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My 2nd opinion from Bostwick is back...

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Posted 7/21/2010 7:16 PM (GMT 0)
Jim, you are right, AS done properly takes the right attitude at all times, and to be working with a good dr that knows AS, its good and bad points, constant monitor, additional biopsies if needed, etc etc. The best part of AS, if you truly dont need treatment, then you dont get treatments, and if you do later on, you can still have treatment. The gambling factor is the big unknown, and thats why it comes down to each person's take on that. AS done properly requires a lot of personal discipline and followthrough. Definitely not a case of doing nothing.
Posted 7/22/2010 7:59 AM (GMT 0)

gibson00 said...
I guess I am in the camp of why bother watchful waiting.......waiting until its too late??

Everyone is different. After witnessing my fathers current battle, if I am found to have PCa, I want it out.

The thinking in your post makes me think that the term "Watchful Waiting" was changed to the more appropriate terminology of "Active Surveillance." Men who choose AS as a means of dealing with their prostate cancer are not sitting around and waiting and waiting and just watching as their cancer grows progressively worse. They are active in improving their diets, getting the appropriate amount of exercise, and most importantly being very PRO-active in making sure that their cancer numbers are not moving up or moving up at an unacceptable rate. AS does not mean that you are not doing anything--it means that you are keeping a very vigilant eye on what your prostate and your body are doing. And I would say that men who are not being vigilant about their numbers, but claim that they are doing AS, aren't following the program.
Posted 7/22/2010 10:00 PM (GMT 0)
I think we got way off track. I irritated some members again, but I really don't mean to. Back to the original topic. I thought the Bostwick evaluation was supposed to be a little more enlightening as to the aggressiveness. Is this information there, but I don't know how to read it. Or was I mistaken in my original assumption? Thanks all and sorry to cause so much trouble. :(
Posted 7/23/2010 12:22 AM (GMT 0)
Just a thought... have you considered color ultrasound by one of the experts Dr Lee or Dr Bahn? John T has some experience with color doppler, my husband also. They could take a look might be able to give you some info that might give you some piece of mind with the Active Surveillance! I for one do not think your doing anything crazy by waiting to see what evolves! I also think there's a hurry up attitude by all... patients & Dr's I know sometimes you have no choice but if my husbands case had been different[pretty sure no cancer] I know he would have done what your doing!!!  GOOD LUCK
Posted 7/23/2010 4:09 PM (GMT 0)
On lung cancer. If your family is prone to get lung cancer, then smoking is a sure way to get there. Like asbestos, it may not ever bother me but the gut next to me it could be deadly. genetics has a lot to do with lung cancer.

On PC. My doctor and I had a long conversation about watchful waiting after all the studies came out. His strongest point was simply the study assumes you are only good for another ten years in a ruff sort of way of saying it.

The only way I can look at it is , if I die of something else before PC would have taken me down, I will be pissed.
Posted 7/23/2010 4:51 PM (GMT 0)

cooper360 said...
Just a thought... have you considered color ultrasound by one of the experts Dr Lee or Dr Bahn? John T has some experience with color doppler, my husband also. They could take a look might be able to give you some info that might give you some piece of mind with the Active Surveillance! I for one do not think your doing anything crazy by waiting to see what evolves! I also think there's a hurry up attitude by all... patients & Dr's I know sometimes you have no choice but if my husbands case had been different[pretty sure no cancer] I know he would have done what your doing!!!  GOOD LUCK

Hi cooper360,

I have not done anything in this regard. My biggest problem is I don't know how to find an expert in AS in my area, let alone color doppler.

Hi Purgatory

I am not in denial. I understand completely what is inside my body. I understand perfectly the risks. Just because I appear to not care about the possible outcome doesn't mean I don't understand it and accept it can happen.

To know one in particular

I am so busy in taking care of my business, and workers, and wife and kids and every other thing that I'm responsible for, that I have no time for taking care of me. By the time I get home I'm exhausted and anyplace to contact are closed. I have a low self esteem and do not like drawing attention to myself in life. My urologist is very intelligent and caring, but clearly does not really support my AS decision. All AS advise I have followed came from here. I need to change my priorities but I can't make myself do it. I just do not care about "me" that much... I have struggled and fought to succeed and survive this thing called life for so long. I have enjoyed a financial success, but emotionally, I am a complete failure. I have struggled with depression long before I was told I have cancer. Honestly I don't know what my underlying problem is. I wish I did. I think coming here helps me to cope. My apologies to all who waste their time reading my ramblings. Sorry..............

Posted 7/23/2010 5:11 PM (GMT 0)

Franchot said...
The thinking in your post makes me think that the term "Watchful Waiting" was changed to the more appropriate terminology of "Active Surveillance."

I think Active Surveillance is going to go away as well for first line watchers. The new term is Delayed Therapy...

That says a lot...

Tony
Posted 7/23/2010 5:13 PM (GMT 0)

Jim is sick,

I've used Bostwick many times for second opinions. Unless you sent special instructions, they only received the slides your original pathologist used to analyze and write the first report.  Bostwick doesn't do anything else to the slides and will only conduct additional tests or use the original tissue cores when specifically instructed.  I would guess that your original pathologist applied the immunostains that are used in helping determine if there is cancer.  Second opinions review the work of someone else.  If they disagree with the original findings, they will state so on the report.  They also will tell you if they agree with the original findings.  The primary method of identifying the aggressiveness of your PCa is the Gleason sum.  It's a subjective measure of the differentiation of cells on the slide.  Higher Gleason sums are associated with more aggressive cancer.  What you originally posted looks like Bostwick agrees with your original pathologists Gleason score and supports the original estimate of aggressiveness. I don't believe the statements about the immunostains are a disclaimer.  All of those stains are used regularly to highlight the various cell characteristics that pathologists look for in calling something malignant.  The last thing in your original post about "confirmation that this is not aggressive" gives me pause.  The aggressiveness is a matter of degree.  Those suckers are gonna grow at a very slow rate or a very fast rate. I prefer to look at it as a Gleason sum of 6 is less aggressive than 7,8,9, or 10. Most Active Surveillance programs use a Gleason sum of 6 as the cutoff for the most aggressive score you can have and pursue AS.

Posted 7/23/2010 5:21 PM (GMT 0)
I am not certain the significance of Color Doppler for AS patients as yet. I think there is some good with it, but it does have its flaws. My understanding now is that 15% of CD scans miss the cancer altogether in cases where the cancer was confirmed in a TRUS biopsy. What's more is that it does not detect micro patches of more aggressive disease. This is important to remember because prostate cancer is a multi-focal disease. Meaning that one lesion of prostate cancer indicates that that the prostate can have more smaller lesions, possibly more aggressive. That stated, CD is giving more data. Just not sure if it's worth the time to do it...

To date, there has been no studies confirming the efficacy of using color doppler for indicating who is better eligible to be an AS patient.

Tony
Posted 7/23/2010 5:29 PM (GMT 0)
Jim - the ability to come here and rant and rave if needed, the abilty to just get something out in the open, to collect a wild range of opinions - these are all natural benefits of being here at HW. You have a lot going on in your life, we understand that. Many are in that same boat.

Tony - then delayed therapy could also be considered delayed treatment. I do have wonder about the true value of color doppler in regards to prostate cancer. I would think if it were openly effective, it would be in wide use. My original medical oncologist said that as a general rule, it was too unreliable to use as a regular testing tool, reserving its use to unusual situations.
Posted 7/23/2010 6:04 PM (GMT 0)
Jim,
One of the suggestions made in Alf's list at the top of the forum is to stop taking care of everyone else's problems, and get busy dealing with your PCa. I had that same issue - was full time at work until two days before surgery.
I should have spent a lot more of my time dealing with my own issues. I won't say that I made any gross errors as a result, but I see a lot of small areas where my life today would be better if I had done more and better research.

It should be said that I did not find this site until literally a day or two before surgery, so it is no fault of anyone here that I went down the road with less than adequate information. Knowing what I know today, the choice was correct, but I might have been less terrorized by the whole affair.
Posted 7/23/2010 7:01 PM (GMT 0)
Jim, not piling on, but here's a thought to maybe help you to reprioritize your thoughts. Remove the "I or My or Me" from your post and think of the consequences to all those people you feel you have such an obligation to put before yourself. Imagine what they are gonna do or would do, if you were removed permanently from the picture. Not talking about a specific course of treatment, but what will be your future usefulness to any of them unless you begin to put yourself and your health ahead of all those other committments and demands. I have a father who is in Stage 4 lung cancer, and less than probably 3 months to live who felt that his obligations to others were more important than his taking care of his own health issues, along with a very strong case of denial of his own vulnerablility to serious disease. He also thought he had no time or ability to go to his doctors or manage his health, sacrificing himself to his "obligations of others", until it was much too late. My anger at the results of his attitude is something I am struggling with each day as we care for him in his slow decline. I think as men that we all have a tendancy to think this way, but some are lucky enough to see our own train wrecks in time to change them. I hope you will do the same, and won't be upset with me for being so brutally honest about how I precieve guys who 'suffer through' for the good of others. I've seen guys here deny their treatments saying 'I'll give them 3 good years because I can't stop', but then they realize that there's gonna be years 4 and on forward that they aren't gonna be around to do what seems so vitally important to them now. Is this gonna be you?

I said all that to say this, if you are gonna pursue AS, then you need to find the best specialists, knowledgeable in how to manage it, you must dedicate yourself to the rigorous demands that you will have to stick with to be successful with AS, and you must be willing to never let anything, and I mean anything , delay, interfere with or stop you from following the AS plan. No business, friends or family demands can be used as an excuse to put off anything needed to maintain the discipline required to do AS the right way. Unless you are willing to put yourself first, as the most important part of all those people who have such demands on you, then you probably should be looking at other alternatives, whatever they may be.
Posted 7/23/2010 9:11 PM (GMT 0)
Hey John T where are you, you've had experience with CD what do you think! I also think OhioState is familiar with CD! I think how reliable it is depends on whose doing it! My husband and I were scared to death when grayscale ultrasound showed 3 bad areas  and urologist was recommending biopsy [ he also said CD didn't make any difference] Yeah Right!!!!! Dr Lee saw no such areas and combined with exam eased our minds! I know we were possible headed down the surgery road!  But psa has come down quite a bit and Dr Lee is going to take another look soon! He's quoted saying "a look is worth a thousand words" I'm not saying its the end all but I do think its worthwhile! Part of the problem is that are very few who do CD well and most urologist say don't bother!! I know Dr Lee is in Mi and I think Dr Bahn is in Ca also I think Dr Sconti in NY is well thought of. The Drs quickly recommend bone scans etc which I believe are known not to show much unless PC has progressed quite far.
Posted 7/24/2010 1:34 AM (GMT 0)
I am pursuing AS and am under the care of Dr. Scholz in Marina del Rey who uses the Color Doppler test as part of his protocol. During my very first Color Doppler he performed on me he saw something suspicious (possible blood flow to the tumor is what I remember him saying) and wasn't sure if I'd be a candidate for AS and he didn't want to chance it. He referred me to Dr. Bahn for a second Color Doppler test to see what Dr. Bahn thought of the suspicious area. Dr. Bahn came to the conclusion that it was not something serious and okayed me for AS.

The cynic would say that one doctor is just throwing some additional business to his friend. The believer would say this doctor really cares about the health of his patient and wants to avoid any mistakes.

(By the way, for an additional charge Dr. Scholz will also video tape or tape record your visits with him if you feel you want a permanent record of the proceedings which you can go back over and review. He uses other tests (blood, urine) to gather as much information as he can. On a follow-up visit I was supposed to do a certain type of urine test and he said, "We're not going to do that. I don't find the results to be very enlightening or accurate...and I don't want to waste your money."
Posted 7/24/2010 2:22 AM (GMT 0)
There is an article on the PCRI website by Dr Bahn on using Color Doppler in AS. Similar to Franchot Dr Scholz gave me a color doppler and saw something suspicious and sent me to Dr Bahn. He said Dr Bahn was much better than he was and had better equipment. I sent a freind of mine to Dr Scholz because of continuing rising psa after a negative biopsy. Scholz gave him a color doppler and didn't see anything and said not to worry about it and have another in a year if psa keeps rising.
From what I understand CD won't pick up every instance of cancer, but will pick up anything large enough to hurt you. My 13th biopsy picked up a small amount of G6 in the right peripherial zone and Bahn or Scholz couldn't see anything. Bahn biopsied the area 3 times three times just to be sure and all came up negative. My Surgeon at UCI recommended surgery based on this one small core that no one else could find; both Bahn a Scholz said this happens a lot because the vast majority of men have small pinpoints of cancer clusters that will never grow into a tumor. Biopsies find these from time to time and these patients are treated for something that would never have hurt them.
Any large agressive tumor needs blood flow in order to grow. Color Doppler sees the areas of increased blood flow and a powerful grey scale ultrasound looks for hyperecho leasions in the areas of increased blood flow. These areas are mapped and measured and a targetd biopsy is done at the edges and center of the suspicious area to confirm a tumor. If nothing is seen than no biopsy is done. I'm personnally sold on CDU as it identified a large tumor that 13 biopsies and and MRIS had missed and it eliminated an indolant tumor that a biopsy said I had.

JT
Posted 7/24/2010 2:52 AM (GMT 0)
Jim if you want to do AS, I don't understand whats stopping you. When you come to a medical forum and ask for advice on the issue, thats what you are going to get advice, advice you agree with and advice you dont agree with. Then YOU make a choice. If you get accolades
for your choice, thats nice. If you get stink eye, oh well. Your life, Your choice. I really can't think of a better system. BTW I used to have low self esteem, too Then I realized I could choose high self esteem..........
Posted 7/26/2010 4:56 PM (GMT 0)
I get it. I come to a forum ask for advise and have difficulties when the info doesn't jive. I will filter on my end and not get so wound up when I get conflicting opinions. Moving on.

I wrote Bostwick about the Biomarkers. From their website they tell this story.

(reference start)
Biomarkers
Biomarkers are used to determine the aggressiveness of cancer. A wealth of clinically useful information is available in even the smallest tissue specimens of the prostate, including biopsies and transurethral resections. Substantial effort has been expanded in the past decade in describing the available factors and determining their predictive value for staging, cancer recurrence and survival.

Proliferating Cell Nuclear Antigen (PCNA)
High PCNA labeling indices may indicate progression of prostate cancer,1,2 and may be an independent prognostic indicator.1

Ki-67 and MIB-1
Recognizes a nuclear antigen present in proliferating cells but absent in resting cells. Ki-67 labeling index may discriminate between organ confined and metastatic cancer.

Microvessel Density (MVD)
Helpful in predicting pathologic stage and patient outcome in prostate cancer.

Bcl-2

Highlights the Bcl-2 protein which functions as a blocker of apoptosis and programmed cell death.
Expression of Bcl-2 is normally restricted to the basal cell layer of the normal and hyperplastic prostatic epithelium.
Overexpression of Bcl-2 is present in high-grade prostatic intraepithelial neoplasia.3,4
p53

Identifies p53 (a regulator of the cell cycle) immunoreactivity in cancer cells.
Most immunohistochemical studies concluded that mutant p53 expression is a late event in localized prostate cancer,6-8 usually present in higher (>7) grade cancer.5,9,10
pP27

The cyclin-dependent kinase inhibitor (p27Kip1) negatively regulates cell proliferation.
Decreased p27Kip1 expression may be an independent predictor for cancer recurrence and long-term survival of prostate cancer.11-14
(reference end)

But my second opinion said nothing about any of this stuff. Will reply here with their answer.

I find that I am doing the stuff I'm supposed to be doing. Reliably, dutifully, religiously! It just takes me about 3 months figure out the simplest things. :( I'm still stuck on supplements, but It's not deciding on what to take. I have lots of info there. It's where to buy and who to trust. Will probably go with Life Extensions, but I was hoping someone here would know of who to buy from and have reasons why. Thanks for all the feedback.
Posted 7/26/2010 5:38 PM (GMT 0)
This is funny I guess...

So I start off on a mission. I'm ready to do this... Find a urologist inn my area that has extensive experience with AS. Here goes! open Google. Type in "peoria urologist specializing in active surveillance"... Browsing through the links and I find none of them provide an email address, and most do not include phone numbers... Some want to sell me a report? Gaaa! So I think maybe a forum somewhere has discussed this, so I type "forum peoria urologist specializing in active surveillance" and the fourth post down is my original "My Story" post here...

Wow I have made a lot of progress.

Unless anyone else has a better idea, I'm just going to find every urologist in the area and call them, each and every one, personally...
Posted 7/26/2010 8:39 PM (GMT 0)
Jim, I think you are making all this too hard on yourself. I doubt you are going to find any clear search in your area "for a urologist that specializes in AS". AS is but one of many choices at the disposal of most mainstream urologists. I don't know what area you live in or how many choices you have. You need a good urologist that is supportative of AS and is experienced with patients choosing that path. I don't think you would find many anywhere that would be eager for a patient to be on AS, for a variety of reasons.

As far as the supplements, perhaps you don't need any at all. Just buy them from Wal-Mart or any number of places, GNC, Whole Foods, gee, and endless list, and unlimited choices online. None of them are going to make your cancer go away, and some could interfere with other meds if you are on any, so make sure you GP if you have one, and your uro when you locked into one, and let them know what you are taking. Some supplements can falsely mask your true PSA situation, making it look better than it really is.

Good luck

David
Posted 7/27/2010 1:25 AM (GMT 0)
Jim,

I agree with the advice that Purgatory gave you about it being difficult to find a urologist that specializes in AS. Where do you live? (Maybe someone in your neck of the woods can give you some idea of doctors around you who will support your wish to pursue AS.)

I live in Southern California and my hospital and medical group is Cedars-Sinai (well-regarded for its physicians and hospital) in Beverly Hills and there may be one or two who endorse AS, but I got tired of trying to filter through all the red tape to get to them. I elected to go outside my medical group. If you can't find a doctor in your area, you may have to make bi-yearly visits to his office by flying or long distance driving. I also know that some of the doctors I inquired about also do telephone conferencing with their patients who don't live in their area.
Posted 7/27/2010 1:55 AM (GMT 0)
To my knowledge, there are no specialists in AS per se. I believe that every patient who chooses to go on active surveillance should do so as their own protocol leader. It is incumbent upon the patient, especially when they are going against established guidelines for AS, to set their own criteria as to what they will do when and if that criteria is met.

Examples or setting AS criteria:
1> I will only allow my PSA to climb to...
2> If my annual biopsy shows a change in volume or in Gleason grade I will decide on a therapy.
3> If my PSA doubles I will change to active therapy

etc...

Don't expect too many doctors at any level to be able to scientifically define when you should start treatment. Simple tip ~ aside from a sudden climb in PSA or Gleason, the doctor will likely just tell you the pros and cons and set your next visit date up.

Remember ~ Active Surveillance is NOT a treatment by definition. So there are likely no "specialists" that will specialize in doing nothing. AS guidelines are well established.

NCCN Guidelines on Active Surveillance:
The NCCN Guidelines Panel took careful consideration, including a thorough review of evolving data, of which men should be recommended for active surveillance. The updated NCCN Guidelines now recommend active surveillance for men with very low risk prostate cancer and life expectancy estimated at less than 20 years or men with low risk prostate cancer and life expectancy estimated at less than 10 years.

“Although the NCCN Guidelines Panel stresses the importance of considering active surveillance, ultimately this decision must be based on careful individualized weighting of a number of factors including life expectancy, disease characteristics, general health condition, potential side effects of treatment, and patient preference,”

Any prostate cancer oncologist, urologist, radiologist (not that anyone should use a radiologist for AS monitoring), or any other clinical care provider, working outside these guidelines is using risks higher than the risks outlined.

Note: Franshot ~ Cedars Sinai is an NCCN participant in this official release. In SoCal, so are UCI, UCLA, USC, and City of Hope...

Tony
Posted 7/27/2010 11:21 AM (GMT 0)
Jim you did have alot of knowledge or found knowledge on the pathology, was it made clear to you that you have to pay extra for such further analysis on pathology. Otherwise the cheaper program is just a review, not a further investigations thing...they have a price list available for further testings like the stuff you mentioned. Just wondering on that, most people don't have all these additional pathologist tests done, instead we waste money on ct and bone scans (especially on low stats patients...really a waste of money). Medical system is really neandrathal on assessments and total evaluations on patients issues (the reknown onco-docs see this clear as day...but not the rest), most of the rest are ready to treat a patient with whatever at the drop of hat. As Dr. Strum points out some are overtreated and some are undertreated in PCa, wonder if any doc would 'fess' up on their protocols, after the fact, hindsight. Knowledge on the dragon one has is less than perfect science is the real truth, very wise on your part to question plenty up front as you are doing.
Posted 7/27/2010 7:20 PM (GMT 0)

TC-LasVegas said...
Note: Franshot ~ Cedars Sinai is an NCCN participant in this official release. In SoCal, so are UCI, UCLA, USC, and City of Hope...

Tony

Tony,

Thanks the information about Cedars.

This was my experience dealing with the lower-rung doctors at Cedars-Sinai:

First urologist barely looked at my stats and solemnly shook his head and said he wanted to do a radical prostatectomy as soon as possible--said he wasn't experienced enough with the da Vinci. It all felt very rushed because he was going on vacation the next day and he wanted to see as many patients as possible.

I asked for a second opinion from a radiologist who said he wanted to start as soon as possible and claimed he could cure me with no side effects.

I asked for another opinion from the doctors at the Louis Warschaw Prostate Cancer Center wing of the hospital (where clinical trials and newer methods are being explored), but the wait was going to be six to nine months IF they granted my request. (Somehow someone had determined that my prostate cancer was not very advanced and that my two previous doctors were experienced enough to deal with me.)

I began reading about AS and was scheduled to have a colonoscopy done at Cedars. I discussed prostate cancer with this doctor (I know--he's not a specialist in prostates) and he said he's seen patients where the side effects of treatment seem worse than the disease and that AS could be a good choice. I was also checked in with my general practitioner who said that AS seemed like a good choice due to my low level of cancer.

Do the specialists in prostate cancer see something that the others don't or do they have a set course of "must treat this disease with MY method" and everyone else is wrong?

-------------

"The updated NCCN Guidelines now recommend active surveillance for men with very low risk prostate cancer and life expectancy estimated at less than 20 years or men with low risk prostate cancer and life expectancy estimated at less than 10 years."

It would appear that I am not a candidate for AS due to my life expectancy, but the doctors who are treating me would disagree.
Posted 7/27/2010 7:24 PM (GMT 0)
Could try searching PubMed on "prostate active surveillance.....", etc. to find docs who publish on AS.

Here's a fairly recent article with some big centers represented. I would think you'd have to travel to a large city to find a 'specialist'. Docs from Chicago, NYC, Cleveland, etc. in this study. Dr. HB Carter at Johns Hopkins publishes on AS as well.


J Urol. 2009 Apr;181(4):1635-41; discussion 1641. Epub 2009 Feb 23.

A multi-institutional evaluation of active surveillance for low risk prostate cancer.

Eggener SE, Mueller A, Berglund RK, Ayyathurai R, Soloway C, Soloway MS, Abouassaly R, Klein EA, Jones SJ, Zappavigna C, Goldenberg L, Scardino PT, Eastham JA, Guillonneau B.

University of Chicago, Chicago, Illinois, USA.

Comment in:

* J Urol. 2009 Apr;181(4):1534-5.

Abstract

PURPOSE: For select men with low risk prostate cancer active surveillance is more often being considered a management strategy. In a multicenter retrospective study we evaluated the actuarial rates and predictors of remaining on active surveillance, the incidence of cancer progression and the pathological findings of delayed radical prostatectomy. MATERIALS AND METHODS: A cohort of 262 men from 4 institutions met the inclusion criteria of age 75 years or younger, prostate specific antigen 10 ng/ml or less, clinical stage T1-T2a, biopsy Gleason sum 6 or less, 3 or less positive cores at diagnostic biopsy, repeat biopsy before active surveillance and no treatment for 6 months following the repeat biopsy. Active surveillance started on the date of the second biopsy. Actuarial rates of remaining on active surveillance were calculated and univariate Cox regression was used to assess predictors of discontinuing active surveillance. RESULTS: With a median followup of 29 months 43 patients ultimately received active treatment. The 2 and 5-year probabilities of remaining on active surveillance were 91% and 75%, respectively. Patients with cancer on the second biopsy (HR 2.23, 95% CI 1.23-4.06, p = 0.007) and a higher number of cancerous cores from the 2 biopsies combined (p = 0.002) were more likely to undergo treatment. Age, prostate specific antigen, clinical stage, prostate volume and number of total biopsy cores sampled were not predictive of outcome. Skeletal metastases developed in 1 patient 38 months after starting active surveillance. Of the 43 patients undergoing delayed treatment 41 (95%) are without disease progression at a median of 23 months following treatment. CONCLUSIONS: With a median followup of 29 months active surveillance for select patients appears to be safe and associated with a low risk of systemic progression. Cancer at restaging biopsy and a higher total number of cancerous cores are associated with a lower likelihood of remaining on active surveillance. A restaging biopsy should be strongly considered to finalize eligibility for active surveillance.

PMID: 19233410 [PubMed - indexed for MEDLINE]
Posted 7/27/2010 9:24 PM (GMT 0)
Hello, new to the community here...just reading a lot of material now.

48 y/o diagnosed just a couple of weeks ago with PC
Been checked regularly with DRE's and PSA since 40. PSA's are 0.8, 1.5 and 1.1. Referred to U-doc for check up. He found a hard ridge, biopsy and then said I have Stage A, with Gleason of 6 (3+3). Awaiting further tests (chest x ray and more blood testing) to find out if I have any other types of cancer. I have had no symptoms up until this month, so still in the shell shocked stage. From what I have read, if I choose to have any procedures done, I am leaning toward the robotic surgery and removal of my prostate. If I get negative results from my other tests, I believe the wait and see approach would be more in lines with my DX.
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