It's been 3 1/2 years - Treatment or still Wait?

Dave, you are certainly a candidate for "active surveillance" (not just watching and waiting). Active surveillance requires a specific protocol of follow up testing, imaging and biopsies that are designed to let you know if and when you may need treatment. For now with your stats it would appear you are a great candidate for active surveillance; most of us would kill for your stats.

I would not necessarily say your cancer has doubled. It may be that the previous biopsy simply missed that extra core.

Here is what I would suggest for you:

1. Get your biopsy slides re-read by Dr. Epstein at Johns Hopkins so you have confidence in the pathology.

2. In another thread there is a link to a webinar on active surveillance. I suggest you register and learn.

3. Make sure you are in a definite AS protocol with the appropriate testing schedules. If your local uro doesn't offer or understand that then find someone who does. The "active" part of AS is critical otherwise you are just shooting dice.

Good luck.

Jim

From another David: ASA and Jim have given you great advice. There's no reason to think your cancer has doubled, as you wonder about, since poking around in different places finds different things at different times. Jim's suggestion of the Epstein read is spot on. And I know that if/when Djin weighs in he will recommend a genomics test (sorry, Djin!), another great idea.

Also check out that AS seminar. If you need more info on that let us know. And of course, get into a good AS protocol program. If I still lived in Boston I'd be confident at MGH to say the least!

Keep us informed.
David

Thanks everyone. It's great to know from you that long term AS is a ok path even though it's a bit unsettling knowing I'm walking around with cancer. Yes, I'm in active surveillance at MGH in Boston with Dr. McGovern. I've had 2 MIR's - the latest one in June showing multiple BPH nodules, a 5 mm focus of restricted diffusion and minimal associated T2 hypointensity with no early arterial enhancement and no disruption of prostrate capsule. My PSA from last week was 7.65. It's been as high 8.6 in the past.

I found an AS Webinar on line by ANCAN featuring Dr. Brian Helfand from September 2020 (I couldn't find the forum thread). Hopefully that's the one Tudpock18 referred me to. In it, Dr. Helfand says that 30% of men on AS as the result of a biopsy may be harboring a more aggressive form of cancer so that's disconcerting to say the least. Apparently, aggressive prostrate type cancer is tricky to diagnose. I'll be interested in talking to my doctor about getting a Genomic or a Genetic test as the seminar suggests. Again thanks for helping me on this.

Dave V.

By many estimates 50 to 60% of men youre age harbor some form of prostate cancer mostly indolent otherwise we would be dropping like flies from this thing. If you continue to actively monitor this thing with PSA,MRI and repeat biopsy you should catch anything aggressiv IF PRESENT. In addition you could discuss with youre doc regarding free PSA, PHI or 4K test, Also not sure you mention youre prostate size. PSA density compensates for enlarge prostate.PSA density is PSA/prostate size. normal PSA density is 0.1 and<0.15 is considered ok(that is 1.5 times normal) so take that into account. also keep in mind that treatment improve with time so if you delay treatment it may be better. so best of luck withnyoure decisions

https://ancan.org/webinar-active-surveillance-beyond-with-dr-brian-helfand/