Quit AS? But PSA going down?

I realize it's pretty hard to know just what to do for many of us!

I just got a new PSA reading @ 3.45! It was 4.0 in June and 4.3 in Jan. Free PSA still only @ 11%, however, (9% in June, 10% in Jan.). My signature details below will explain how things have developed.

I've been on active surveillance but now have RALP scheduled for Dec. 14. I do have one further appointment with Dr. Scholz next week and I just sent him my latest numbers. Any guesses on what he'll advise?

Maybe I should at least get a second reading on that MRI targeted 3 core biopsy that found Gleason 3+4 (G 4 est. @10%)?

With my old TURP scars, etc., it has always seemed quite likely that I'd have pretty bad SE's from either RT or RP. So risking continued AS despite high volume cancer, 40-60% est. ECE chances, and pretty good estimated longevity, might still make sense? After all Prolaris results were incouraging, and now this latest PSA result.....

Or is that declining PSA an irrelevant fluke?

Thanks for any thoughts,

Whippoorwill

so if it was mri guided you know where the gl4 is...Like in real estate location location location...at 73 pushing 74 and with a nice location of the 4...I'd cancel any tx...and continue AS...and it is not neceasarily true that "you're gonna have to do it...lawd amighty where does this come from Halbert...its witty ...clever and all dat... but pul-ease...

Whip, With the PIRADS 5, the 10% G4, and the high ECE possibilty, I would take action if I were you.

If the biopsy only showed that you had a lot of G3+3, then I probably would sit tight and stay on AS, but the other factors are concerning.

Thanks responders!

As usual the input here is helpful.

Halbert: Certainly true that the final call is mine. And it's a wise guess that that will be Scholz's message as well. Seems like most (good) practitioners know that PC is so variable and hard to call, so they defer, when all is said and done, (rightly!) to the patient's own judgment.

ASAdvocate: I agree that "...the other facts are concerning..." I have felt throughout my journey that I just keep teetering right at that point where AS and definitive treatment are almost equally reasonable. Now that I've gotten this new PSA reading I wish I'd asked right away for a second pathology report from JH after that targeted biopsy turned up the 3+4. That still may be the wise choice.

Michael_T: It is interesting, isn't it, that the variability of PSA is often mentioned and yet PSA is also just as often a key determiner of decisions that get made. That new lower number in my case was a definite surprise. I do not recall any others here who may have reported such a decline during a stretch of AS.

BTW, Dr. Lam was a possibility at first but when they worked me in it turned out that Dr. Scholz could see me sooner. These guys all see a lot of cases for sure. And you are right about the importance for me of my past TURPS. They don't apparently rule out RT, though forms of Brachytherapy would apparently be a lot trickier.

Thanks, again to all responders!

Whippoorwill

IT and then you can get treatment and live another 10 years and more..." what...me worry " does any one see that when you die..the whole concept of time...is gone...surely even for the "power rangers"? present...you can see this from your last 30 years...where did it go? " we all die and live at the same time...so simple... but as Ive said before you can not touch your own finger with that finger..ceptin in a reflection...{mirror...or the best... each other}Heck even Michaelangelo knew that ...witness the sistine chapel

Thanks for the latest!

I always enjoy Bololidat. Poetry and philosophy. And he makes us think.

Thanks for your input, island time. One big difference with our numbers is your age. Looks like I'm your senior by about 15 years? And that must matter in those 10-years-out calculations, right? It also seems I have a lot more G6 in a lot more of the prostate (and now some G3+4). I just asked yesterday for my urologist to request a second reading from JH on those most recent, targeted, G3+4 cores. I should get results back before it's too late to postpone surgery. Not in time for my Scholz consult, though.

Thanks, again,

Whippoorwill