Active Surveillance - PSA Went Down

Hey all, a quick update...

As many of you know, I have chosen AS for now against the advice of my URO who would like to do the RP surgery. I just had my first PSA test done at a 3 month interval (see PSA history below) and it came back at .7.

So, the URO now says I could opt for the radiation treatment if I don't want to have surgery but I am thinking with this number I am going to continue with AS.

I post this as info for newly diagnosed folks AND to get feedback from the old hands here.

Anyway, I'm feeling very relieved today. I thought there was a chance I would be scheduling a surgery if the PSA really shot up.

Just FYI, the only thing I really did diet-wise was drink 8oz. of pomegranate juice every morning and try to cut back on dairy and red meats.

good for you. dr. myers has a new educational video on AS, you may be interested: askdrmyers.wordpress.com/2014/04/29/surveillance-or-surgery/

enjoy!

sounds like your AS plan is working just fine. I'd keep it up.

Andrew

Wow, GeetarMan, that is great news. I certainly think that AS is a great choice for you. However, given the lack of support of your uro you might want to consider Ziggy's advice and move on to a doctor who is more in tune with what YOU want to do. IMHO, AS should be monitored by a physician who has experience in that protocol and is supportive of patients who follow it. A properly monitored AS program is far more that just getting an occasional PSA test. OK...off my soapbox...I really just wanted to say congrats and best of luck for the future.

Jim

Edit for P.S. The Dr. Myers video IS powerful He is very clear about his opposition to treating some G6 cancers, likening them to "no more dangerous than dandruff".

I agree and my thought is to seek out a good AS program and follow a protocol for it. I am also a believer in good diet and exercise. I started with a personal trainer a couple weeks ago and got a metabolic assessment to fine-tune my workouts. I'm not out of shape, just want to be in better shape.

You are a great poster boy for AS, I would continue doing AS as you intend. Sounds like you need a new doctor that will get on board and be on board for your AS journey. Sorry he's not able to cut you open and make his money off of you, too bad for him, great for you.

You are doing well.

David

Did you make any specific diet or supplement changes that would explain the big drop in PSA? The drop is surprising.

".58, .60, 1.11, 1.00, 1.74, 2.85 (01/2014)"

You should never have been given a biopsy in the first place.
Instead, after that 2.85 in January, he should have retested you in 6 months, at which time he would have seen the 0.7 and then even the earlier 1.74 would have been viewed differently.

He really jumped the gun and now you'll live the next 5 or 10 years always thinking you have cancer.
The reality is you are probably just one of the 40% or so, 55 year old guys who have tiny amounts of Gleason 6 in them and nothing will come of it.

Think of yourself as completely normal. If your psa continues at 1.75 or less, don't let them continue to poke holes in your prostate. And if you get another 2.0 plus, wait 3 or 4 months and retest.

This entire episode should never have happened.

You should have been told to watch the following video 6 months ago

http://www.medscape.com/viewarticle/804988

Some updated data on AS

http://prostatecancerinfolink.net/2014/04/30/albertsen-to-discuss-contemporrary-recommendations-on-as-at-aua-annual-meeting/

Post Edited (Franklen) : 5/2/2014 1:23:21 PM (GMT-6)

Hindsight is indeed easy, however in this case the patient had one single PSA over 2.0 at age 55.

There would have been no problem in waiting even 3 months to retest.
As we now see, it went down to 0.7
Had a follow up test gone to 2.5 or 3.0, then sure, that confirmation would have indicated a biopsy.

Goodness, PSA's in many people jump all over the place.
I've had mine twice jump over 5.5 and then 7.4, only to drop back to 3.6 and 3.8 a few months later.
I'd be getting biopsies all the time if I jumped after every blip up in PSA.

One risks very little by waiting 3 to 6 months.
Perhaps someone else reading here will ask the doctor to wait a few months before doing a biopsy.

Especially troubling is his URO wanting to proceed with treatment now.

davidg said...
not everyone risks very little by waiting 3-6 months. That can be deadly for some no matter what a small minority they belong to. Not sure what good this does to GuitarMan...

I think the good it can do for GeeTarMan is to make him feel like his case is more like the average 55 years old guy walking down the street, who would not have had a biopsy, who would not have been diagnosed, and wouldn't be worried about whether he should be treated with surgery or radiation.

As we all know, some 30 to 40 percent of 55 year old guys are walking down the street with a insignificant prostate cancer that would be found if we just biopsied them all enough times.
There are many prostate cancers we don't want to find.

Hi Geetarman, I'm guessing your uro freaked at the velocity of your 2.85 result. I've been on AS now for 5 years. PSA continues to rise slowly but my uro says not to worry. PSA of 10 or positive DRE is his trigger point. I get psa twice a year & dre annual. If I can help you in any way please feel free to contact me.

It was the 1.79 to 2.54 that caused my primary care dr to send me to the uro at age 60. Being totally uneducated, I didn't object to the biopsy. Wish now that I had known more before having it done. A followup biopsy one year after the 1st confirmed 3+3. I've not let it preoccupy me or effect anything I do. The 1st uro I saw was eager to get me to surgery & asked if I wanted to talk with the surgeon. I said yes & in the meantime found this wonderful place & educated myself somewhat & discussed AS with the surgeon. He agreed & continues to agree that until the psa spikes or the dre is positive, there's no rush to treatment. I met a guy at the local Us Too support group who had about the same psa as mine but had surgery because his wife had just had breast cancer. I know, two totally different cancers. But he said several times he wished he'd not rushed into his surgery based on his wife's needed surgery. I can only hope that others will somehow find this site & get a basic understanding of pc before rushing into something they may regret later. Everyone is different, but an informed decision is always the best, regardless of what that decision is.