Active Surveillance vs RP for early stage PC

Hey everyone - newbie to the site and PC club. Rather than figure out how to filter through and find older threads from members on their actual opinions of active surveillance versus RRP for early stage PC, I thought I'd just ask the question. I had been on TRT for a year; starting PSA was <0.04 from one lab, and 1.1 from another lab (PSA fluctuated between 1.4-1.8 after being on TRT for 9 months). A routine PSA test in March 2015 yielded a PSA of 2.7; my normal doc was out for surgery and a physician's assistant who had worked previously at a urology practice was filling in...he suggested I go see a specialist due to PSA velocity rise...something that my normal doc subsequently commented that he never would have done since PSA <4 didn't worry him!! But that's another story entirely. Anyway, went to see a urologist who's specialty is PC only. Biopsy comes back 2/12 positive cores, Gleason 6, clean MRI, staged at T1c. I'm scheduled for another biopsy in September to see how things look. I've read horror stories about post-RP incontinence and impotence, even with nerve sparing surgery, so I'm going active surveillance route for now. My surgeon was one of the first in the midwest USA to do surgery with Da Vinci system, and he reckons that he's done thousands of RRPs. I'm 49 now, active runner/fitness person, no BPH, so surgeon said operation should be quite easy, and chances are extremely good that I won't have any issues with incontinence or severe impotence. Problem is..."extremely good" doesn't mean a heckuva lot to me. National stats are pretty much useless as well. I'd rather continue on active surveillance for as long as possible...if there are younger guys out there who have gone this route and just put off RP until such time as things begin to get worse, I'd like your advice on whether to continue AS or just get the thing yanked right now and be done with it. Thanks!

Welcome to HW.

AS is a great option for you. A G6 isn't likely to every be a problem. The only thing I'd do is decide what would trigger you getting treatment - a specific PSA or biopsy result, or something. Also surgery isn't the only option for you. Brachy and radiation would work fine too.

But you've got a long time before you'd need to do that.
Hang in there and keep us updated on your progress,
Andrew

Read the sticky for the newly diagnosed:
www.healingwell.com/community/default.aspx?f=35&m=2652250

You will read there a recommendation to get your biopsy slides re-read by Bostwick or Epstein.

I agree with your doc that it's a shame you got diagnosed - now you have to deal with it. PC is most often indolent and insignificant, as yours probably is, and most often does not require treatment. In the longest running study on active surveillance (Klotz), over half were still on it and did not have treatment 20 years later. Like GeetarMan, they continue to enjoy their lives free of the symptoms of treatment. Your follow-up biopsy should be with a multiparametric MRI at an institution that has a great radiologist.

There are LOTS of other treatment options, and it will take you a while to explore and understand them all, their benefits and risks, and to do the self-examination necessary to make an informed choice. Fortunately, you have plenty of time.

I'll second what everyone above said. I get excited to go all "rah rah AS", and I forget about those other basic things, especially the second opinion on the slides. I did that (Johns Hopkins) before deciding to go with AS.

Hello Homebrew and welcome. I'll just say you should re-read Tall Allen's post and then re-read it again.

Jim

I'll throw in my two cents for AS for the reasons that others have stated. But do get that second opinion on your biopsy slides. Good luck and keep us posted!

GeetarMan said...
Hey Homebrewer...

I'm a relatively "younger" guy and I was diagnosed at age 55 with very similar stats to yours. My UR predictably encouraged me to have RP within 2 months. Well, it's 18 months later and as you can see by my signature, my PSA has actually fallen from a high of 2.85 to <1.0 and has remained in that range, and I have had no treatment at all. Zip, nada, none. Even my UR would not recommend surgery, or any other treatment for me at this point.

I too, am relatively fit (not as much as I used to be), active, and I enjoy a great relationship with the wife, so I was none to keen to risk ANY chance of the SEs I read so much about on this site. Let alone the long recovery from surgery. No thank you.

So, you won't find a stronger advocate for AS than me on this site, well, maybe you would but I love to take these opportunities to tell my story and encourage men, even younger men, to strongly consider AS.

P.S. I love a good homebrew myself!

Ditto all you said, strictly IMHO of course! If I had only been someone's(anyone's) idea of a good candidate for AS, you can be sure I would have allowed no surgeon near my privates! (and maybe not any other treatment either, but for sure no surgery) But again, that's just me. I felt that way before the surgery, and I feel even stronger about that after the surgery.

Welcome, Homebrew, may you be forever on AS and both SE free and advance of PC free!