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Posted 12/11/2013 8:50 AM (GMT 0)
Mikla,

NCCN continues to recommend AS for both very low risk and low risk men. That hasn't changed from last year.

Like last year, it is the only recommended option for:
• very low risk men with life expectancy of less than 20 years, and
• low risk men with life expectancy of less than 10 years.

It continues to be one of several recommended options for:
• very low risk men with life expectancy ≥ 20 years and
• low risk men with life expectancy ≥ 10 years

For both risk categories, they now recommend no intention to definitively treat (and no repeat biopsies) if the life expectancy is less than ten years, only palliative treatment. In a nomenclature change, they now call this "observation."

What has changed is they've relaxed the surveillance somewhat. They've now set a limit on:

• the number of PSAs - "no more than every 6 months unless clinically indicated", whereas they used to call for PSAs at least every 6 months.

• the number of DREs - "no more than every 12 months..." changed from at least every 12 months.

• the number of biopsies - "no more than every 12 months..." changed from as often as every 12 months.

Of course, each NCCN cancer center continues to have its own protocol variants.
Posted 12/11/2013 11:51 AM (GMT 0)
Hi Tall.... I think we are both kinda right. yeah If you go back to last years version and for "Very Low Risk" men with > 20 year LE then it says to use Initial Therapy for "Low Risk". I can't remember if it was in the chart or one of the footnotes. For "Low Risk" men it provided AS as a choice but had a similar footnote to PROS-B where there was a similar statement to what I said above... something like:

"Active surveillance is usually appropriate for men with very low-risk prostate cancer when life expectancy is < 20 y or men with low-risk prostate cancer when life expectancy is <10 y."

Again... stayed silent on over 20 years... but since the classification was change to "Low Risk" the <10 years applies.

In the end, it is close enough that one could choose AS and feel comfortable they were on the fringe of the guidelines. After all, it is just a guide.

Agree that there are variants by the various cancer centers involved in NCCN, which leads to additional confusion.
Posted 12/11/2013 12:03 PM (GMT 0)
Oops... meant to have a point in my last post (only 1/2 cup of coffee so brain not completely engaged):

The good news is that the NCCN and several of the associated centers are relaxing the guidelines for AS. So those considering or making that choice can feel some comfort that they are making a relatively safe and supported choice. I assume, the guidelines will relax even further as more studies are done and evaluated.
Posted 12/11/2013 12:07 PM (GMT 0)

Wow.....

I am blown away with the responses...my thanks to all who took the time to check in.  I'm humbled and grateful.  What a great group I joined!!

As Clanda and others mentioned, the key to AS, it seems to me, is to get one's mind wrapped around it.  In fact, what fascinates me about this illness is how taxing it is on every level; physically, mentally, spiritually, emotionally, etc.  And that dynamic is certainly inclusive of the treatment option exercise.  I'm wired to make "bloodless" data driven decisions, and this gig I'm dealing with now requires so much more. 

I'll share this with y'all....

After getting my diagnosis, my uro went over the options, as mentioned.  I had lots of questions, as did my wife.

The uro, a pretty cool dude, told me that in his view AS, although an option, was merely a delay for the inevitable i.e. surgery.

Here's what I said..

"Doc, what I'm hearing is this; the only real cure is for you to smash me in the nuts with a Louisville Slugger as hard as you can swing it.  You can do that next week, or I can wait for a year or two.  Hmmmm, what to do, what to do...."

He chuckled, my wife got red.  I got a good talking to on the drive home, but what the heck; it's my cancer and if I want to joke about it, so be it.

Again, my thanks to all who checked in.  I'm going to keep in touch.  You guys/gals rock.

G Man

Posted 12/11/2013 12:36 PM (GMT 0)
G man, you really seemed to have your head wrapped around this, good for you!  You do have time to make a decision on which course to take.  Remember that you should have many options.  Urologists will almost always suggest surgery, because that's what they know and what they do.  It's a good option, but you can also look into Brachytherapy (Both LD and HD), and radiation (including SBRT) as well. Talk to a radition oncologist, before you decide on a treatment if you ever need to do so.

Sounds like you're ok with AS for now, and I wish you the best of luck!

Mike

Posted 12/11/2013 2:58 PM (GMT 0)
G Man, I read a lot on this board that AS is only deferring treatment and certain individuals choose treatment now when one is young and can heal faster. My thought is 3,5 or 10 years from now there will be more treatment options. We will have more historic data on Cyberknife, Photon Therapy, HIFU, Focal Laser Ablation. Also testing to identify more aggressive cancers are advancing with MRI technology, MRI guided biopsy's and gene testing. Everyone is wired different and I believe there is no wrong treatment decision. We are all in this together and these forum's are great for sharing thoughts. Keep us posted.
Posted 12/11/2013 9:52 PM (GMT 0)
G Man welcome aboard!
Posted 12/16/2013 5:28 PM (GMT 0)
Gman

I am 10 days past my robotic surgery with dr Samadi in new york. I am 41 years old and had inital psa of 4.6 with 1 of 12 cores positive at gleason 6 and 10% involved. My next psa, 5 months later,was 5.8
I decided on surgery my final pathology report had me at a gleason 7 with a 2.0 cm tumor involved in 90% of the slides. If you choose AS please stay on top of it. Good luck to you
Posted 12/16/2013 10:10 PM (GMT 0)
Hi Gman,
Last year at this time I was going thru the same thing. AS was never an option as my wife was scared at this point. I was G6 1 core. I chose Da Vinci removal. At least with it gone I won't have to worry about it. The operation was Feb 25 and it went very well. With that operation they have two 3d cameras to look at everything and make sure your clean. I am doing quite well. I was able to get back to functions after 6 weeks
My psa last year at this time was 7.8 up from 1.2 in July 2012. It is now >.002. That is a great number!
Good luck!
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