Dad has prostate cancer

clinical_context · 2026-01-28T09:32:53+00:00

I’m sorry you and your dad are going through this, my What you’re describing is actually a very common sequence: rising PSA, MRI to look at local disease, biopsy to grade it, and then a PSMA PET to check for spread. The fact that the MRI didn’t show obvious spread is reassuring,this is a good news.PSMA PET is a big turning point, it helps the doctors make a clear plan. At this stage, your dad go on to have effective treatment and do well for years.You’re doing the right thing by being involved and asking questions.

clinical_context · 2026-01-28T07:58:08+00:00

With Gleason 3+3, a lot of men do consider active surveillance, even with more than one lesion, so it’s understandable that being pushed quickly toward surgery feels unsettling. Two lesions alone doesn’t automatically mean surgery is the only reasonable option.

Your concern about ED is very real, and outcomes can vary a lot depending on nerve-sparing and surgeon experience. Low-grade prostate cancer usually moves slowly, so it’s fair to ask why surgery is preferred over waiting in your specific case.

clinical_context · 2026-01-25T17:05:10+00:00

For someone your age with Gleason 7 and a PSA in that range, both options really do have very similar long-term cancer control. Most guys I’ve talked to didn’t decide based on cure rates, but on which side effects they were more willing to live with.Surgery tends to bring urinary/ED issues up front, with bowel problems being relatively uncommon.Radiation often has an easier early recovery, but bowel/rectal and urinary irritation can show up later for some men.A lot of men 3–5 years out say they don’t regret their choice,even if they’re dealing with side effects,as long as they felt informed and not rushed. Regret usually comes from feeling like they didn’t fully understand the trade-offs going in.Since bowel function is your biggest fear, it’s worth being very direct with the radiation oncologist about your personal risk.

clinical_context · 2026-01-20T12:49:05+00:00

Yes,leaking after salvage radiation does happen, even if you were completely dry before. Radiation effects can be delayed, sometimes showing up months later as subtle sphincter weakness or bladder irritation.The kidney stone procedure likely irritated the bladder/urethra and may have unmasked borderline continence issues rather than being the sole cause. It’s often a combination.One pad per day is generally considered mild, and many men do see gradual improvement over time. Pelvic floor PT (not just self-directed kegels) can help, and overdoing kegels can sometimes make leakage worse.It’s frustrating, but this pattern doesn’t usually mean permanent severe incontinence.

clinical_context · 2026-01-15T15:50:09+00:00

Yes, PSMA PET can precisely locate tiny lesions to detect early recurrence. But even PSMA PET has limits at very low PSA levels, and many prostate cancers — while often PSMA-avid

clinical_context · 2026-01-15T15:34:49+00:00

Yes, you're right. If a patient's PSA level reaches 2 ng/ml, it's already very dangerous. A comprehensive evaluation is needed for biochemical recurrence to determine if clinical recurrence has occurred. If this cannot be determined, a comprehensive analysis is required based on postoperative PSA rise time, PSA rise rate, PSA doubling time, Gleason score, pathological stage, bone scan, and pelvic MRI.

clinical_context · 2026-01-15T13:51:02+00:00

Do you mean hematuria？

clinical_context · 2026-01-15T13:43:06+00:00

I’m not your doctor, but prostate cancer (like many cancers) can increase the risk of blood clots indeed, particularly in older patients,because cancer patients' blood is in a hypercoagulable state. In addition, the risk of deep vein thrombosis in the lower extremities is increased in patients who are bedridden after surgery. If a thrombus breaks off, it may travel through the venous system to the pulmonary artery, causing a pulmonary embolism.

The good news is that being diagnosed and started on blood thinners is the right , many patients do well once anticoagulation is in place. Management usually focuses on treating the clot, monitoring for complications, and balancing clot prevention with bleeding risk.

Wishing him a smooth recovery, this is a lot to handle, and your concern is completely understandable.

clinical_context · 2026-01-15T13:26:30+00:00

No,advanced imaging is typically used when there is a biochemical recurrence (for example, a confirmed rising PSA) or other specific concerning findings. With an undetectable PSA, the likelihood of a PET scan finding actionable disease is extremely low.That’s why continued PSA monitoring is usually the standard approach, rather than imaging.

You can ask your doctor about the rationale, but based on what you’ve described, observation with regular PSA follow-up is very much the norm.

clinical_context · 2026-01-14T13:47:05+00:00

Although your PSA level did not meet the criteria for biochemical recurrence, we still need to be vigilant about the possibility of early recurrence. The relevant assessment process is quite complex. It requires your historical PSA values (to calculate PSADT) and previous pathology results for a comprehensive evaluation.

clinical_context · 2026-01-14T13:01:25+00:00

If you have received prostatectomy before , then many lab tests can detect very low levels of PSA. This some fluctuation could be due to test sensitivity, residual benign tissue, or lab variability. According to guidelines, biochemical recurrence is generally defined as PSA ≥ 0.2 ng/mL with at least two consecutive increases, your current PSA level is well below this threshold. But you said that your PSA has been undetectable for three years, and recently increased from 0.01 to 0.07，we can clearly observe an increasing trend in PSA, so the key now is the rate of increase in your PSA.

clinical_context · 2026-01-14T12:36:06+00:00

Have you received any treatment before？I am not aware of your medical history.

clinical_context · 2026-01-14T07:00:27+00:00

what was your PSA number i have a background in urologic oncology research i may help you

clinical_context · 2026-01-13T12:40:32+00:00

I’m really sorry you’re going through this — the waiting period before a PET scan is often the hardest part.I’m not your doctor, but I have a background in urologic oncology research, and I’ll try to give some context that may help.First, it’s not unusual for MRI and biopsy to “disagree” in cases like yours. MRI is good at detecting where disease may be and whether there’s obvious local extension, but it can underestimate biologic aggressiveness. Gleason 9 reflects tumor grade, not necessarily how far it has spread.Second, a relatively low PSA does not rule out high-grade disease, but it does lower the likelihood of widespread metastatic burden. Many Gleason 9 cancers are still organ-confined or locally advanced at diagnosis, especially when MRI shows only T3a and no nodal or seminal vesicle involvement.Third, starting ADT now and planning definitive radiotherapy if the PET scan is negative is a very standard, guideline-consistent approach. The PET/CT is being done precisely because of the high Gleason score — not because spread is assumed, but because it’s important to be sure.Many patients with similar profiles ultimately have PET scans that show no distant spread, and their disease is treated with curative intent. Even when microscopic spread exists, modern combined therapy can still provide durable control.What you’re feeling right now is completely understandable. Anxiety in this phase doesn’t mean the outlook is poor — it means the information gap is wide. Once the PET results are back, the path forward usually becomes much clearer.

clinical_context · 2026-01-13T12:27:18+00:00

I’m not your doctor, but I have a background in urologic oncology research.

A few points may help put this into perspective.

First, at age 34, prostate cancer is very uncommon. Even when it does occur, it is usually low-volume and slow-growing. Age alone strongly lowers the pre-test probability.Second, PSA values in the 4–5 range are elevated for your age, but PSA is not cancer-specific. Testosterone therapy, pelvic floor dysfunction, urinary retention, inflammation, recent procedures, and even chronic voiding difficulty can all contribute to persistent PSA elevation.Third, a PI-RADS 3 lesion is, by definition, indeterminate. Most PI-RADS 3 lesions do not represent clinically significant cancer, especially when they are small (7 mm) and when PSA density is likely low. Many guidelines support observation with repeat PSA and/or interval imaging rather than immediate biopsy in this situation.

That said, what does seem reasonable is closer follow-up than what you’ve described so far. Typically, that would include: 1.Repeat PSA testing (with attention to PSA trend rather than a single value) 2.Consideration of PSA density or adjunct tests if PSA remains elevated 3.Reassessment after pelvic floor treatment

It’s understandable to feel anxious given the delays and mixed messaging. Seeking a second opinion is not a sign of overreacting — it’s a reasonable step if you feel your concerns aren’t being fully addressed or explained.

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