prostate cancer - diagnozed PC prostate needle biopsy adeocarcinoma 4.7mm in core biopsy stage

Hi, The PSA change is one index to determine risk for progression. There are two calculations made: PSA doubling time and PSA velocity – both would estimate the rate of PSA increase. Based on your PSA rise, the best fit would be a doubling time of 2.14 years (range of 1.8 to 2.6). A doubling time of less than 3 years is taken as an indicator that the prostate cancer is progressing. The PSA velocity which tracks the rate of rise per year. Looking at your figures, it is 4.4 ng/ml/year. A validity study showed that at a cut-off value of 1.42, there is evidence of disease progression on MRI. You may consider doing another bone scan at this time, to help re-evaluate your risk. The extent of metastasis will determine overall prognosis. Most cases advised watchful waiting have lower Gleason scores and baseline PSA so some things you may read on “good risk” or “favorable risk” may not apply to you. In general, those who are “good risk” have a 30% risk of progression and thus requiring treatment using a watch and wait approach. For your case, since you are intermediate risk from the start, this is probably higher than 50%. For a Gleason grade of 7 and a PSA velocity > 2, a prostate cancer related death is in the order of 15%. An intervention is indicated at this point, however if life expectancy is limited, and there is a doubt that the treatment may impair quality of life, then a discussion on treatment initiation in the face of symptomatic progression may be in order.

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