A Plea for AS

My parents died at ages 93 and 94.  Neither had cancer or heart disease.  

Regarding Walsh.  In my opinion, he became famous by successfully curing low risk patients.   He would not operate on intermediate or high risk patients because he knew surgery wouldn't cure them and thus hurt his success cure rate.   In doing this he surely operated on many men that could and should have pursued AS or less invasive forms of treatment.   In one of my talks with my uro, I mentioned Walsh and my uro said that Walsh would not have operated on me and showed me the data on Walsh's success rates. 

The biggest question for those considering AS is "how do I know if the cancer is more aggressive than the biopsy?" This can never be answered with a 100% certainty, just as we cannot guarantee a 100% cure using any treatment.
AS comes the closest to answering that question, because only with the passage of time can you be sure the cancer is stable or progressing. The main purpose of AS is to separate out those that really need treatment from those who do not. This basic idea is often overlooked when discussing AS. The vast majority of all progressions are identified within the first year either by scans, a rising psa or a follow up biopsy. These are the patients that truly need treatment and their subsequent treatment is just as successful as immediate treatment as supported by Hopkins and other institutions.
As Klotz pointed out the 2% who die while on AS would have died from PC regardless of treatment or whose progression was identified and refused treatment.
AS is the best tool we have to separate out those who truly need treatment from those that don't. Save the 70% from unnecessary quality of life issues while treating those who really need treatment while assuming the same risk of dieing on the table from surgery. There is no diagnostic tool in our quiver that does this better than AS.

Thanks for the post, CapHuff.

AS should certainly be something everyone considers with 3+3, but the decision is ultimately a personal one. I obviously opted for surgery, and I am happy with that decision. Had the surgery not worked, I would certainly be second guessing myself. There is more to consider than just the Gleason score, however. Age being one of them. AS would certainly have given me months of SE free living, sort of, but RT or surgery was inevitable, in my case. My brother, who was 3+3 at diagnosis, and 3+4 a few months later, wishes he hadn't done AS, but he also wishes he hadn't had surgery either. That said, surgery was still the best treatment option for him.

This forum is such a wealth of information, and I think anyone who comes here is likely not rushing into anything.

6 months, toyoung