun 2024 at 14:08

Just remember that the urologists almost always push for RP surgery and the oncologists almost always push for RT. It's the nature of the beast. The bottom line is that in most cases the results are the same - ie curative - but individual cases may respond better to one or the other treatments.

I found it hard to get a truly unbiased opinion as neither seem to communicate with each other and they each only fully understand their own speciality.

User

Posted 25 Jun 2024 at 11:14

A curious case just happened to me now...

In addition to the prostate I am on a follow-up program to monitor a pelvic cyst that requires annual pelvic MRIs.

In the MRI report from 2 weeks ago, the radiologist talks about the prostate as well and compares it with the results from 1 year ago.

Well, the surprise is that it says that I have triangular morphology lesions in both prostate lobes, compatible with prostatitis changes and that remain stable compared to the MRI from a year ago.

Between both pelvic MRIs, a multiparametric MRI in October 2023 was performed in another hospital due to a rise in PSA, which only saw a 10x11 millimeters (square) unique pseudonodular lesion in the left peripheral lobe.

Therefore... in different hospitals, with different radiologists, with different scanners, you see different things... and now what...?

This is crazy!!

User

Posted 30 Sep 2024 at 21:15

Hello again i have bad news... today i get my last psa result and is 35.80 mg/ml.

30/05/2022: 4.14 ng/ml
25/09/2023: 5.33 ng/ml
12/06/2024: 5.85 ng/ml

27/09/2024: 35.80 ng/ml

I am in Shock. To say that at the beginning of August for 2 weeks I had somewhat dark semen and I feel some slight discomfort in the perineal area. At the beginning of August my semen was somewhat dark for 2 weeks and then it returned to normal and for a few days now the semen has had a somewhat yellowish color. :(

What do you think of this sharp increase in the PSA level in just 3 months and diagnosed with Gleason 6 on active surveillance?

Thank u

Edited by member 30 Sep 2024 at 21:26 | Reason: Not specified

User

Posted 30 Sep 2024 at 23:49

Such a rapid rise could be an infection especially with the semen symptoms. It is very rare for prostate cancer to change so rapidly.

Dave

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