Pratorman said...
...here is what i am confused about - you say, that i am lucky in that i "caught the cancer at its earliest state". What does that mean? My understanding is that its not yet cancer, is highy predictive of cancer appearing within 10 years, maybe much less, but the cancer appearing is not a sure thing either.
Regarding AS - if i am lucky that i "caught the cancer at its earliest stage" whats the benefit to that, if nothing is done about it. If i just do active surveillance, what am i waiting for? For the cancer to no longer be in its earliest stage?
Pratorman - Other posters are correct; it is not cancer yet. I did not state the situation accurately in my earlier post. Here is a good way for you to look at the options:
1.) what you have may or may not turn into cancer, and it may or may not turn into the kind of aggressive cancer that needs to be treated. Some cancers remain "indolent" and may never need treatment.
2.) All prostate cancer treatments have significant risk of serious side effects such as impotence and incontinence although these vary by type of treatment.
3.) Extensive research has been done on whether curability is lost by waiting a little while. In other words, if you take 1000 people with a small amount of gleason six cancer in one core only, and you treat half of them right away, and take the other half and treat them only if their cancer shows advancement on a subsequent test you can learn two things: first, what percent of cancers like this get worse with time, and second, do people have any lower a survival rate if you wait a bit to see if the cancer gets worsre. It turns out that a lot of people DON'T progress, and among those who do, there is a very small barely measurable decrease in survivability and curability that results from waiting -- assuming the patient monitors closely and does not let things go too long.
Here is a useful link that gets into the percentage of men who progress while on active surveillance as well as the monitoring process that would kick someone out of active surveillance and into an treatment program, to ensure that treatment (if necessary) is done soon enough to be curative
www.roboticprostatesurgery.com.au/prostate-cancer-management/active-surveillance-prostate-cancer/active-surveillance-prostate-cancer.html4.) Therefore, most docs think that if you can handle the anxiety, it is better not to rush into treatment right away at the first sign of a small, low-grade cancer, and certainly not to treat a pre-cancer that may or may not even become cancer. By waiting you avoid a significant risk of unpleasant side effects and incur very little loss in terms of curability.
That said, a lot of patients with small low grade cancers opt for radical treatment because they find the anxiety of waiting and monitoring too unsettling. Responsible doctors discourage this but ultimately it's the patient's decision.