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JoshMD, Doctor (MD)
Category: Health
Satisfied Customers: 298
Experience:  Family Physician
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I am a 55yo with prostate cancer. PSA 7.4/Gleason 3+4/one

Customer Question

I am a 55yo with prostate cancer. PSA 7.4/Gleason 3+4/one core in 14 malignant/10% of core malignant. I am feeling pressure from surgeon and radiation oncologist to act quickly, but I want as much time as is reasonable. (Newlywed.) I teach decision making, but I cannot find relevant data. What I want to know if what (good or imperfect) DATA exists that will help me predict the INCREASED risk of metastasis of ACTIVE SURVEILLANCE. I plan to retest (PSA+) and re-biopsy (if sensible). Do I increase risk of metastasis or mortality by 1% -- more? -- by waiting a year WITH MY NUMBERS. I know watchful waiting studies with Gleason <7 show about a 1% per year increased mortality associated with waiting. WHAT ABOUT FOR ME, WITH MY NUMBERS?
Submitted: 8 years ago.
Category: Health
Expert:  JoshMD replied 8 years ago.
I'll be happy to help you find the info to help make your decision. Fortunately, for prostate cancer we have a number of formulas that should match what you're looking for. As I'm sure you're aware, dry scientific studies don't always take into account an individuals goals (quality of life, quantify of life, sexual function etc.) Please feel free to ask as many follow up questions as you need b/c more info tends to create more questions.

The cancer treatment centers of America have a web page that tackles this very issue, entitled "How bad is my prostate cancer."

As the site mentions, the simplest scale includes simply your PSA, Gleason score and pathology report. Most likely you fall into the LOW-RISK category here.

Next, you can use your data for a more in depth scale known as the Partin Tables (excel sheet/calculator included). Since I don't have your pathology report, I can give you an accurate grade, but I'd assume on the lower risk side.

Next, there's another table called the Kelly Prognostic Table for which you can calculate your score, which again is likely to be low.

Lastly, there's a table of additional risk factors that you may read.

I hope this first piece of information was helpful, please be sure to ask any follow questions.