To Continue AS or Not

Or you may have 10 cores with some G9, all missed on 1st and 2nd Bxs. Or you may be exactly as your 2nd Bx is showing: 4 cores and all less than 20%(is that considered low volume?) and all G6! Not bad seems to me. You just never really know with those needles going in blind, they can miss a lot or hit every thing. But all you actually know is what it found. How is your PSA and DRE?

It's that old rock and a hard place, isn't it? Any of us would much rather be free of cancer, and would jump at the chance if treatment did not have serious SEs. We know that G6s rarely, if ever, kill folks or met or even cause serious problems. Look back at that recent thread that is a plea for AS. And isn't there a brand new thread about the standards for AS being moved up to intermediate risk? And though you could have something worse lurking in that rascal, the only info you have available on which to make decisions is your Bx/PSA/DRE. Seems to me the stats are on your side.

OTOH, nobody wants that living in them. And the odds of a cure with 1 treatment are maximized with your G6- if for no other reason than it was never going to hurt you in the 1st place! Maybe.

EDIT: Just remember, I think the stat, at least the one given bu Prolaris link listed in the following post by Akai, that is looking at all PC Dx, considering all G scores, 30,000 out of 240,000 diagnosed will die from it. So, that is one out 8 who have PC will die from PC, 7 out of 8 will not. Though I suppose that includes all who are treated and not treated, it also includes G9-10s like me as well as the G6s. So I assume your odds will be significantly better than 7 out of 8 in your favor, though I don't know the odds for unreated G6s.

Well, at least if you go for it(RT), maybe you won't have to deal with most of the SEs that so many of us have. So, what is the likely SEs of the treatments you are considering? Are you willing to trade an SE free life for whatever SEs you will have to take on in order to most likely become G6 cancer free?

Sorry I am no help, it is just a tough decision for most of us. Good luck in your decision.

sure throw us a difficult problem first thing in the morning. ;)

That is a hard one to figure out. One question - how bad are your heart problems?

At G6 it's likely to stay in the prostate but you do seem to have rising PSA so at some point you'd likely need to do something. In your place I'd be very tempted by the IMRT. I am a little biased as that is what I did partly because of some heart/lung issues that made surgery risky for me.

So if you're thinking of treatment IMRT would work well for you. It's easy to do and the side effects aren't too bad. I had some fatigue towards the end, but not everyone gets that. I am not a doctor but think it likely that IMRT would be curative for you and would have little to no impact on your heart problems. Worth checking out.

Hang in there and keep us updated on your progress,
Andrew

I may have stated PSA badly. It is actually going down.
9/13 PSA 4.7
12/13 biopsy and started proscar
4/14 PSA 2.2
9/14 PSA 1.8 and then TURP
2/15 PSA 0.8 and then second biopsy

Post Edited (ShinytopPC) : 2/20/2015 1:30:58 PM (GMT-7)

So is your prostate size shrinking too?

I didn't get that you PSA is dropping. In that case, I'd be tempted to wait a bit longer. If it was still rising, I'd want to treat it.

Has the docs given you any idea why it's falling?

Andrew

What was the pathology from your TURP that you had in October

Hero

I am not a doctor and I could be wrong, but I'd be temped to wait on further treatments until there was a pattern of rising PSA - ie the PC is growing again. I think that continued AS might just be the right thing.

just my non-medical thought.

Andrew

The tissue in the central zone removed by TURP is a relatively rare place for PC to crop up. The peripheral zone, which is what is sampled by TRUS-guided biopsy is where it mostly occurs.

TRUS biopsy is random - so your two results are probably no different.

The purpose of AS is to look for signs of progression to a point where it's safer to treat than watch. That means, primarily, increase in Gleason score (which you didn't have) to where there is some Gleason 4+3 found. Sometimes, you want to look at PSA kinetics too - yours are great! Keep in mind that the criteria for going on AS are different from the criteria for coming off AS and getting treatment.

I very much agree with Jim's 3 points. Based on your good current biopsy, you can wait a year or two for the next one, but I think that you should consider that that one be an mpMRI-targeted one at a center with a great radiologist.

IMRT makes no sense to me as a primary treatment. It is inconvenient and costly and no better in any way than SBRT. With your TURP history, there is increased risk of urinary strictures with any kind of radiation, especially seeds. As Jim said, SBRT and HDR brachy with some urethral sparing is probably a much better idea. (I don't know if your heart problem precludes the anesthesia with HDR brachy). A man in my support group who has had a TURP is having SBRT next week - I'll let you know how it goes.

I think you may be mistaking sbrt with something else. Urinary incontinence is practically unheard of with SBRT. See link in my signature.

I believe before starting AS you should establish parameters of when to seek more conventional treatment. Mine were:

- PSA under 10
- nothing above Gleason 6
- No more than 3 cores positive (from individual biopsy of 10-12 cores)
- No more than 50% in any core
- T1C rating (cancer only apparent through biopsy and not palpable or shown on imaging)

With those parameters you still seem fine but of course, those are my parameters and you should set up your own in your comfort zone.