Time to leave AS behind?

Have you asked a doctor that question?

At this point I think it comes down to how comfortable continuing. In your place, I'd wait till the next MRI.

but I'm not you.

If you do decide to move to treatment a blast of RT (sbrt or LDR brachy) might be enough to clean out an PC.

It's a tough call.
Andrew

I don't see any reason to change course.

Certainly not from your PSA...values of 4 to 10 ng/mL are considered the "gray zone." Yours is not high, but above the common threshold for investigation (which you have now done, and are monitoring).

Certainly not from your fPSA...at 23%, that's darned close to the value where you shouldn't even bother having a biopsy

Certainly not from your most recent biopsy...tiny, tiny, tiny amounts of 3+3

Certainly not from your earlier mp-MRI...PI-RADS 3...along with your biopsy results, you appear to have a small amount of insignificant prostate cancer, which is a natural part of aging


Your case seems perfect for AS!
Congratulations!


There's some great study published by Dr Klotz (are you familiar with Klotz?) about the psyche of men on AS. It definitely got "easier" over time which he assigned to two main reasons: First, most men learned and understood the disease much better and more thoroughly over time than they did when they were first diagnosed, and in learning more about it they understood how low their risks were and that men on AS who advance later to treatment have the same outcomes as men who went into treatment right away...so they realized there was really no downside to AS itself. Second, the men on AS over time saw more and more of the needless side effect suffering that their cohort peers who sought treatment had to suffer, and gained increased appreciation for their choice. Both of these factors made it "easier," but both required the perspective of some time passing from their initial AS decision. Check out some of Klotz's writings...

Post Edited (Blackjack) : 3/7/2019 11:26:13 AM (GMT-7)

Blackjack -- thanks very much for your reply.

Your observations make a lot of sense.

It's just that PSA increase of one full point in six months that caused me to take pause. It just caused a lot of those "there could be more here that I don't know" thoughts and caused my head to spin a bit.

I will investigate those articles by Klotz.

the increase and the number of biopsies would push me toward treatment. another increase and you probably wont ask next time if you should do it. why put yourself through it.

its a tough tough decision.
Do they say if you have BPH. Has the prostrate volume increased - I see the first one at 43cc but you dont have new volume numbers. Did they do a DRE and felt anything ?
The higher than normal PSA is the only concern.

I to struggle with the AS decision in roller coaster fashion even though most would say I barely have cancer at all. Reading through Dr. Walsh's book at the moment and some chapters have me feeling good about the decision and others not so much. I to am relatively young so the odds of getting a cure at this stage is really good and waiting to long could change that but doing something to early could cause regrets if the fix doesn't come out successful far as SE's go.
PSA took a pretty good bounce last month but for now I am going to stay the course at least through the next biopsy.
Leaning towards eventual surgery if things get worse or maybe SBRT I don't know, my thoughts now are if it's out on the table they know what it is and the SE's are immediate so that starts the new normal where radiation's effects are more gradual and will have to deal with that in my mind just like AS.
Hang in there this forum has helped me a lot even though I am mostly a lurker.

I would recommend that you read Dr. Mark Scholz' new book, The Key to Prostate Cancer. he interviewed 30 other prostate cancer experts for this book, which covers all possible treatment options.

Dr. Walsh was the most famous of the pre-robotic surgeons, but he did not write the chapters on other treatments in his book. They were written by a medical writer. Both books are needed for a balance perspective.

I would not change course if I were you. But, there are two new criteria being used by my Johns Hopkins AS group that you might ask for. One is the use of the PHI test, which includes PSA and FPSA, but is considered more accurate. PHI Density, which is a simple calculation using the PHI score and your prostate volume, is now used as the most accurate of the pre-biopsy predictive tools. Also, they are using a new biopsy device, the Precision Point transperineal system. In addition to accuracy, this device requires no antibiotics, and is a quick outpatient procedure.

Of all the ways to monitor cancer, PSA is the least accurate. I personally wouldn't make a decision based on PSA alone, but your personal comfort level is really what's important. At any rate, you don't need to be in a hurry. Maybe you can use the period prior to your MRI to talk to surgeons and ROs to learn more in case you are treated.

ASAdvocate, how are you doing on this fine Friday afternoon?

I just wanted to voice my concurrence that Scholz's new book The Key to Prostate Cancer is displacing Walsh's old standard as the most comprehensive book covering all aspects of PC. The names of the 30 expert contributors is a "Who's Who" in the world of PC care today...the approach to this book was brilliant. As Scholz points out in the preface: "The book is divided into seven sections...Five sections cover each of the 5 stages...The average reader will only need three sections...The other sections, the ones provided for the other four stages, can be skipped over," unless, like me, one wants to learn more about all stages.

The downside of this comprehensive book (in the context of this thread, and Hope4Happiness's needs) is that only one chapter is devoted to AS. By contrast, Scholz's previous book, Invasion of the Prostate Snatchers, is a deep-dive into AS...and addresses both the science behind AS but also the psychological processes for success.

I think BOTH of Scholz's books are excellent, and while Scholz's new book is essentially an update/improvement on, and replacement for Walsh's, Scholz's two books are not replacements for each other.

Have a great weekend everyone...


added as edit
The Key to Prostate Cancer ... have you see Scholz's logo with the 2 "keys" crossing? Check out his Instagram site HERE

Post Edited (Blackjack) : 3/8/2019 1:54:24 PM (GMT-7)

Hi
I am realtively new at this but will share my perspective

having been diagnosed with low risk PCA and choosing AS have been doin a lot of research to understand

First based on all I have read PCa is common as you get older so much so it almost seems an unfortunate natural part of aging and most of the time?? does not seem to progress to something serious I find the stats that 30 to50% guys my age have some PCA which lead to the controversy of over treatment and PSA testing. I am strongly in favor of PSA testing there just need to be better ways to follow up and a balanced view of what test results mean(PSA,MRI,Biopsy ect)

But
at youre age with the PSA level the trend and the Pirads3 MRI(the biopsy results almost seem insignificant) there is reason to be concerned and alert.
However do some legwork and get and additional PSA and maybe another 3 month later. Another MRI probably after the next PSA if it confirms a trend, as has been said you may find it may drop down as much as it has gone up. Understanding the variability may be an advantage of more frequent testing(but you wll have to deal with the associated stress)
Consult youre team to figure out if there is any other cause for the increased PSA

My GUESS is that if the PSA trend continues and no other cause is found treatment is in youre future

Well so much for my ameturish 2 cents-wish you the best