When is treatment recommended for rising PSA values?

Question

Hello doctor,

I have been on active surveillance for three years with a Gleason score of 3+3=6. My initial PSA was 4.2, now 5.8 ng/mL. I am having more difficulty urinating lately and some new hip pain. A surveillance biopsy is scheduled for next month. Should I be considering active treatment now, given these changes? Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Active surveillance is indicated for a Gleason's score of 6 or lower, which denotes a slowly growing, non-progressing cancer. Within the first three years after diagnosis of Gleason 6 prostate cancer, there is a relatively low risk of grade progression. Active surveillance includes regular physical examination, PSA level measurement, and rebiopsy one year after diagnosis and every three years thereafter.

Treatment is triggered by progression to Gleason 7 or higher, other evidence of progression such as PSA doubling time, or patient preference. More than 50 percent of men with low-risk prostate cancer who chose active surveillance received treatment. Depending on the histopathology Gleason score results, the next step will be clarified. Keep in touch for the biopsy result.

I hope this helps.

Thank you.