Gleason 7 (4+3), PSA is less than 1, and 78 years old. Doctor recommends active surveillance?

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In November my father was diagnosed with prostate cancer following a TURP surgery.

His Gleason score was 7 (4+3) and today, we were advised by the doctor that his PSA is LESS than 1.

The doctor is completely against the idea of a radical prostatectomy and is recommending active surveillance. So my dad would have to get his PSA done every 6 months.

I'm not quite sure how I feel about this, since based on what I've read, my father has a Gleason score of 7, which is based on a 4+3 and NOT a 3+4 (these two scores are VERY different) and a 4+3 is more aggressive and likely to spread.

When I asked the doctor about this Gleason score and the PSA results, he said that if my dad was younger (say, 40's or 50's), he'd recommend my father having his prostate out immediately - no questions asked.

In one way, my father was relieved because he trusts this doctor's advice and although initially he wanted the cancer removed, is happy that he doesn't have to go through surgery/a prostatectomy.

On the other hand, he doesn't like that he has to live with the cancer.

The thing is, if the Gleason score was lower 6 or under, I wouldn't be wondering or worrying so much about this doctor's advice. But something just doesn't sit right with me under the circumstances.

Has anyone had a similar Gleason score, PSA test results and then had the doctor recommend active surveillance?

This is also a frustrating situation for me, because I feel like I'm the only one researching and reading since my father's diagnosis. And my dad has not done ANY research. And if by chance I find something even a little negative, he doesn't want to hear it and buries his head in the sand. It's like he wants to know, but at the same time doesn't.

My dad is relieved and happy with the doctor's appointment today (he was expecting his PSA test results to be through the roof, and was going into the doctor's with this mindset that his life was over - it's been a tough 1.5 months since the prostate cancer diagnosis! For him and us, as his family).

But I do think he should get a second opinion.

Anyone find themselves in a similar scenario?

Thanks in advance.

~F.

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14 Replies

  • Posted

    My PSA was at 4 and I started seeing it rising steadily. My doctor recommended active surveillance for me as well and saw my score as high as 12. I had several biopsies performed as well during this time period and there were cancerous cells located in the center of the prostate so it was not spreading outside the stated area which can become dangerous.

    I finally decided to have Cyberknife radiation treatments that consist only of five high powered treatments. My score is now at 0.77 and I am 71 years old. I, not being a physician, do not think complete removal of prostate is always necessary with the many options to stop the spread of cancer.

    Best of luck to your Dad.

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  • Posted

    It sounds perfectly sensible. to me. I can quite understand your Father's wish to just get rid of his prostrate. I was 74 when I was diagnosed with PS and had a similar result but a rising psa of about 8 and my first reaction was to have surgery to get the cancer as far away from me as possible! Following discussions with the PC team I accepted that the best way forward was the hormone treatment followed up with RT. that was nearly four years ago and my psa has been at about .1 since the completion of the treatment with the most recent test just in. Any treatment has its dangers and side effects but the route that I took worked well and the side effects quite easy to deal with. I count myself very fortunate in the circumstances! Good luck, Richard

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  • Posted

    I was diagnosed with exactly the same grade 7 (4+3) in 2018 and was recommended to have treatment. I researched and questioned consultants. The radiation one wanted to pursue that but there can be side effects from the radiation, depending on the method used . The Surgeon wanted to cut but I did not want something that rendered me impotent. In the end I was fortunate to be able to get Pencil Beam Proton Therapy, which was private as not available on the NHS, here in the UK.

    You are right that leaving it is not an option but it was slow enough to give time to look into options. If I had not had Proton Therapy I would have gone for Brachytherapy which is localised radiation treatment.

    My PSA was at 6 and I have had 4 tests since treatment in late 2018. The most recent was just 0.12 so I am now on 6 monthly reviews and very happy with the treatment.

    Wish your Dad good luck but if his PSA is now 1 then I guess that his Dr is correct and keep checking. I know someone who put off going to his Dr at all, and it had spread outside the Prostate.

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    • Posted

      Thank you for sharing your experience, dennis. We're still in the very early stages of exploring options. My dad is actually going to be getting, at least, a second opinion from a hospital and oncologist there that specializes in prostate cancer treatment.

      I'm glad to hear you're doing well that you're happy with the treatment you chose.

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  • Posted

    You are good to help your dad with researching this problem. At his age, I would not think removal would be his best option. The active surveillance sounds like a viable option - especially at his age. I do understand his fear of knowing that there is cancer in his body and wanting to get rid of it. Is his overall health good? If so, look at all your options. I had a situation when I was diagnoses 3 years ago. I had a PSA of 5.6. I had a biopsy done that showed 2 out of 12 core samples had cancer cells. Fortunately the cell type was a non aggressive slow growing. So I had time to research. My doctor told me that I could do the active surveillance as a choice, or look at other options. I didn't like the fact that I had cancer in my body, and if I could get rid of it, that would be my choice. I considered radiation therapy which I have heard from others had good results. I am in my mid 60's. One of my friends retired from the Cancer Research Center where she was a director in the the radiation area. She told me about her uncle that was in his early 80's that had the radiation therapy for prostate cancer... and he is fine now... and in his late 80's. She also told me about something called Brachytherapy - low dose radiation seed implants. It is a one time treatment done as an outpatient. It takes about 45 minutes. She put me in touch with a doctor that she used to work with so he could discuss options with me. That really helped me decide what to do. There are side effects with most any treatment - Brachytherapy seemed to have the least. So that is what I did. It has been nearly 4 years for me and I am fine. My last PSA test was 0.9. The proton therapy discussed below also sounds like a great option for your dad too. If your dad's overall health is good, look at your options for treatment.

    Good luck to you and your dad.

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  • Posted

    Hi Francesca,

    I agree with the majority view that at 78, major treatment is not indicated.

    Certainly not radical surgery, even more so if your Dad has other health issues.

    A Gleason 4+3 means that he has cancer but the speed of its progression is the key to deciding on treatment, not just the Gleason score.

    If I were him I would have another PSA test in 3 months. If it rises quickly then consider treatment, if not then wait another 3 months for another PSA test.

    As for treatment, I have a 90 acquaintance (who is a GP) who at 86 began hormone therapy for PCa, but I can't recall the Gleason score. I bet it was 4+3 or worse. It would be, IMHO, so wrong to suggest radical surgery for anyone of your Dad's age when other options are available.

    Best Wishes,

    Barney, age 53 Gleason 9

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    • Posted

      Hi Barney, I hear you. I have reservations about my dad having a RP, too. As soon as he was diagnosed, he wanted the cancer surgically removed immediately, which is a typical and understandable response for anyone diagnosed with cancer.

      We're still in the somewhat early stages of reading about and researching prostate cancer and various treatment options. I did, however, read a book by Dr. Patrick Walsh regarding prostate cancer between when my father was diagnosed in November, 2019, and when he received his PSA test results this month. In his book, Dr. Walsh, an expert in this field, advises against active surveillance for someone with my dad's Gleason score, yet active surveillance is exactly what my father's doctor recommended. Further to this, his doctor is recommending my father have his PSA test done every 6 months, and not every 3 months. In my opinion, I do not believe his doctor his dealing with his case the way he should be. I think his doctor's office should be doing more to assist him and therefore, did some digging and was advised by another doctor that my dad "needs a new doctor". Whether or not this is the case is anyone's guess, but the oncologist who we meet with to obtain the second opinion from will be very telling.

      What was heartbreaking, was leaving that doctor's appointment a week ago where my dad felt relieved after his doctor told him about his LOW (below 1) PSA and the doctor recommending active surveillance, to me having to tell my dad that I was questioning his doctor based on what I've read and his suggestions, and that he should get, at the very least, a second opinion. It wasn't easy to do, but I couldn't sit there knowing this information and not share it with him.

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    • Posted

      Your Dad's doctor is suggesting treatment based on his experience with PCa patients. The more experience a doctor has, the better the advice given.

      The reason many offer 6 month and not 3 month PSA checks is the belief that 3 monthly checks will drive a patient mad.

      A low PSA in say 2 or 3 three monthly tests would indicate that surveillance is a good bet.

      I agree with your point on obtaining a second opinion.

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  • Posted

    Frances, my urologist/oncologist does a DRE and PSA check every 6 months. He hasn't mentioned doing another biopsy - which is no fun at all. As my PSA continues to drop, and the DRE is always normal no biopsy would be necessary. I know that having a cancer diagnosis is really scary and like you and your dad, if there is a way to get rid of it - that is the best solution. My doctor directed me to a couple of websites where I could do some search on various treatment options and their success rates. Here is a link to one that I thought was pretty informative. prostatecancerfree.org/

    Check it out...

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  • Posted

    Hello Frances,

    At the age of 64 I was diagnosed with PC with PSA 11 and Gleason 9 .At the beginning of 2005 I underwent a series of Zoladex implants through to Sept 2005. Between mid April and mid June 2005 I also underwent 40 shots of radiation. At Sept 2005 my PSA was 0.2 and remained like that more or less until 2010-2011 when my PSA rose to 9.0. I was again then given Zoladex implant. I have undergone such treatment lasting 10-12 months 3 times since 2011. My Oncologist tells me that it is impossible to have Gleason 9.0 after undergoing radiation therapy and I have not had a biopsy since Dec 2004.

    I have just passed my 79th birthday. I underwent a TURP operation in July 2019 due to enlarging prostate. I am, I hope temporally, bladder incontinent at the moment but I am hopeful that it will come right and I can then return again to my active life. My wife is longing to see our new G.Grandchilren in Australia but at the moment it is too cumbersome to travel such distances when bladder control is difficult.

    I hope my experience gives you some comfort. If I can help just write and I will do my best

    Regards

    G

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