surgery vs. active surveillance

[BaldiR]

I am 67 years old and in good health. After a PSA of 6.6 and a firmness observed in a DRE, my biopsy showed a high-grade prostatic intraepithelial neoplasia in the left apex; and a Adenocarcinoma, Gleason score 3+3 tumor size <.1 cm of length of core biopsy in the right apex. The other 10 samples were benign prostatic tissue.

The comment was
“The core biopsies showed a focus of atypical glands. They are small to medium in size and crowed. The nuclei are modestly enlared with occasional nucleoli. A small battery of immunohistochemical stains was performed to clarify the focus. The glands in question do show positive cytoplasmic staining for racemase. A basal cell layer is not evident with p63 or high molecular weight cytokeratin. We felt the changes were most consistent with adenocarcinoma but the pattern was slightly unusual overall.” A second opinion by Dr. Netto at Johns Hopkins agreed that this represented a small focus of adenocarcinoma and this tumor has features of pseudohyperplastic carcinoma”.

IS ACTIVE SURVEILLANCE A REASONABLE ALTERNATIVE? WHAT ARE THE ODDS THAT WAITING WOULD ALLOW THE CANCER TO SPREAD BEYOND THE PROSTATE?

[HeinrikMD]

Hi,

Based on your PSA and the Gleason grade then it seems that expectant management is a reasonable option. Another thing to find out is how bulky is the disease, and whether it has not broken out of the prostate. If this is not so, then it is reasonable to do expectant management.
You should discuss this decision with your doctor at length. There will be changes with the prostate over time, you shouldn’t think it will be completely stable. One of the difficulties is deciding when to do an intervention. Some men would wait for the symptoms, others may want to intervene earlier – should certain blood tests become no longer reassuring. There are limitations to either decision and on the data to support either side. At the end of it, each man must set his threshold for acceptable risk.
Since you are classified as low risk, then your odds for being alive at 10 years are the same as for those who choose surgery or radiation AT THIS TIME POINT. Over time, it may become clearer, whether you really have low risk disease, and hence monitoring becomes important, and your odds would of course also change over time.
Stay positive.

[BaldiR]

I couldn't find your name among the doctors.
Could you please indicate if you are an MD
and what your profile is? Thanks.

[BaldiR]

Thanks so much for you time.
As far as I know, the firmness hasn't broken out of the prostate.
Do you any data relevant to the relationship between green laser surgery
for BPH and development of cancer post-op?