Prostate Cancer Community

I was in your situation in July, 2010. My urologist suggested a biopsy when my PSA went from 2.9 to 4.2. My gleason score was 6 and only 1 needle was positive. Take the time to explore all of your options. I would certainly get a second reading of the biospy, Johns Hopkins is a wonderful facility to have this done.

I explored radiation, surgery and seed implants. I chose to have robotic surgery and it will be a week this monday that it was done.

I am 56 and in good health as well. This cancer is not going away or going to get better. Use this time wisely. I am very pleased so far with the robotic surgery. Go to someone who has done thousands of them, not a local urologist. My outcome has been excellent so far, having the "diagnosis" hanging over your head for a year is not very pleasant to do either.

I went for years having my PSA slowly rise. After a biopsy with a Gleason of 3 4 and hearing about proton therapy, which is more precise than conventional x-radiation, I consulted a proton therapy center and had the treatment. It was a totally pleasant experience with no pain and no side effects, and that was almost two years ago. I suggest that you investigate it before you commit to surgery, which can have very unpleasant side effects.

While I am not permitted, in this forum, to provide specific medical advice, please know that your scenario is very, very common. In the PSA Era, many men are diagnosed with very early stage prostate cancer, such as having only one biopsy core positive for cancer and having a low (less than or equal to 6) Gleason grade. I assume your PSA level is also less than 10.0ng/ml and that the doctor could not feel a lump or nodule on your prostate when he/she did the digital rectal exam? If all these factors are favorable, (ie. Gleason 6 or less; PSA less than 10ng/ml; and a clinical stage T1c-nonpalpable tumor) then you have "Low Risk" prostate cancer and have a very high chance that the cancer is confined to the prostate gland and you would have an outstanding long term prognosis with treatments, such as surgery or radiation.

Treatment with active surveillance or watchful waiting is also becoming more commonly done by men with low risk disease. In general, this approach is best for men who have a more limited life expectancy of less than 10-15 years. You describe yourself as in "decent health" which could mean that you have more or less of a chance to survive more than 15 more years. If you do choose active surveillance, it is important to realize that it is a commitment. You will need to be seen regularly every 4-6 months for a check-up with a PSA test and a digital rectal examination (DRE). You will also likely need periodic repeat prostate biopsies-some doctors recommend repeat biopsies every year. You also run the risk of losing your window of opportunity for a cure of the cancer if it starts to spread in an occult way. Doctors around the world are still learning about how best to do active surveillance and a number of ongoing multicenter studies are further examining the best way to monitor men who are being followed without treatment. The bottom line is taking an honest assessment about your overall health and making a sound decision working with your doctors and your family.

Best wishes with your decision.

Dr. Moul

What did you ultimately decide to do? My situation is very similar to yours. I was told just this week that I too have prostrate cancer. My Gleason score is 6. Only 1 of 12 biopsies showed positive. My doctor recommends removal of the prostate via da Vinci robotic surgery. I am 52, have diabetes type 2 (controlled) and in reasonably good health. Seems like proton therapy would be less invasive and present less risk of having long-term side-effects. My doctor says the advantage of prostrate removal surgery is that there is no future risk of the cancer coming back versus a treatment that does not remove the prostrate.

There is ALWAYS risk of the cancer coming back, no matter what treatment you have..97% of the Gleason 6 guys live to die of something else regardless of what form of treatment they choose..Surgery or radiation produce the same results..So now it becomes a side-effect / cost choice..

Everyone should know you can't rely 100% on your biopsy results..When men choose surgery and the entire gland is removed and biopsied, about 40% of the time the cancer is found to be worse that the original needle biopsy suggested, more extensive and/or higher Gleason grade...This can be a death-trap for men who choose 'Watchful Waiting" thinking they have non-threatening, indolent cancer..

Yes, Active Surveillance, AS, IS a good choice for MANY men, but you must take steps to insure as much as possible that there is no high-grade cancer lurking undetected...A 40 core saturation biopsy is a good place to start..