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Posted 1/20/2015 4:11 PM (GMT 0)
So I am a little over a year from my 1st biopsy. AS has been used with falling psa's taking into account the finasteride I have been on. I did have a Turp (hat a relief it is). So early next month I will have another biopsy. Doc says primary reason to make sure I am still a 6 before I start radiation.

I have heart issues so radiation is felt to be the best course. But after reading about the SE's from radiation I am considering continuing with AS unless the biopsy comes back with higher readings than my first.

How many here have continued AS longer than a year? If so, what are the downsides.
Posted 1/20/2015 4:42 PM (GMT 0)
Not an AS guy so I have no info for you but I am curious why you are considering stopping AS. You haven't mentioned anything that sounds like an AS deal breaker to me.

I'm not asking Socratic questions trying to lead you to continuing Active Surveillance, just curious.

One other question: when was your TURP? I don't know if there is an issue with letting that heal fully before you start radiation but it might be something to ask about.
Posted 1/20/2015 5:02 PM (GMT 0)
TURP was late October. Second biopsy scheduled for Feb 4. Delayed to give time for healing. TURP removed 28 grams. Minimal leakage for a short time. Some urgency when need to urinate but appears to have been okay.

My understanding is that due to three cores on first biopsy I am borderline for AS. But with my age and other health conditions I am considering extending AS.
Posted 1/20/2015 5:33 PM (GMT 0)
Rather large prostate you have there shinytop!

Bill from Florida cool
Posted 1/20/2015 6:02 PM (GMT 0)
Shiny top, I also had G6 3 cores on biopsy and I was told by Epatein, pathologist at JH, that I was "not an optimal candidate" for AS. Dr Mark Scholz, MEd Oncologist specializing in PC told me that I might be a candidate and suggested an Oncogene test to help me decide.(I declined, because I'm not built for AS)

FWIW
Posted 1/20/2015 8:44 PM (GMT 0)
Shinytop -

You seem to be a great candidate for AS. That bit about too many positive cores is a relic from the early days when they were trying to be extra careful because they didn't know how safe AS would be long term. The combination of AS and Proscar may be especially good. With over 15 years of follow-up, AS has proven to be as safe a strategy as any treatment for low risk men.

If you can't live with AS, and your heart condition rules out surgery, you may be a candidate for focal ablation. If anesthesia is a problem, focal laser ablation is done without it. That may be a middle ground between AS and radiation, but it depends on where the tumor is in relation to the urethra. It often means a second procedure within the first couple of years.

You can also look into SBRT (see my signature) and HDR brachy, but I think you want to wait as long as possible for the TURP to heal. The prior TURP may rule out LDR brachy (seeds).
Posted 1/20/2015 8:49 PM (GMT 0)
Shiny, I agree that continuing AS would seem to be a logical path. If and when you need treatment both HDR Brachy and SBRT would seem to be good options. As TA said, your prior turp and ginormous prostate would likely make LDR Brachy a no.

Jim
Posted 1/20/2015 9:51 PM (GMT 0)
Shiny You asked "How many here have continued AS longer than a year? If so, what are the downsides."
I'll be on AS for thee years in March. The downside is a PSA test and DRE every 6 months, a 3TMRI and guided biopsy every two years. Besides that their is the anxiety of knowing you are living with a low grade cancer and is there a higher grade lurking. On my next biopsy and if they find a positive core or cores I would like to have a genetic test done on it for aggressiveness.
Posted 1/21/2015 3:14 AM (GMT 0)

Shiny,

I also underwent a TURP which came before the PCa diagnosis: in fact, it was the TURP that found the cancer. I decided to deal with the cancer with Active Surveillance against the advice of two urologists. It has been almost three years since my decision to use AS and I still have confidence in that decision.

I have dealt with the AS with a semi-annual PSA and a yearly 3T mp-mri (without the endorectal coil): both my urologist and I have decided that any additional TRUS biopsies (after 3 negative TRUS biopsies in the past) will not provide any additional information.  On the other hand, if the mp-mri shows something suspicious, I will accept  a targeted biopsy.

As for your case, you appear to be a very good candidate for AS.  I find it unfortunate that almost every person who has come to this message board with a diagnosis of Gleason 6 has chosen to treat with either surgery or radiation. However, as long as the doctors we consult are not on board with AS, it will never be used in any wide scale.  One of the pieces of misinformation  that is passed on by both doctors and patients is that people on AS will inevitably be treated sooner or later. This is just not true, as shown by all the studies coming out of the various AS programs (see the studies out of Johns Hopkins and the Sunnybrook Ontario AS programs). In fact, 60% to 75% of people on AS are never treated, and those who do progress to the point of needing more radical treatment do not face a closed window: See the John Hopkins AS program which has not had a single person dying from PCa since the program started in 1995. This is why it is called ACTIVE surveillance. 

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