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prstate cancer questions - low grade Gleason 6

I am a 55 year old man, in otherwise good health. Slim, I exercise and eat well.

I was diagnosed with low level stage I prostate cancer with a Gleason Score of 6 in June 2012 -- just a little over a year ago. There was zero evidence that cancer is outside the prostate, so it is localized.
I decided to do "watchful waiting" as a course of action. After that biopsy my PSA scores fell from 5.4 to 4.9 to 4.4 to 4.1. Recently they read 9.1. However, my urologist said after that last PSA reading that upon digital exam my prostate felt "perfect."

I am very wary of surgical removal, or chemo, or radiation because of less than perfect results in reducing recurring cancer or death rates, and their side effects such as impotence, and incontinence, and rectal issues, and other various side effect on body.

1. In general, with this type of patient and data, would you think that one should go ahead with another biopsy in the next 30 days as scheduled? Even with the unfortunate chances of needle tracking or spreading of cancer cells, and other potential side effects?

2. Should a patient like this try imaging using for example the MRI as a better diagnosis tool ?

3. Would cryosurgery be a good option for a patient like this as opposed to the other options because of fewer side effects, and ease of treatment?

What do you think?
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replied August 15th, 2013
1. Although it is thought that cancer could be spread after biopsy, in general, the needle is so tiny it cannot do any harm.

It is advisable to follow your doctor's schedule as he/she knows better your health status.

With regards to PSA readings, I would ask if the sample was taken after the digital exam. Please understand that PSA readings are usually falsely "high" when the sample is taken after digital exam.

Other side effects of biopsy, although rarely, include bleeding or semen in the urine. You can discuss them with your urologist.

2. Although MRI is considered as a safe procedure, however, as it is expensive, it is reserved when the specialists wants to clarify better the current situation of your prostate and the nearby organs (e.g.lymph-nodes).

It is better that the last decision would be taken by your urologist.

3. Cryosurgery is a procedure when an apparatus is used to freeze the prostate gland cells, particularly the cancerous cells.

It is an excellent choice for the early stages of prostate cancer although it can be used in advanced stages too. The decision is up to your medical team.

With regards to side effects, patients have mostly reported the urogenital problems, such as incontinence, blood in urine, erectile dysfunction, fistula, etc.

At the end, it all depends on how your personal urologist see your current situation to give the final decision.

Hope it helped!

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