Cut, burn, or watch

Hello Brothers,

I took a break from being a cancer patient but I'm back now. I was Dx'd in early April and my Journey began with a lot of encouragement from the members of this community.

My RO suggested that we take another PSA reading and that I get a 3T MRI after I was thoroughly healed from the biopsy. Done. I have not gotten the PSA results yet but the MRI did not show any visible cancer. Good news, I suppose, but it makes me think that we got very lucky when we found it with the biopsy. But if you can't see it, how do you know what's its doing? My RO said he was pleased with the results, so that's something.

Well, back to the treatment decision and I'm still struggling. We all know the arguments for and against both treatments but I just can't make up my mind. My RO, who was an advocate for seeds, was also waffling now so I need more data.

I'm thinking AS for the next 3 months assuming PSA is still stable. This PCa lifestyle sucks but it could be worse so I'm thankful.

I don't know what I'm asking for here, just wanted to vent a little.

Peace to all of us,

-John

Thanks, Susan.

Well hello again John, and welcome back. . . .  Yep, this is all sure a P I T A isn't it?!  Still, with your stats and latest update (and assuming your PSA results don't do anything crazy) it sure seems like AS is an option if your pschy can deal with it. Not sure if you've seen the new "Sticky" thread at the very top of the "Prostate Cancer Forum" page that Casey59 started "Newly diagnosed with PC? – read this thread first " - if you haven't I'd highly recommend you check it out as it contains some phenomenal information, help and guidance across the many realms of the PCa journey. With respect to AS, partway down the page, are the following helpful links:   Free online patient education material on Active Surveillance from several leading institutions: a. “Active Surveillance for Prostate Cancer,” published by Univ of California at San Francisco b. “Active Surveillance for Prostate Cancer: What a man needs to know before deciding on treatment,” published by the James Buchanan Brady Urological Institute at Johns Hopkins Hopefully we'll all behave better for you this time around! Continued best to you.

Thanks, David.

My PSA is back and it's 7.2.

This is concerning to me because my PSA has only chnaged .32, from 6.18 to 6.5, in the last 3 years. Now I get a .7 point increase in 6 months. I wonder if the biopsy, although it was 4 months ago, could be a factor.

Playing phone tag with my doc, so I'm stewing in it now

John

You are quite young for AS, imho. There is a chance that within 20 yrs, your cells would mutate enough to be able to eventually take over. This goes along with what Dr.Walsh said, that usually in older men, PC is more extensive, beyond local therapy cure, because it had decades to mutate, become more agressive and capable of leaving the prostate. I bet with your rising PSA that more cancer would be found on post-op pathology (have you been on antibiotics to eliminate the possibility it is due to infection?).

On the other hand, there can be a point in the future (3, 4, 5, 10 yrs?) that you would still be able to cure your cancer with local therapy. You have to ask yourself are you ready to live with the side-effects now or later. Some men have regretted surgery because of the side-effects. Not sure how you think and how important things are for you. Having a father who is now battling advanced PC, I would give anything in the world that he had a chance to be cured some yrs ago. If you do AS, you better find docs who are REALLY GOOD at it, first knowledge-wise, then practically: frequent scans, etc. Good luck on your decision.

John,
I was told by three very well known specialists in PC is that if a scan like a 3T MRI or a CDU cannot identify a tumor then it cannot harm you. This does not mean that it will not grow in the future, but simply that in its present form is harmless.

The entire premise of AS is to identify those tumors that will eventually grow from those that will not. We know that 30% will eventually progress, and these are the ones that should be treated.
As Dr Strum always preaches "status begets strategy". Your current status does not require treatment, but careful monitoring, and if that status changes in the future then your strategy must change.

Thanks to everyone for the thoughtful and insightful comments!

I'm going to meet with a medical oncologist to get his take on my status and options.

I'll report back.

John