3rd year of AS

My hubby was diagnosed 3 years ago with PC and has been on AS. Original Urologist was ready to go into surgery upon diagnosis of 1/12 at 5% positive. Second opinion at Moffitt in Tampa lead us to AS to see what might develop as state by Dr. "why kill a fly on the wall with a cannon". There is a strong possibility of better treatments IF and when he might need treatment. We have had two follow up biopsies, one negative for PC, the second we are scheduled on the 10th to get the results of another year of AS or is this the year for the decision of surgery or radiation. Had an MRI w/wo contrast last year and it was a Pi-rads 2.
Dr. Pow-Sang at Moffitt said that so far there has been no sign of any clinically significant cancer in the biopsy or the MRI that we had done over the past two years.
We live 2 hours from Tampa and have moved AS back to our town with a different local urologist who almost immediately brought up possibly surgery as he claims that anyone who is young should complete treatment as PC is usually more aggressive at a young age. We had seen that urologist previously after a bought of prostatitis late last year and really liked him, but now that we are using him for the AS I am concerned he will turn out just like the last local and recommend surgery right away. I guess we will find out on the 10th and decide from there what 2018 will bring to our household.
Ultimately I am not afraid to go back to Moffitt if necessary.
Anyone else have issues with such an insignificant amount of PC detected and doctors wanting to do surgery right away?
Sorry such a long post, just wanted to get the history in there.

I had created this in a signature, but wasn’t sure if it had posted. I guess I did not click the correct box to include the the original post.

Thanks for the signature - that really helps us understand your situation better.

Unless the biopsy shows something more than a Gleason 6 (3+3), you're safe to continue AS. Age isn't really a factor in AS. The point of AS is to delay treatment for as long as possible.

If you can do the travel, I'd say go back to Moffit for an opinion before selecting treatment over AS.

Hang in there and let us know what happens,
Andrew

In my opinion, with one small percentage of G6 in a single core, stable PSA over many years (despite fluctuations) and negative mpmri (pirads 2 is negative), there are not enough reasons that justify treatment at any age; this is a textbook case for AS. Just the PSA density is borderline. Close surveillance with regular mpmirs seems to be the most adequate option. But I understand your doubts, uncertainty is intrinsic to this disease.

Speaking from what I know now regarding MSKCC's qualifications for active surveillance (AS), your husband's current state would surely have him continuing on AS there.

Side note -- I'm getting the feeling that this "fly" analogy has entered the oncologist's "playbook" for AS. My doc over at MSKCC in NYC used the variation -- "Why try to swat flies with a sledgehammer?" -- when discussing AS with my wife and me!

We're here to answer questions best we can. I like your Moffit doc - keep that one.

Andrew

ASAdvocate,

As you can see below, I have just started by AS journey. I appreciate your comments and all that post here describing their issues.

Last week I had my first PSA update since my biopsy and the number actually went down. I know that this really means nothing other than my PSA is somewhat stable. I am scheduled for an MRI in April. My urologist stated that a clear MRI could eliminate my need for a biopsy this year.

I have noticed that some folks state that it is highly recommended/almost mandatory that a confirmation biopsy is performed within one year of your initial positive biopsy.

I wonder what others thoughts may be.

Thanks

I am seriously thinking all the docs are out for money. The one at Moffitt said that he would need another MRI this year followed by a biopsy 2 months later since it will have been 2 years since the last one. So that is money and money. I am grateful that we have wonderful insurance so our co-pays are cheaper than some who are out of pocket or higher deductibles.
The new urologist here in town said, skip the MRI since it's actually a biopsy that is called for this year and save the MRI money.
It seems that each doctor has their own protocol for what they feel is necessary for AS and the NCCN guidelines are not very clear either since it states that for "very low risk" T1c is a biopsy "no more often than every 12 months". So for some docs that could mean every 13 months.

I'm one of those patient spouses who will continue to ask questions to the point of even writing them down and taking a list with us to the appointments. I have a nice thick binder with all the tests and other pages from the docs in date order with tabs so that I can refer to it during the appointments and show the new doctors if necessary because they didn't look or didn't have access to previous records. I have gotten complements from the doctors for being so through stating they wished others where half as prepared.
We are our own advocates and have to stay on top of it since these physicians see upwards of 30 plus patients a day. They can't remember your name most of the time without looking at your chart so how will they remember your history?

Seriously thinking that if this biopsy is negative, it will be the last for awhile unless PSA spike or an MRI shows something suspicious. I don't' think he will allow another one next year. 3 biopsies in 3 years is enough.

I have the same PCa condition, going on year 3 with AS. Check out my journey, you might want to consider doing some home natural treatments during the AS period. Right or wrong, doing "something" to mitigate the cancer lets me sleep at night.

Best Wishes . . . .

My Story: https://www.healingwell.com/community/default.aspx?f=35&m=3528051
___________________________________________________________________________

SEP 2017: PSA 3.8
NOV 2016: PSA 3.7, Biopsy (12) cores Benign/Negative
JUL 2016: Bone Scan (NEGATIVE)
APR 2016: PSA 3.7

OCTOBER 2015 (Dx)
Age: 59
PSA: 3.0 elevated to 3.5 in (6) months
3T-MRI: (1) lesion identified
Fusion Biopsy Results: Lesion cores benign, addtional (12) cores = (1)5%
Pathology Summary: Grade Group 1 (G6:3+3), 2nd pathology verification
Clinical Stage: T1c

PCa Treatment: "Active Surveillance" + "Home Natural Cancer Treatment"
Risk: Undetected Cancer Progression
Risk Likelihood: LOW

I'm going to be the exception to the rule and speak from my personal experience. My case is very similar to your husband's. There's a wealth of knowledge on this forum and I have the utmost respect for those that take the time every day to help educate and comfort those that have landed here out of necessity.

Having said that, and not to detract from anything said previously, given the chance to do it again with the knowledge I have now, I would have had RALP as soon as cancer was confirmed. Everything said I may never need further treatment. Biopsies were hit and miss, MRI's didn't show anything, no ED or other symptoms. Genetic test predicted less than 20% chance of aggressive growth or escaping the prostate. The only indicator was my sky-high PSA (and it is tempered by the fact I've been taking finasteride for decades to slow hair loss). In my case, I only postponed the surgery by doing AS.

I may be an anomaly. You can see in my signature my progression was not linear. I am also on the younger side of the spectrum to be diagnosed so I would much rather deal with the surgery and recovery at a younger age than when I might not be able to recover as easily.

I chose surgery over radiation partially because of my age. I'm planning to live longer than the onset of side effects from some of the radiation options so surgery made the most sense. My RO even agreed.

I am not trying to influence your decision in any way, just wanted to relate my journey so far. I wish I would have been one of the many that never need to seek treatment. My only piece of advice is to not ignore it. Keep learning and asking questions and be proactive in the testing and treatment.

This forum is fantastic! I've found answers to all of the questions I have had and being here gives me comfort to know I am not alone.