Active Surveillance 2 year Check Up

So, last week I had my two year follow up testing for my low grade Gleason 6 PC. Had the PSA, followed by the endo rectal 3T multi parametric MRI. Then went to my urologist for my check up, fully expecting him to suggest another ultrasound/MRI targeted biopsy.

My PSA is now up to 6.07 (4.99 at time of cancer diagnosis two years ago). Knowing my PSA was higher, I expected the MRI results to show either growth of my existing Prostate lesions (3, but only 1 cancerous). What I found out shocked me in a positive way.

The MRI showed NO LESIONS. The radiologist report (same radiologist who also did my MRI report two years ago), stated that the previous abnormalities/lesions in my Prostate were no longer distinguishable and therefore were less convincing of any potential for prostate cancer and more indicative of sequela of the prostate, or chronic prostatitis.

My urologist chose not to order another biopsy and just wants to do my routine PSA again 90 days from now. Needless to say I am thrilled!

Now, I am no naive to believe that I no longer have PC. Let's face it. My biopsy two years ago did find a small amount of G6 cancer in one of nine cores. However, is it possible that my cancer is truly indolent and that the diagnosis two years ago was to a certain degree misdiagnosed?

We all have heard that many men can have indolent PC that may never affect them. Is it possible that I may just truly have chronic prostatitis (with no significant symptoms) and that my small amount of G6 PC (it only was 1% of the core) may not ever become a problem for me?

Has anyone on this board had a similar experience or heard of PC disappearing without any treatment?

Thanks in advance for your feedback.

Post Edited (PC Legacy) : 6/3/2016 8:49:13 AM (GMT-6)

Hey, that's great! Good for you for not taking "the easy route"...and that choice is paying you back now!

PC Legacy said...
Needless to say I am thrilled!

Here's a new word for you: "ebullient"

Dr Lawrence Klotz (perhaps you've heard of him...he publishes a ton of work on his long-running AS program) gave this comment at an AUA meeting panel discussion about men on AS:

"...men on AS frequently were "ebullient" after being on AS for a few years; they looked at the side effects their friends were enduring who had had active treatment, and they were delighted they had NOT gone that route."

Your findings are not all that uncommon. Klotz has reported that the results of confirmatory, re-biopsies for men initially diagnosed with favorable risk PC who went on AS stay the same about 50% of the time, the go up about 25% of the time, and they go down about 25% of the time.

Again, great news for you! Stick with your AS program.

Post Edited (JackH) : 6/2/2016 3:41:50 PM (GMT-6)

Allen,
I am fully aware that an MRI cannot determine a diagnosis of cancer. I am also fully aware that a lesion in itself does not indicate cancer in any way.

I was only asking how common it is for someone with a "bad" Initial MRI and a positive biopsy to later have an MRI showing no lesions.

I still have cancer. Just happen to be hopeful that mine is indolent and won't need treatment.

Btw, you are pretty negative.

I have not had the follow up biopsy at this point. My urologist, who is the chairman of Urology for the UTSW program here in Dallas, originally was planning on doing the follow up biopsy this past week to coincide with the two year follow up from my original diagnosis, however, when he read the results of the MRI, he decided the biopsy was not necessary right now. I still fully expect that if my PSA ticks up a notch again, another biopsy will still be in my future.

Let's face it, if my urologist (who is a surgeon who does several RALP's per week) now doesn't think my cancer is much of a problem and is not advocating the additional biopsy at present, I am going to listen!

As stated earlier, I am not naive. I do have still have some g6 cancer and maybe still someday will develop additional cancer (God forbid) in my prostate since I have a family history of more aggressive PC. But I also have hope that although I have a small bit of g6, that the underlying problem to my high PSA is the chronic prostatitis and not the 1 core of g6, 1 mm in size and 1% of the core sample of cancer that was previously diagnosed.

Further Reiters syndrome also runs in my family which frequently manifests itself with inflammation of the urinary tract and the prostate. I do exhibit minor symptoms of this as well and the MRI clearly shows long term chronic prostatitis. I believe this is what has given my urologist pause on the biopsy. Even though I have a small amount of g6 cancer, it is highly possible that my PSA is elevated, not so much because of the small amount of cancer, but from the prostatitis.

That is my hope anyway. Only time will tell.

Post Edited (PC Legacy) : 6/3/2016 8:54:48 AM (GMT-6)

PC Legacy said...
Allen,
I am fully aware that an MRI cannot determine a diagnosis of cancer. I am also fully aware that a lesion in itself does not indicate cancer in any way.

I was only asking how common it is for someone with a "bad" Initial MRI and a positive biopsy to later have an MRI showing no lesions.

I still have cancer. Just happen to be hopeful that mine is indolent and won't need treatment.

I have never seen an answer to your specific question, and that may be because the MRI, as noted, is not a definitive test. What I have seen reference to is "negative biopsy after positive biopsy." This was noted a couple of years ago in a Johns Hopkins article about AS. (I probably can't locate it now). But, the research noted that having a negative biopsy following a positive one was an optimistic indicator that the cancer was indolent.

I had the same thing happen.12th biopsy showed small cancer< 1% in PZ area. Biopsied again found no cancer in that spot. Dr Scholz said it most likely was cancer clusters that never turned into a tumor and it happens a lot.. Fortunately that same biopsy using color Doppler found the real cancer in the anterior.