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Posted 9/11/2017 9:13 PM (GMT 0)
Just found out my PSA was .23 in 2008 and now at 3.9 with a steady climb since then. With a 5/12 biopsy G6, is there any real decision to make about AS vs taking action with RP or radiation?
Posted 9/11/2017 9:59 PM (GMT 0)
Why not order an OncotypeDX or Prolaris genomics test on your biopsy cores? They are sometimes a tie-breaker when a biopsy has more cores than most guidelines suggest.

Here is a good article about Johns Hopkins' AS program, which I have been participating in for eight years.

https://urology.jhu.edu/newsletter/2016/Discovery2016.pdf
Posted 9/12/2017 2:26 AM (GMT 0)
For me, AS would be a clear and obvious choice. For you, it may not be. I don't see any reason to adhere to a #of cores criterion as long as you have a really good confirmatory biopsy. But that's me. You have to do what makes you feel comfortable.
Posted 9/12/2017 2:55 AM (GMT 0)
I wanted to do AS, but the docs talked me out of it. In your case, on a good AS program you'd be fine.

But it is your choice and sometimes based on what makes you feel comfortable and what you can live with. For some, the anxiety is too much. Not an easy decision.

Andrew
Posted 9/12/2017 8:39 AM (GMT 0)
The # of cores being less than 3, I believe was driven by a low number of cores taken at biopsy when the standard was developed. SO if you did a 4 core biopsy and found 2 positive that is 50% but if you do 12 and find 2, clearly less. One of the good news is it is all 3+3. One other metric is the% core involvement. if that is low it may inform you. I am awaiting decipher test results to support my decision. I (we) must remember this is a slow growing cancer. At the PCRI conference, many of the docs were still in the debate as to is G6 cancer and a couple stated there has been no evidence the G6 ever caused a cancer death.

I also get the indecision part. AS is as much science as it is philosophy IMHO, we all are making a bet no matter which way we go. I say trust your intuition. I wish you well. Denis
Posted 9/12/2017 2:46 PM (GMT 0)
Here's a point of reference: For "high-volume" 3+3 cases, Dr Klotz has commented at the 2016 AUA conference that he would recommend an mp-MRI and targeted biopsy to confirm your likely eligibility into his AS program.

You don't, however, qualify as a "high-volume" 3+3 case...you have less.
Posted 9/12/2017 11:46 PM (GMT 0)
Just found out my DNA report came back very unlikely so my surgeon backed off the RP and said I would be a good candidate for short term AS whatever that means. I'll follow up on that. Still having issue with the fact that if the biopsy only hits about 1% of the prostate and they hit 5/12, that tells me its pretty prevelant. I sent my biopsy to JHs today for a second opinion and am seeing proton and brach specialists this week.
Posted 9/13/2017 1:13 AM (GMT 0)
The advantage of a good AS program is that if there is something else there, it will find eventually find it. And in the meantime, AS is considered safe with a 20-year study to back that up.

Some people aren't cut out for AS and I completely understand it. But if you're okay with it on the emotional side, you shouldn't worry that you're putting yourself at risk.

BTW, good decisions with sending the biopsy to JHU and seeing the other specialists. That's all part of good due diligence. Good luck to you!
Posted 9/13/2017 1:56 AM (GMT 0)
Malcolm Tent,
Fortunately for you, prevalence is not a big risk factor when it's all GS6. In fact, at Johns Hopkins they found that the % remaining free from disease 5years after RP was statistically no different if there were originally more or less than 6 positive cores. It might mean AS won't last for 20 years, but even if it lasts 5 years, why not?

/www.ncbi.nlm.nih.gov/pmc/articles/PMC3978182/
Posted 9/22/2017 2:48 AM (GMT 0)
Malcom,
As long as you are on good AS program, you should enjoy life free of SE and still keeping all your options open for later time. With Gleason 6, time is on your side. No need to rush into any decision especially with one that you might regret later.
MK
Posted 9/22/2017 8:56 AM (GMT 0)
I also endorse getting the genomic test, I a waiting on Decipher results. The 1% issue is a concern but none of the tests are foolproof. We need a preponderance of evidence to make a decision. PSA, MP MRI and possible follow-up biopsies will be the tools you use to monitor the disease. Age is a factor, I am 65 and hoping for 25 or more years on this journey so there is some likelihood I will have an intervention at some point. I hope that is a bunch of years from now to delay SE and hope for better interventions. I wish you well. Denis
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