Gleason 6 RP right away?!

Hi, my understanding of PIRADS 4 is that it indicates most probably a cancer is there and a biopsy is needed.  I believe you're right in thinking that only a biopsy can determine how aggressive the cancer is.

As long as the MRI image shows that the tumour is contained in the prostate capsule then the whole range of treatments are available.  

With Gleason 6, Active Surveillance is a possible option, but it seems that at some point, treatment will be needed.  It's your dad's choice, but he might decide that AS is too anxiety provoking and intrusive in his life and he'd like to get it sorted.

The way you describe the doctor sounds like you're in America.  The practice there, is I hear, that doctors are paid for each patient they manage so each time a surgeon carries out an.operatiln, they're paid.  In that case a surgeon will want to push patients into having surgery, an oncologist will want to push patients into having radiation.

If you're in the UK, this is not the case.  Doctors are paid a salary for their time.  Usually in the NHS a prostate cancer case is discussed by a Multi Disciplinary Team comprised of different specialists and THEY suggest the treatment options.

If you're in the US then it's advisable if you can, to get a second opinion from an oncologist as well as a surgeon.

With a Gleason 6 particularly, there's no rush to go into treatment.  If your dad does decide to opt for treatment then he can take his time in making his own decision about what treatment suits him best.  This would of course entail getting as much information about each option as possible.

In summary, it sounds as if there's no great rush for your dad to have treatment, months rather than weeks if he wants treatment.  I can't say definitively if all options are open, but surgery doesn't sound like the only or even most suitable option.  Part of depends on what particular treatments are available where you live.

Thanks for your reply.

My dad could go through radiotherapy if that's what he wished for, in the next few years- and most likely will if PC progresses further. We'll do the whole AS diligently. He'll never agree to surgery unless it's a matter of life or death.

Our Dr. told us that once he goes through radio, surgery is out of question - had he agreed to go under the knife right away, "radiotherapy would be a trump card in case of recurrence" (his words). I find this misleading to say the least.

All sources I find online state clearly that (3+3) Gleason with a PSA under 10 is just to be monitored regularly 

Hi 

The Dr is correct. Once you've had radiotherapy, surgery is out of the question. Many men will opt to have prostatectomy, and hold radiotherapy as a back up should a rise in PSA occur and further treatment is required.

Whilst the Prostate is the prime target for radiotherapy, the treatment beam passes through the body completely, so as a result other organs can be affected. The planning for such treatment is designed in such a way that the other organs nearby receive as little radiation as possible.

My radiotherapy, of which this was my only option, targeted my prostate, seminal vesicles, and lymph nodes. To do so, part of my bladder, and bowel were in the treatment area, as could my spine. It's now on my records as a warning to any surgeon I may meet in the future, as surgery in my pelvic region is compromised to some degree by my radiotherapy..

The final decision for treatment will be your fathers. Whether he chooses AS, surgery, or radiotherapy, and when are his to chose.

Best wishes to you both.

Is that the case with brachytherapy as well?

I don't understand why would someone want to address a low-risk Gleason 6 with surgery or therapy right away, other than for psychological factors.

Hi

My situation is similar to your dad's.

After my diagnosis I got conflicting advice from different medics. I did a lot of research myself, including reading hundreds of postings on this site, and I concluded that a Gleason 6 is something that you need to keep an eye on.

I'm in my third year of Active Surveillance. Please see my profile.

Best wishes.

Just read your profile, Mr. David.

Pretty similar indeed. My dad won't go through another biopsy unless it is extremely necessary. Antibiotics taken during and after biopsy are far from harmless -  have you seen Ciprofloxacin side effects? If you can detect changes through regular AS exams (PET PSMA, MRI, PSA) then that looks like the way to go.

No cashgrab for oncologists and surgeons >:-(

Hi Arv

The reason some people go for surgery or RT straightaway is because they just want the cancer got rid of, everyone is different.

I went on active surveillance for 4 years which worked out ok for me.

If someone is going on AS I would just say that the tumour should not be near the edge of the prostate capsule but then the specialist would be aware of that..

Steve

What pushed you into doing radio? Do you regret it? Would you rather go under surgery if you could go back in time?

I suppose that they did try and push me into surgery but decided against it.

Many concerns about RT but I was worrying needlessly as it was not nearly as bad as I had anticipated

Steve

 Arvoisa88

I have no experience of brachytherapy, so I cannot comment. I'm sure that there is someone here that has had brachytherapy. You may have to sift through some earlier posts here in the group.

Chris