AS suggested by my Uro

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<!-- / icon and title --><!-- message --> Had a visit with my Uro yesterday for the first time after my Bx. He went over the results again, three out fourteen cores, all G6, 10%, 20%, and 20%. Stage T1C, organ confined based on the US.

He went over available treatment options which include AS. I asked him what option he would choose if it were him, and his answer was "AS". Kind of surprised based on my age of 58. Seems like AS is gaining momentum in the low risk patients? Or is it the west coast laid back attitude?

His AS program is a lot less stringent than most of what I have read. PSA every three months, Color Doppler Elastography US ever six months, perhaps add MRI (not a requirement) once a year, and Bx every TWO YEARS???
My Uro seems to have a lot faith in the CDEUS to catch cancer eventhough it did not do so during my Bx. He said that my tumors are too small (smaller than 5mm) for the reason the CDEUS failed to catch my tumors during my Bx. Dr. Walsh, in his book, warned about doctors that use CDEUs to detect cancer tumors.

At UCLA, their AS program requires a Bx six months after the initial Bx to confirm the results, then PSA and DRE every six months, and depends on the results of PSA and DRE, Bx at least once every twelve months.

These programs seem to be so much less stringent than most of what I have read from the most popular books, their requirements are much more stringent especially the Bx requirement (more frequent).

Will be seeing another Uro for his opinion, and perhaps more, before decision is made.

Comments welcome.

AS is a valid treatment option and is being recommended more often for G6. You didn't mention your current PSA but there is a possibility that AS might be a reasonable option for you. The important part of AS is "active." As long as you're keeping up the regular testing the risks are much worse then treatment. PC is a slow growing thing so you'll get plenty of warning when you need to start treatments.

A second opinion is called for - especially if you decide to go this route you'll want to have your testing schedule set up and understood. It would be good to know what test results would be the trigger for starting treatments.

Of course the choice is yours - and all the choices have some level of risk.

Forgot to mention that my last three PSA were 3.1, 3.36, and 3.6 (withing 6 months but all from different labs and different testing methods).  Free PSA 14% (too low), PCA3 scores = 29 (too high and was labeled positive - interpret with caution by the lab).

mP

 

AS sounds reasonable to me in your case, but it is your call. if it were me, i would want yearly biopsies to be on the safe side, a lot can happen in 2 years time.

david

What you doctor has recommended is very reasonable. A second opinion is always a good idea.
JT