Just Joined The Frat.....

G-Man,

I hate it when a guy arrives here all calm and sensible with a good grasp of his options and a well-thougt-out plan. It doesn't give us much to do except say ...

Welcome to the Forum! Sorry you need to be here but glad you found us.

Sounds like you are well on your way to figuring it out for yourself, it really is a very individual choice in the end. Wishing you the best.

Welcome aboard!

Beyond the metrics, when thinking about AS you have to get a sense as to whether you could handle it psychologically. I think that it takes a certain personality and way of looking at things to be able to handle it. If that is you, it leaves you with a reasonable, defensible option. Regardless of what you ultimately choose, try to wrap yourself around whatever that choice is so that it becomes part of your being so that you feel secure in the knowledge that you've made the right choice for YOU.

Best of luck!!!

As the others have said, welcome to the group, but we sure wish you didn't have too.

You have already received some really good input and it is not they task of any of us to try to sway you one way or the other. You sound as if you are level headed and willing to take control and responsibility as an involved member of your team.

I would like to point out another issue to cogitate over as you approach this. You are a younger guy (hell everybody seems you to me), you lead an active life and I would assume (hope) that you have an active sex life.

Don't minimize too much the possible side effects of treatment, be they short or long term, on Continence and ED. Many of us have run the gamut on those two. Some had no nerves left and never experienced ED, some had them spared and haven't recovered yet. Some have never had continence issues from the day the catheter was removed and some still go through 4-5 pads a day or had to resort to further surgery to resolve it.

As a Gleason 6, with limited involvement (per biopsy) you seem an ideal candidate for AS. But you also need to make yourself aware that surgery or AS are not your only options. Various forms of radiation therapy have performed very well for some of our members and you need to educate yourself in them as well.

I was a 7 when diagnosed, 4 out of 12 cores at 60 years old. I elected surgery for my own personal reasons. I was active and had a very strong sex drive. I feel I was one of the more fortunate in that I never had continence issues and at about 2.5 years I recovered from ED issues to about 60-70%. Today at 4 years I am about 80-90% recovered.

There is always the thought in each of us, to greater or lesser degree, just get the crap out, cure me and let me get on with my life. But that life takes on a new norm, maybe good and manageable, maybe not. But that part of it must weigh in on the decisions we make.

Whichever path you choose to travel this journey, just know that we are here. We are a brotherhood. We support each other. And each of us continues to search for developments that if not helping ourselves, helps another in dealing with this crazy Pca.

Good luck,

Sonny

Welcome to HW. Sorry you need to be here.

You've got the numbers to have a good run at AS. It would be hard to argue against it with that report.

But you should look at all the options on the table first. In your place I'd also talk to an RO about beam or brachy therapy (seeds) for a second opinion. If for no other reason than to know what treatment you want when you do decide it's time to stop AS.

Hang in there and keep us updated on your progress,
Andrew

GMan,

Welcome. Sorry about your diagnosis, but I admire your rational approach -- I think it will serve you well on AS, if that's what you decide.

In over 10 years tracking of men on AS, about two-thirds are still on it. Hopefully, like those men, you have the indolent form of the disease that never becomes a problem. You certainly have an insignificant amount of PC by the current definition, and you are what NCCN calls the "very low risk" category.

You mentioned Johns Hopkins -- is that where your AS program would be? They currently have among the most stringent requirements, but have announced they will be relaxing them based on their long-term experience. The direction is towards making the tracking less cumbersome and more efficient (e.g., fewer, more effective biopsies, better criteria for treatment, etc.). You might also consider discussing with your Uro taking Proscar or Avodart, especially if you have symptoms of BPH.

Hi G Man,

Welcome to the forum with a reluctant welcome to "the club."

You are getting wonderful advice from everyone else. Another thing to be aware of is that a biopsy (standard 12-core) only samples about 1/1,000 of the prostate -- which means that other, more aggressive tumors could have been missed.

With that said, your PSA, while high for your age, is not horrifically high in itself. This would seem to suggest that your biopsy was pretty accurate. So you should be relatively safe on AS, at least for a while.

In the meantime, I just wanted you to be aware that about 28% of patients going into surgery with a specific Gleason score (as "estimated" by the biopsy) are revealed in post-op pathology to have had a higher Gleason tumor in there as well.

The average cancerous prostate has between 3 and 7 individual tumors, all of which tend to spring up at the same time.

Once again, however, your PSA would still suggest that you only have a low risk form of PC with the Gleason 6 and I certainly would see good reasons for you to start this journey with AS.

I'm sure your doctor will be doing frequent PSA tests, probably every 3 months, along with future biopsies. If the PSA begins to rise, you can then be right on top of it and go for some form of treatment.

Good luck to you!!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

TA, I don't think you can conclude he is "very low risk" without knowing his PSA density. With a PSA of 4.2, his density would be greater than .15 if his prostate is less than 28 cc. Probably not likely the case, but possible. If his density is over .15, he would be low risk.

Quite right, FrackMe. Either way, a good candidate for AS.

G-man...we are one week ahead... (read that as we are in the same boat!!). Trying to figure out where to go from here. I have already learned so very much from this site and I wish you well in your journey. We are also in NY, on Long Island and am in the process of arranging second and third opinions. I am going to contact some of the doctors mentioned on this site (Eastham and Tewari are my primary). I have been flooded by well meaning folks giving me names but I feel more comfortable with the ones I have read about here....I wish you well... Your numbers are low and you are young. We are leaning towards AS. Really, Really AS.. Meaning we will probably be tested every two months until we are sure it is not going up by a lot. I wish you the best and are in the same place as you are. Read, Read and Read!!

Susan

Mikey72,

Congratulations on your great results! Was your post-op PSA of <0.1 done at MSKCC? Did they automatically use the standard test (vs. the ultra sensitive) or did you request that? I wish you a lifetime of undetectable PSA readings!

G Man,

Welcome. You've done your homework on PCa. I suggest you also watch Dr. Mulhall's videos or read his book (all linked below) for detailed info on how surgery or radiation can impact erections.

-Gedman