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Posted 4/13/2010 2:58 PM (GMT 0)
So...

Since my last post two things have happened.

With my conflicting pathology reports (2+3=5 from uro and 3+3=6 from MSKCC) on the advice of one of the posters here (sorry I forget who), I contacted Dr. Jon Epstein at Johns Hopkins and entered their pathology 2nd opinion program for the tiebreaker pathology report. JH confirmed the 3+3. Darn. I keep searching for a way to have an edge on this thing. Turns out I've got the run of the mill PCa.

I also had a prostate MRI at MSKCC. All good news: Small low grade tumor, organ confined. I also went back to all my PSA tests since 2004 and graphed them. That was interesting to look at. The dip at the end is after a two week course of Cipro before my second biopsy. Go figure.

So anywho... I'm still undecided and considering finding a doctor who might support me in a period of AS. Since I am only 50 now, it is likely that I am going to have to choose a course of treatment sooner or later. Having a small cancer in my prostate doesn't freak me out and I would like to hang on to it as long as I can without putting myself at serious risk.

Interested in any and all comments!

Be well!
Posted 4/13/2010 3:08 PM (GMT 0)
Obviously you have time here to consider. If you can't stand the wait, Brachy would certainly be a good choice, that let's you have your cake and eat it too. You can keep your prostate, and attack the cancer as well.

There are many that recommend surgery for 50 and less, but I don't think the guidelines are as scientific as they are logical. They just say that if your life expectancy is 30 years, then removal is the best option, which may not be true.

I think AS is certainly what I would do for some period, and get 3 month PSA's to see what it is doing.

Good luck on your journey.
Posted 4/13/2010 3:28 PM (GMT 0)
BassGuy,

You are near the age I was when I was first diagnosed, (see my signature). While I chose brachytherapy and remained cancer free for 10 years, it did come back. Because of your age, I would ask you to ask your doctor that if you choose brachytherapy, what would be your treatment options IF the cancer returns? I can tell you from personal experience that the salvage prostatectomy is a difficult surgery usually with extenuating circumstances.

Wigs
Posted 4/13/2010 3:29 PM (GMT 0)
Dear Bassguy:

You will undoubtedly get a variety of advice on this thread and obviously none of us are in your exact shoes.  Having said that, I can tell you without hesitation that if I was in your shoes I would make the same exact decision you are making, i.e. AS.  JohnT has posted often on this forum with facts indicating that treatment success is the same for people who have been on AS and required treatment later as compared to people who treated first without AS.  I would encourage you to go back and reveiw some of his posts on this or perhaps JT will drop in on this tread with those facts.

Oft quoted AS guidelines promote this approach for patients over 60 but newer thinking seems to avoid the age issue and focus on the diagnosis.  The link below takes you to a presentation by noted PCa surgeon Peter Scardion wherein he makes the case for AS rather than surgery for low risk cancers such as what yours appears to be.

http://www.urotoday.com/media/presentations/auany2009/scardino_restaging_low_risk_prostate_cancer_10_27_2009/player.html

I think the real keys to successful AS, IMHO, are having the right mindset (which you appear to have), the right stats (which you have) and a doctor who is experienced in working with AS patients and will work with you on the proper follow up.

So...count this vote as one in TOTAL SUPPORT of your decison and I wish you the best.

Tudpock

Posted 4/13/2010 3:31 PM (GMT 0)
Bassguy, I'm with goodlife on this one. If I had your situation when diagnosed, knowing what I know now, I would most certainly go AS. Look into diet changes also. That's all part of it. There are foods to avoid and foods to eat a lot of. Take it slow, enjoy your life, and continue with your research. You'll be fine.

peace,

john
Posted 4/13/2010 8:14 PM (GMT 0)
Hey maybe it was me on the pathology review, it is always a good consideration for any patient. Good luck with whatever you decide to do...nobody has a crystal ball or would know how to use or interpret that (LOL), we guys might have crystaled balls but that is different and we know how to interpret that. :-)
Posted 4/13/2010 8:38 PM (GMT 0)
Bassguy
It sounds like you are in the NYC area. In that case, Run to Dr. Aaron Katz at Columbia-Pres (W168th St.) His book, "Dr. Katz's Guide to Prostate Health: From Conventional to Holistic Therapies" is good. He is a great doc. I saw him a couple times. He is great with AS and has all kinds of approaches to help you. VERY nice guys.

Email me with any questions about him.
Paul
Posted 4/13/2010 8:41 PM (GMT 0)
Bassguy,

I can honestly say that if I had your scores in the beginning I would not have jumped on this train without stops. I just keeping transferring from one coach to the other.

I am with the others that back you on the AS plan.

Sonny
Posted 4/13/2010 8:58 PM (GMT 0)
Hopkins has a great AS program. I think a Dr Ballentine runs it, but not sure. the latest studies inclusing those from Hopkins still say that only about 30% of those on AS show signs of progression and these are usually all in the early years. about another 25-30% choose to get treated without showing any progression. All data shows that cure rates for treatment for those on AS are exactly the same as if they were treated immediately.
The real risk of AS is not the progression of a G6, but the initial misidentification of a higher gleason grade. This is why an addtional biopsy within a year is necessary. You are one step ahead in having your path read by Epstien. Even if you choose to be treated in the future you have bought a few years without any QOL issues.
JT
Posted 4/13/2010 10:12 PM (GMT 0)
You got my support and vote for your AS situation. You sound like you did all your homework, and off to a good start.

Good luck.

David in SC
Posted 4/13/2010 10:43 PM (GMT 0)
I'm sorry for the dumb question......what is 'AS'??
Posted 4/13/2010 11:04 PM (GMT 0)
AS= Active Surveillance

The concept of active surveillance, or watchful waiting, has increasingly emerged in recent years as a viable option for men who decide not to undergo immediate surgery or radiation therapy.

During active surveillance, prostate cancer is carefully monitored for signs of progression. A PSA blood test and digital rectal exam (DRE) are usually administered periodically along with a repeat biopsy of the prostate at one year and then periodically thereafter. If symptoms develop, or if tests indicate the cancer is growing, treatment might be warranted.

Definition from the Prostate Cancer Foundation website: www.pcf.org/site/c.leJRIROrEpH/b.5813295/k.FA2E/Active_Surveillance.htm
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