Another new member from Houston, Texas

I apologize in advance for a very long, first post:

I am currently 53 years old, married with 3 children in high and middle schools. There is no know history of prostate cancer in my family. My PSA was 4.5 in Dec 2014 and 5.7 in Dec 2015 and I was suffering with BPH symptoms. Flowmax provided relief in the begining but later also started on Proscar.

Back in Jan 2016, I had a biopsy done and out of the 12 cores, one came with 5% tumor(Section J). The pathology report indicated stage T1c, Gleason Score of 3+3=6, PSA was 2.7. My prostate volume was 34 CC at that time of biopsy. Due to Proscar, the PSA dropped to 2.7 at the time of biopsy. Based on this biopsy result, the urologist recommended active surveillance, continue the meds and follow-up. He also indicated this cancer is very slow to grow and many people outlive this cancer.

One week prior, to each follow-up prostate examination a PSA test was done. During each prostate examination, the urologist indicated the prostate feels nice and smooth. The PSA numbers while on Proscar during the follow-up are:

Apr16 = 2.7
Aug16 = 1.7
Dec16 = 2.1
Mar17 = 1.5
Dec17 = 1.8

Earlier this month, since it had been 2 years since first biopsy, my urologist secheduled second 12 core standard biopsy. My prostate volume has come down to 21 CC based on the ultrasound. So it reduced by 13 CC (38%) in two years. So all this made me feel real good. I was having typical side effects from Proscar but was dealing with equivalent of 5mg of Cialis.

The pathology report of the second biopsy indicates, 3 additional cores to have varying degrees of tumor. Still Stage T1c and PSA of 1.9. Following are the cores with tumor.

Sec J = 5% 3+3=6 (same as before)
Sec L = 40% 3+3=6
Sec C = 5% 3+3=6
Sec F = 25% 3+3=6

The first recommendation from my urologist is for robotic prostatectomy, since cancer is in more than 2 cores. He is not proponent of radiation, hormore therapy etc. I told him I am not ready yet for surgery yet and I need to do my own research. Urologist also recommended me to watch the documentary "Forks over Knives" and was ok to continue active surveillance for one year with a follow-up at 6 months.

I have watched Forks over Knives and makes sense to me and I have also seen videos by "Chris Beat Cancer". Is anybody in this forum changed their diet to a whole grain plant based diet and experienced any benefits?

What is bothersome to me is, if the cancer is spreading than why did section J did not change. I am assuming and hoping since the prostate volume decreased by 38%, the second biopsy was more accurate and first one missed these tumors since the sample size was 38% larger.

Knowing my complete history now, what would you do if you were in my shoes?

Welcome to HW.

I see no reason to go off AS at the moment. Likely you can go more years without treatment.

Keep doing your research. Surgeons recommend surgery and often have a bad opinion of radiation and the main competitor to their trade. Find a good RO and get an opinion from them. If you wanted treatment, RT in its many forms might be a good choice for you.

Hang in there and ask all the questions you have, we're here most days.
Andrew

I see nothing in your biopsy or PSA that would change your decision to stay on AS. The Proscar has made PSA a much better tool for indicating cancer progression. Since 8/16, your PSA has been very stable, with minor fluctuations in the range of 1.5-2.1 -- a very good sign.

A very much agree that your most recent biopsy probably did not discover any newly generated cancer but only found some bits that were missed last time (when your prostate was larger). You also did not have any pattern 4 - I suggest you get the biopsy slides confirmed by epstein at Johns Hopkins. Also remember that the criteria for accepting patients onto AS are not necessarily the same as triggers for intervention. You are watching it closely, and if it goes from being indolent to progressing, you will know in plenty of time to safely act.

I thank you all for your opinion on AS. For some reasom my URO said that AUA does not recommend AS if the cancer is in more than two cores.

I feel really good, as everyone said to keep on AS. I have two questions:

1. Will an MRI be useful in my case? I intend to ask the URO when I visit in August for follow-up.

2. How can I get my biopsy slides sent to Dr. Epstein @ John Hopkins? Do I tell my URO or contact the lab directly?

Thanks again for such prompt responses.

Post Edited (Ray-Texas) : 2/26/2018 6:06:55 PM (GMT-7)

Paxton said...
Ray - You’ve gotten a lot of very good advice here, so I will not repeat it. I will just echo the points that: 1
1. As long as no grade 4 cells are found on biopsy, you are good to stay on AS.
2. At your age, you look forward to a long future life. All treatments (other than AS) have side effects. The longer you can safely delay treatment, the shorter a period of your life will be lived with the side effects of treatment.

So — take your time. Don’t let any doc rush you into treatment until you are ready to do so.

Congrats on successfully holding the fort!

Thank you Y'all

Thank You Allen....

You have received some great advice and I wish you the best. I'm in the Woodlands, so not too far. If you are a runner, there is a Dad's Day 5 K in downtown Houston. Good luck!

AS for continued QOL.

Roger