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Harvard Health Blog
Early-stage prostate cancer: Treat or wait?
- By Marc Garnick, MD, Editor in Chief, HarvardProstateKnowledge.org
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
eugene one of my 14 cores had 5% cancer cells,doctor said surveillance I have high anxiety over this,3 months later PSA 4.56doctor says I will not die from this. How do you become cancer free ??
I am 58 had Psa level 10 last year did 16 poke biospsy no cancer. Follow up psa almost year latter level up to 16. Now doc order mri then mri driven biopsy. I see on site most have levels in 6 to 8 range and have cancer anybody have high psa and not have cancer out there. I think I rather see what happens especially if I have cxncer n spread outside of prostate then what point of taking on all the complications?? Of removing it if already spread. Anybody take out prostate and and not experienced the bad side effects or it for sure?
I am 65 years old and my PSA is 5.1 I have done 2 retests in the last 2 months and my result has not changed Urol ordered biopsy. I had Prostate Biopsy in 2007 which was negative. I know I have an enlarged Prostate and have been taking medication for it. I have been told that the Prostate medicine can elevate a PSA test. I have also been told that constant bike riding could effect it. Do I really need biopopsy ?
Is there a more recent report please ? The information in this article is excellent thank you
I have low grade prostate cancer I am 74. My PSA has gone up from 7 to 12, I have had a bad cough for 2 weeks after flying home from vacation could that causeit to rise?
My PSA 2.1 6/29/16, 5.54 4/26/17, 4.29 8/30/17 6.7 3/7/18. MRI clean, CT Scan with contrast clean, Biopsy Gleason 6. They want to do another biopsy. First one took 14 with 3 showing something. Doctor performed rectal examine before blood drawn on the high readings. The 4.29 was without rectal examine. Could the rectal examine raise the PSA level?
My Gleason score is 3+4 how ever I went to surgery removing my prostate do you think I still have cancer
I just received the results of my biopsy and was diagnosed with early stage prostate cancer. 6 samples were positive with Gleason scores of 6 ( 3 + 3 ) My Dr. even though a surgeon recommended that I take my time and suggest that I investigate Radiation as an alternative to surgery. He definitely was not a fan of HIFU based on a lack of historical data. Your article was very helpful along with this Blog but still confusing at best as to what alternative I should seek. I am recently retired at 64 years old and looking for any advice you can send my way. My wife based on family history is of the belief of just get it out. Thank you
Just diagnosed with same diagnosis and Circumstances as you. Any help or advice is greatly appreciated !
I have moderate Gleason, psa fairly low 4+,small tumors on one side. Went to the big city for 2d opinion #1 survelliance [internet opinion with review of biopsy records], #2″ Hifu”[high intensity focused ultrasound] Docters who offered this lost my confidence because they did not tell me that this is not an accepted procedure for prostate cancer by most of the medical community . Their office people were also coached to keep me in the dark regarding the cost to me which is 25 G’s+.When I asked the cost, they said”no one really knows what a insurance company will pay” This is pure BS.It is not approved yet for cancer- they pay nothing! Brachiatherapy is still the accepted norm for moderate cancer,by my research[NCCN.org and Medscape.com], and has been proven, although these guys consider it obsolete and give a low risk man like myself only the option of focused radiation or surgical removal in addition to the Hifu. I’m going back to my small town urologist who is skilled and ethical. May consider observation only. In my case, my research is indicating that I should not get in too much of a hurry.I am 68, very fit,from heredity possibly will live another 20 years so, I’m not sure if I want this hanging over me, for that long, but research seems to show that radical treatment may not make a difference in the final outcome regarding a case like mine.
I was diagnosed with early stage Gleason 6, t1c in May 2009. Confirmed by three different opinions. My PSA was 4.6 ng/ml. I am now 65 years old and have been on watchful waiting for the last 8 years. I have PSA test every 6 months. My last was November, 2017 and my score was 2.6. I am due for another PSA test in March or April, 2018. After diagnosis in 2009, I made radical changes to my diet and stress level. I am hoping to continue watchful waiting, but if PSA goes over 5, I will find a treatment.
I suggest reading a book called “THE GREAT PROSTATE HOAX” by Richard J. Ablin, PhD who invented the PSA test. PSA does not detect prostate cancer simply it is not a cancer-specific marker. Biopsy test disturbs the gland. You do not want to awaken up the giant!
What are the risks of having the initial biopsy through the bowel wall – have heard reports from a couple of people that this caused an infection and the patients died as a result?
My husband was diagnosed in 1995 at age 49. His PSA was 4 and the tumor could not be felt on DRE. I no longer remember all the staging/grading numbers, but he had a radical prostatectomy. He suffered some incontinence for a while, but not long term, and he did suffer erectile dysfunction and later had a prosthesis surgically implanted. However, the point is, he is now almost 71, and continues to get a 0 PSA every year. I’m checking out this website for info for his brother who age 69 has just been diagnosed with stage 1, level 7 prostate cancer. Surgery has been offered as an option. I’m not sure I understand his hesitancy.
I am 68 physician in very good health PSA 4.1/4.4 biopsy 3 out of 12 positive, 5% or less involvement. one small area is 3+4, but the 4 the pathologist says is even very small and very early stages, ( he is a personal friend and emphasis how small area it was and that changes where early if they were there, but he wanted to say 4 with that comment). whats next ?
I’m 73, good health with no under laying conditions with a PSA 6.4. Prostate Volume 32.4, Nothing found on DRE or ultrasound. PSA density 0.2. Biopsy on Dec 13,2017,12 needles, 0 on the right side, LH base Gleason score 3+4=7 in 1 out of 1 core involving 30%. LH lateral medium, 3+4 involving 20% & LH lateral 3+4 out of 1 core involving 30%.
I’m coming to grips with the Radical Prostatectomy and I was looking for feedback on this choice. Help & suggestions are very welcome.
71 yo. PSA in Oct ’17 was 9.8 experiencing ED, weak stream, night time pit stops. 4KScore test result was 38% and doc said it would be best for biopsy. That is taking place Jan. 3. Trying to get as much info as possible and realize there is no “do this then this and all is well”. Appreciate all the comments I’ve read so far. Will try to keep updating as I gather information. At least learning to ask some of the best questions.
Biopsy revealed five of 12 core samples cancerous, Gleason score 6, T1C, currently Sedentary lifestyle due to other medical conditions. Dr. said could live 10 to 15 more years with no action, currently 60 years old. Please advise best you can and include information regarding FDA approval of HUFI for low aggressive prostate cancer like mine. Thank you.
Has the FDA approved the HUFI procedure for prostate cancer like mine which is Gleason six, T1C, five of 12 for samples cancerous, Dr. said if I did nothing probably live 10 to 15 years, I am 60 I don’t have existing medical problems that have me housebound/sedentary. Have family history but at much more aggressive levels. Please advise best you can!
I had a rising PSA 2.2 to 3.2 over 4 years, had a PHI test showing 55%, MRI scan showing a small mass, then biopsy 2 of 20 cores had 5% cancer cells and given a Gleason score of 3+4=7.recommended for Di Vinci procedure.
I am 69 with PSA scores averaging .8 over a 10 years of active surveillance. Biopsies have indicated cancer exclusively on the right side. Gleason scores have been 3+3=6 in the base, mid, and apex. Last biopsy indicated 3+4=7 in the mid-apex. I am going to have another biopsy in January 2018. My doctor and consulting oncologist must think of me as the patient from hell, because I ask so many questions. Admittedly, I have been dragging my feet on treatment. I can’t understand why my entire prostate needs to be removed/destroyed rather than just the side with cancer. I am scared to death of the possible side effects of treatment.
I was just diagnosed with PC. My PSA increased from 4.2 to 5.2 over a few months. I had a biopsy 10/17 and my Gleason is 4+3=7. 4 of 12 cores had cancer, 3 were 3+4 with low % but one was 4+3=7 with 35%.
My Urologist (who performs Di Vinci robotic) recommends surgery. I am leaning toward the robotic surgery but worried about the incontinence side effects.
I am wondering if surgery is the best method to cure my situation vs radiation seeds.
PSA started to go up and eventually was going up 1 point per month to 10.6. Biopsy was Gleason 4+4=8 but M.D. Anderson reread it as Gleason 4+3=7. That meant I could qualify for a clinical trial of double strength proton treatments M-W-F instead of the regular single strength M-T-W-T-F. After a 6 month Lupron shot to reduce testosterone that feeds the cancer, I had 15 treatments that apparently cured it with no side effects, a particular advantage of protons. I still have to go back every 3 months for a PSA test to make sure the numbers stay low.
This is great general information, but if you’re looking for something outside of the orthodox treatment methods, you’re going to have to find it on your own. I’ve been researching health for some years now, and most breakthroughs are not going to be revealed to the masses. Do an internet search for smashcancer for more information on cancer and how to beat it.
Recently diagnosed with gleason 6, 1 of 10 cores no DRE – PSA was 6.6 at ttime of diagnosis (rapid psa acceleration from 4.1 in August of 2016, Feb 5.1, April 6.0) after a week on antibiotics and psa still rising -urologist rule out infection and recommended biopsy in May 2017 in which we found the PC. Researching and trying to find the best and most recent data and recommendations for treatment as url did nto offer much and suggested I speak wit a radiology oncologist, surgeon that specializes in prostate cancer – which i am trying to find the best = also learning that a urologic oncologist with those specialties may be the way to go whether surgeon or radiologist but will suggest the latest testing and diagnostic assessments to determine risk of future aggression or other cancer missed on biopsy. Also learning that you must do your own research and question everything, keep reaching out to experts, organizations and most importantly patients and people that can share –
information and learning – any other advice out there ?
My PSA has been rising over the past five years. Small amounts though. I am 67 and PSA is up to 6.4.It was 5 a year ago and I had a biopsy. Gleason 6 said my Uro, Nothing to worry about. This year it is 6.4 and he wants me to Come in and discuss my PSA history. Is this just a ploy for a visit or, could it be important. I believe he is am excellent Dr.
PSA 4.2. Gleason 6. Biopsy 2 sections with cancer 1-5% 1-15%
Digital – negative
Totally confused by avaible inf
Get comfortable with watchful survailance and then see article against it
Thankful that my numbers appear low ; but confused and intimidated.
Had 2 growths biopsied, the smaller one 1±2=3, second one was 3+4=7. Not want prostate removed but thinking of radiation, as side effects of removal greatly outweigh the need. Lifetime incontinence being major treason. I’m 66, with healthy sex life.
Need know my best options please?
Thanks for very informative article. I am recovering from TURP procedure as a result of enlarged prostate and difficulty urinating. PSA of 2 and rectal exam before the operation indicated no cancer but biopsy after TURP showed Gleason of 3+3. What further testing and treatment is recommended? Many thanks, Mike
PS. Jay, my PSA is 5.08. Arnold
Hello Jay, I am age 65, Gleason 3+3, one core 5%, one core pre-cancerous, diagnosed in Jan. 2017. Have opted for AS, semi-annual PSA, annual biopsy. As you must be doing, I am reading a lot and learning, I find the side effects of some treatments to be alarming so am taking a cautious approach. Fortunately I have a terrific doctor and have completely put my faith in him. Be well and good luck.
My PSA is 5.2, an MP MRI was nagative, but a TRUS biopsy showed 1 of 12 cores 3% positive, with a Gleason of 3+3+6. My uro favors AS with semi-annual PSAs and an annual biopsy. And I tend to agree, though I am looking into cyberknife if needed if this progresses. I am 73 and otherwise in good health. What do you folks think? All responses appreciated.
Just received notification today that the results from my prostate Biopsy showed five spots out of 12 were cancerous. Therefore, I am doing as much research on various treatments and side effects so that I can formulate questions to ask my doctor.
Beware of scalpel-happy urologists, who are ready to start carving up your nether regions even before a biopsy confirmation of cancer.
Of course, performing radical p-ectomies are how they pay for ski villas & boats, but they also want to keep their skills sharp.
Get a 2nd or 3rd opinion before any surgery and READ READ READ to inform yourself.
Know your Gleason score, Stage, & PSA and remind your MD of his Hippocratic Oath:
First , Do No Harm
I agree 100% if I could have my time over again I’d still have a prostrate and ” normal ” lifestyle
Beware of scalpel-happy urologists!
They’re eager to start cutting up your nether regions even before a biopsy.
Of course that’s how they pay for ski villas & boats, but also need to keep their skills sharp.
Get a 2nd or 3Rd opinion and READ READ READ to inform yourself.
Know your Gleason , Stage & PSA & remind your Dr of his Hippocratic Oath:
First Do No Harm
I am a 70 years old and I had a biopsy with a Gleason 6 score, but my PSA is 20.7. Am I still a candidate for Active Surveillance?
After a biopsy 23jan 2017,Gleason score 3+3=6 and 3+4=7. Originally my P s a was 5.7 feb,2016 now at 3.5 does it matter at this point? What’s my best option besides surgery? Thank you
My dad is 87 and his Gleason score is 5+5 has started on hormonal therapy there is a tumor in his bladder bur no cancer in his bones. Doctors are saying if the hormonal therapy is a success he can have 10 years added to his life.. after reading this I feel like we are treating not curing is this correct?
My boyfriend is young (46) and has a psa of 51. He has cancer and more test to determine if it has spread. We obviously want to him cancer free and not incontinent but our sex life is very important. What is the best suggestion for treatment?
Just diagnosed with stage t1c, Gleason 6 (3+3), but high volume: 6 areas biopsied, 60% in one, 50% in on, 20% in one, 5% in one, less than 1 % in one and 0 in the last. The two options recommended where Active surveillance and surgery. Radiation is not an option because of ulcerative proctitis. Has anyone had to make a similar decision with low grade, low stage, high-volume prostate cancer?
Yes i have first psa was7then doneanother in a month and it was5doctor recommend getting it out kind of leaning that way since I’m53 and the side affects are good dad got it hey radiation cancer came back uncle have prostate removed he’s cancer-free both has leakage
My husband Gary obtained a second opinion after his urol advised more watchful waiting in Jan. 2016. In June 2016, we saw the second urol who ordered an MRI as PSA was up to 5.8. A targeted biopsy in October revealed that his Gleason is 7 (4+3), which is more aggressive than 3+3 or 3+4 . Laparoscopic robotic surgery followed by radiation is being recommended given that he is very young (54), is healthy but is considered high risk as his father and two brothers had/have it. After 3-4 years of bi annual PSA, DRE and now two biopsies, we are considering getting HIFU even thought it is not covered by OHIP. Really scared of radiation and hoping that HIFU plus lifestyle changes pay off. Thanks for the informative article.
Just had my PSA result levelled at 6 … After a brief discussion with my doctor I have opted for a biopsy .. I have read with interest and some trepidation and fear what prostate cancer is all about, so much to take in so many options and varying factors to take on board .. Depending on the biopsies results and my appointed consultants analysis whatever the outcome the next steps and or decisions appear to be in my hands … Catch 22 comes to mind … Fingers crossed .. We venture into a lot of unknowns, this article can only but help me with my ability to understand and convey my thoughts.
Thank you to date.
I had Gleason 6 in 5 cores and PSA of 4.5 and UROL wanted me to go under his CyberKnife for complete killing of my gland. I said no, I want to investigate. I had mpMRI done a few months later and it found a 16mm lesion in the apex area (where TRUS biopsy needles can’t reach!!) This lesion was focally biopsied with MRI guidance and it turns out to be a low aggression 3+4 Gleason 7. Only 20% showing 4. I am strongly considering MRI guided focal laser ablation, but issue is that insurance won’t cover it and cost is $20K out of pocket. But insurance will happily cover procedures that destroy your entire gland. What if insurance wouldn’t cover breast lumpectomy but only full breast removal? I believe women would revolt and we men should also!
Would you be able to email me?
I have similar diagnosis and would appreciate a conversation
I went from a Gleason 6 3-3 to a Gleason 7 3-4. My doc recommends a total immediate prostatectomy. My PSP as never varied between 1.9 and 2.1 in fours years. When I was first diagnosed my GP had found a hard spot during a digital exam and referred me to a urologist who biopsied and found 2 tumors, one each side at.a Gleason score of 6. Neither related to the hard spot. He recommended immediate chemical castration and radiation pills. I went to 3 additional urologist before I found one that actually recommended an MRI and active servalance. My understanding is that a 7 3-4 is virtually the same thing as a 6 3-3. Is this your understanding. I do not plan on following my doctors advice for surgery or radiation.
To all people with Gleason 6, PSA’s below around 6 and good low aggressive genetic marker tests… DO NOT let a urologist talk you into Cyberknife or other treatment until you have had a multi-parametric high-res MRI to see if there might be something worse that the TRUS biopsy (only 60% accurate) missed! If nothing higher than Gleason 6 is found in mpMRI, then DO NOTHING and enjoy life and have a semi-annual PSA! Best advice you will get and comes from a LOT of due diligence.
I stumbled across this article while researching exactly what it means when prostate cancer has escaped the capsule. I cannot stress enough about the PSA levels. My dad is battling cancer which was initially treated twice as an infection due to low PSA levels. Months later when a biopsy was performed, he had cancer in 6, potentially 7 of the 12 areas biopsied. Within 1.5 months had robotic surgery to remove prostate yet the cancer still had escaped the capsule. We will find out next steps from radiologist in the AM. I shared this article to stress how the PSA #s do not necessarily directly correlated to cancer. And 2nd opinions is a wise decision. It’s not worth risking your life in hopes the doctor you have knows best.
I have6out of12 would you recommend the surgery
Das ist ja super, dass es schon bei einigen eingetroffen ist und ich freue mich riesig, dass es euch gefÃ¤llt. Wir haben uns bei diesem Kit wirklich sehr viel MÃ¼he gegeben :)Viel Spass beim StrpKeln!!mathaeina x
MY father(age 65 years) recently diagnosed with prostste cancer.It was identified through TRUS biopsy guided by PET CT SCAN.
PSA level is 1.66
the gleason score is 3+3,and doctor is recommending cyberknife technology of radiation.
actually which method of treatment is better -surgery/radiation/cyberknife technology.
can you please suggest me the best method of treatment for early stage of prostste cancer.
PTEN FISH testing is also an option for discovering the loss of the tumor suppressor gene PTEN. IF lost, there is little to suppress the growth of the tumor.
Also a Johns Hopkins study discovered that amplification of the ERG gene in prostate cancer results in twice the likelihood of aggressive disease progression outside the prostate.
This article helps bring everything into perspective. Since this article was last reviewed (04/2011) there is new technology, the Oncotype DX Prostate Cancer Test that is genomic-based diagnostic testing. Looks promising.
Thank you for the interesting information!
Possibly the most important fact/paragraph in the entire report is buried under an unrelated heading, it gets little elaboration, and most importantly, the source reference to “clinical studies” was not made or discussed! That paragraph is the second paragraph under the heading, “Treatments may have side effects” and here it is: “Yet clinical studies have not provided any evidence that one treatment is better than another — or that any treatment at all actually prolongs life: The average 5-, 10-, and 15-year survival rates are virtually the same for all treatment options in early-stage prostate cancer, including active surveillance. It’s also important to understand that no mathematical model is foolproof, and some men diagnosed with early-stage, locally confined disease will later find out that their cancer was more extensive than originally believed.” .
Thanks , This is a great information.
Great and better information then articles written in 2015. I have PSA 8.3 and 3D MRI shows a significant tumor. So far I am not decided on an initial biopsy. Reading about cancer cells escaping the capsule, I was wandering if they can escape during and after the biopsy when the needle holes bleed a bit.
I (age 76) am getting annual checkup for BPH since 1997 when volume was 35 cc. Now it is 70 cc.I have been taking Tamsulosin 0.4 mg OD for several years. Otherwise asymptomatic. However last month PSA was 6.5. Dr asked for PSA profile in which the PSA came down to 5.2 but the free to total ratio was 17.8%. Since I was also experiencing mild burning in urethra suspecting prostatitis for which Dr gave antibiotic and another PSA profile after 3 weeks.If the ratio is still >20 he may go for MRI guided biopsy.
I am a widower and erectile dysfunction or infertility don’t matter but possibility of living with side effect incontinence for many years worries me. In the event of early stage cancer can I start with hormone therapy or take Dutasteride/Finasteride also instead of just Tamsulosin? Will starting medication improve chances to obviate or delay the need for radiotherapy or surgery?
HIFU has been approved by FDA now. I think that is another option that hasn’t made it out to the public yet although it’s been used in Europe for years. It’s non-invasive with less side effects and short recovery. Still a few unknowns with it yet and time will put those to rest, but then again absolutely every topic in regards to prostate cancer is a bunch of unknowns at this point with different opinions by each Dr. Still early yet but the more options the better for patients.
a commendable write up for layman like me.
Very nice document with comprehensive information.
Thank You, this is the first article I’ve read after receiving the phone call 45 minutes ago.
This is great information!!
Oh yeah, faouubls stuff there you!
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