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Had a biopsy and diagnosed with prostate cancer. What is the treatment?

May 2014
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Practicing since : 2002
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To help me in coming to an informed decision. In January 2011 Prostate MRI scan indicated possible small tumour. Prostate Cancer diagnosed on biopsy, found in left lobe only. 3+3Gleason Scale, cancer cells in 20% of 12 samples. Stage 1, PSA 1.2. Active monitoring. October 2013, went for second biopsy. Between the first biopsy in 2011 and my second biopsy last month my PSA was taken around a dozen times ranging up and down between 0.9 to 1.7. Several DRE's revealed mildly enlarged prostate but soft. A second prostate MRI also in October 2013, resulted in mildly enlarged prostate, but otherwise unremarkable!! My second biopsy has again been diagnosed at XXXXXXX 3+3, but now in both lobes and in 60% of 12 samples. Last PSA was 1.4. My Consultant Urologist has asked me to start thinking about treatments (Beam Radiotherapy, Radioactive seeding, or Surgery and in the meantime, he will arrange an appointment with an Oncologist. ''My'' conclusion is that I should never had a biopsy in the first place, as the tumour was so small at around 4mm and the grade and staging very low. The Oncologist at that time revealed that he had difficulty in classing it as cancer. I am aware that he may have wanted to lighten the blow! I feel that as a consequence of 12 biopsy samples being taken from both lobes, the procedure would obviously have caused this proliferation. How could it not, as it's not rocket science. I did say this to the Urologist at the time, but he astutely avoided answering the question. I now have the dilemma of making a choice to have what treatment, or just to continue with active monitoring. With treatment, a high chance of a cure, but with all the possible consequences that can go with it ie. incontinence, impotence and so on. Without it, a possibility that it spreads outwith and I then have serious consequences, or a possibility that it doesn't and that I live healthily for the next 10-15 years and die of something else. I have read much about it and there appears to be opposing schools of thought on the treatment of "Gleason 6" particularly differences between the USA and the UK. I would appreciate your take on it.
Posted Mon, 25 Nov 2013 in Urinary and Bladder Problems
Answered by Dr. Vivek Chail 4 hours later
Brief Answer: Please find detailed answer below Detailed Answer: HI, Thanks for writing in to us. I have read through your query in detail and understand the dilemma you are facing having been told that your score is Gleason 3+3. Also the number of investigations confirm a relatively stable disease. Stage I disease in prostate cancer relates to, I quote: T1, N0, M0, Gleason score 6 or less, PSA less than 10: The doctor can't feel the tumor or see it with an imaging test such as transrectal ultrasound (it was either found during a transurethral resection or was diagnosed by needle biopsy done for a high PSA) [T1]. The cancer is still within the prostate and has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Gleason score is 6 or less and the PSA level is less than 10. OR T2a, N0, M0, Gleason score 6 or less, PSA less than 10: The tumor can be felt by digital rectal exam or seen with imaging such as transrectal ultrasound and is in one half or less of only one side (left or right) of your prostate [T2a]. The cancer is still within the prostate and has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Gleason score is 6 or less and the PSA level is less than 10. There is recent review of medical literature done in 2012 for patients like you (Gleason 6 and PSA normal with no significant symptoms of disease). This has been done keeping in mind three thoughts, that patients receive the proper counseling/treatment; two, reduce the risk of overtreatment and its associated harms; and three, improve shared decision making. This study was done at XXXXXXX XXXXXXX and their approach was in modifying the Gleason score and emphasizing the indolent behavior of Gleason 6 Tumors. It is mentioned and I quote "Gleason score 6 should be considered in the context of a prognostic category of 1 of 5, not 6 of 10. In addition, the reporting emphasizes that based on the conclusions of a recent National Institutes of Health Consensus Conference, those men with low-risk disease (Gleason score 6, PSA < 10 ng/mL, and clinical stage T1c to T2a) who are untreated have a similar cancer-specific survival when compared with those treated over 10 to 15 years after diagnosis. It is hoped that this will alleviate some of the fear associated with a diagnosis of Gleason score 6 “cancer” and give patients a more realistic perspective regarding their prognosis whether treated or not." This article may be found using the link: WWW.WWWW.WW Since it is a research done recently and at an important institute, it can be considered acceptable. Though medicine is an ever changing field, we need to upgrade ourselves with current research and developments and review newer updates to treatment. Hope your query is answered. Do write back in case of doubts. Regards, Dr.Vivek
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