Psa lowering with active waiting

It's surprising how many men undergo radical surgery just after two PSA tests and a single 10-12 needle biopsy seen by a single pathologist.

Those with low numbers who do are treating anxiety more than Pca. IMHO

Not only is AS a very reasonable option to choose it's more and more being vindicated over time. When the possiblity exists that many men enter the operating room as rather active middle aged men and wake up elderly(temporary to permanent in various degrees) was enough for myself to really look at all options less to non invasive.

goodlife said...
Realziggy,

Not sure how to take the elderly thing. How about just young without a prostate? Baby's are incontinent too. (haha)

I don't think any guy wouldn't do some sort of AS if he could. The medical community obviously doesn't advise it unless you really are elderly.

My earlier post about the downsides of AS are real. But as Tud said, we still go through anxiety with each PSA test. It does get better with each test tho. With AS, it is my opinion that it would get worse. We expect the PC to continue to progress at some rate, so with each month, we would naturally expect some change.

Probably a Color Doppler should be mandatory ( I mean one should have it) for those pursuing AS. If we had and EPE or apex tumor, AS may not be the path to take.

Goodlife

First of all you're wrong about most guys would do AS if they could. You're ignoring all those guys with low risk numbers who have to have it out of them stat!!! as if all cancers are equal. Those are the ones I say are really treating anxiety first and are the majority who schedule radical procedure as soon as they can after dx. Of course with the disclaimer of those only of the lower risk dx group.

You are also wrong that doctors recommend AS only to the elderly. In fact more and more studies and recommendations keep coming out describing the status quo as over treatment for many. I personally have long subscribed to the belief that in the near future and it's happening now that these days will be looked back some what in horror for all the unnecessary radical treatments that were done since the psa test came out.

Not all Pca progress as you say, much of it is indolent. Plus it's a fact more men will die with Pca than from it. Those who refuse to believe that fall into the large get it out of me asap!!! the panicked anxious group. Many of those seem not to know or ignore the fact that if it's systemic and not local getting it out asap is only a slight delaying action at best. Note I am only referring to those with low risk numbers.

Yes a color dopler along with my 3d saturation biopsy I had are preferable to one biopsy and then a rush to radical treatment. We agree there.

The elderly thing is probably a poor way to illustrate the quality of life issues. There's no guarantee as far as I can see if one winds up continent early on to never. To me going from a normal activity to wearing diapers forever is yes waking up elderly if it becomes a worse case scenario. Unlike many who arrived her and became convinced radical surgery was the way to go I arrived here leaning towards surgery and after the horror stories of much of the incontinence that was here back in late 2007 resulted in my studying and finding other options. ED was a distant secondary concern compared to that for me.

As far as the anxiety we all face in periodic psa tests I don't see how early post surgery psa tests are any less stressful than those doing AS. In fact I can see it being worse for if the psa rises post surgery it's logical to think youre PCa was systemic and what's left is primarily salvage radiation with only a 30% chance of being curative. For someone on AS it's could still just be local. Now if years go by post surgery with continual zeros yes that would be less anxious.

Post Edited (realziggy) : 12/23/2009 7:06:29 PM (GMT-7)

Realziggy,

Just a curiosity, why didn't you pursue AS. Is this a recent opinion since your treatment ? With 1 core out of 45 at 2 %, it reallky seems as tho you were low risk.

Goodlife

Thanks to all for sharing your experiences and information.

A little less freaked out about the latest PSA thanks to you.

Urologist appoinment 1/11/10 (good lord is it 2010??)

I'm sure he will want a biopsy

I'm going to try and get a color dopler

Should i do both?

Thanks to all, Best to all of you in the New Year!!!

Sounds like the Acitive Waiting is working well for you, at least based on your numbers. How about your head? I mean, do you worry about PC all the time, or in between your doctor's visits, you simply don't sit around thinking about it?.

Glad it is working for you, and hope you can continue that for many years.

On the color ultrasound, not surprised at what you said, that was the attitude I got when I asked about it in my area. They felt that it didn't add much usefulness to prostate cancer in particular.

Keep us posted.

David in SC

I had a pow wow with the surgeon recently and asked a bunch of point blank questions about color doppler and he dismissed it as unnecessary. Also brought up pointed questions about over treatment with lower scores. He felt like even tho my scores were low that the 3 of 12 positives were just too much too let ride especially since i have a strong family history of this stuff. I would love to wait for some new technology but i dont think its going to come fast enough.

brb,  The table below shows my PSA over the last 15 yrs.  It shows how erratic PSA can be.  Just keep on doing what you are doing.  Don't panic until you have to.  Good luck.

Date	PSA Level
7/26/1993	2.5
1/5/1995	5.1
2/8/1995	1.5
3/7/1995	3.5
9/12/1995	2.9
3/13/1996	2.5
12/19/1996	1.6
11/3/1997	4.2
3/2/1998	3.4
9/22/1998	2.8
4/2/1999	3.0
5/24/2000	3.6
1/3/2001	3.6
1/2/2002	4.1
6/27/2002	2.5
7/1/2003	2.7
7/2/2004	3.0
11/10/2005	3.2
11/14/2006	3.8
11/28/2007	6.5
12/27/2007	6.9
1/17/2008	9.1   Carlos

BRB0923, I am a newbie here..add on vit D, fish (or, may be fish oil supplemengt) to your list..may be 2000 units..do regualr excercise..&, try your best to stay on AS.. Treatment options are so barbaric for this disease..Gosh! There R so many good people with very high degree of knowledge are available in this forum..value their opinion.

brb0923 said...
 

Consultation 12/2008 decided active waiting (diet) while researching options.

I've added Green tea, saw palmetto, garlic tabs, v8 juice daily

Increased broccoli ,tomato and cauliflower consumption, eat mostly chicken, fish, and veggies.

Hello brb0923,

Was wondering if you could go into more detail as to your diet. I have been working on adjusting my diet as well and am wondering, what CAN I eat. lol Do any of the other members know where to get some menu's specific to PCa and AS?

I agree that some day RP will be considered barbaric for lower-risk patients, but for now Uros tend to be surgeons and RP is what they are convinced will save your life -- though not your love life. With great optimism my uro said 75% of patients regain adequate erections (and of course you think that means you), but the risk of surviving Russian Roulette is 80% and I wouldn't consider that. I didn't have the nerve (or discipline to change my habits) to do active surveillance but admire those who carefully do.

Update Sept 2010
psa 3.9, dre no change. Still watching closely, (every four months)

so far so good.
It's been two years since first diagnosis.
I have none of the classic symptoms
thanks for this great forum, good luck to all

brb, good report, your pc is definitley acting very indolent, so keep taking advantage of your AS program