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cutoff point for active surveillance is ....

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Posted 7/23/2014 11:52 AM (GMT 0)
Just read this article on the CNN website ...

http://www.cnn.com/2014/07/18/health/prostate-cancer-overtreament/

I was wondering, for an otherwise healthy 58 year old, what level of PCa is considered non threatening enough to be considered for Active Surveillance. Is it based on the rate the PSA rises ? The Gleason score ? Not looking for medical advise here as I already had my RP 2 months ago and have recovered well, but I was wondering how close I was to being able to choose AS as a form of treatment.

Post Edited (Ravineman430) : 7/23/2014 2:31:36 PM (GMT-6)

Posted 7/23/2014 4:50 PM (GMT 0)
Hopefully you did not have RP unnecessarily, but your doctors should have explained why they ought RP was appropriate. From what I've read, Gleason 7 or higher is an automatic signal for treatment. Usually Gleason six qualifies for AS but the amount of cancer ( volume in each core) and PSA doubling time are factors that dictate treatment for Gleason 6 because it's probably not just Gleason 6 if it's that aggressive. Only RP discloses your actual pathology, which is one strong reason for having RP.
Bob
Posted 7/23/2014 6:07 PM (GMT 0)
My impression is that you were right on the dividing line. Some AS programs are starting to take low-volume Gleason 7(3+4) guys but I don't think most of them do. They also generally kick a participant out when their PSA approaches 10. Yours was 7 -- not that far off. What was your PSA velocity like? That might have made a difference. Also, did you only have one positive core? Multiple cores can also be a disqualifier.
Posted 7/23/2014 8:22 PM (GMT 0)
It varies from program to program. NCCN advocates AS as an option for any man who is low risk: GS6 and PSA<10 and stage T2a or less. Some still adhere to a stricter definition of very low risk = low risk + 2 or fewer positive cores + <50% in any one core + PSA density <.15. Some will take on GS3+4s if it is low volume and they have good imaging equipment to monitor it. PSA kinetics are an unreliable indicator.

- Allen
Posted 7/23/2014 8:31 PM (GMT 0)
These answers are awesome ! Thanks.
So much experience and information here.

I wish everyone a swift and full recovery of their health.
Posted 7/23/2014 10:35 PM (GMT 0)
Ravineman430, I was told that the AS group at MD Anderson in Houston accepts patients with Gleason 7 scores. There are 800+ participants in that group, and approximately 15% of them have Gleason 7 scores.
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