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Considering End of AS

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Posted 1/3/2018 7:00 PM (GMT 0)
Hi,

My confirmatory biopsy at diagnosis+1year still shows 1/12 positive cores (in same location), but pathology upgrade to 3+4=7 @ 30% G4 (see updated sig).

I don't like that G4 and am strongly considering treatment. I know 1 core of 3+4 still makes me an AS candidate in many if not most circles, but after this Gleason upgrade it feels a bit like Russian roulette. It seems like treatment is inevitable at some point, so why not just get it done?

Appreciate any thoughts on the matter.

-Paul
Posted 1/3/2018 7:44 PM (GMT 0)
I understand things are progressing on the AS front in the medical community. But the thought of having cancer inside my body....that's proven to be a metastatic cancer.....is more than I can comfortably sleep with at night. That's me.

There's a chance (possibly a reasonable one)....that one could live for years with that path with no adverse effects.

I'm not that brave (or rational?). But...I can completely understand people doing it.
Posted 1/3/2018 7:45 PM (GMT 0)
Tutor_Paul:

As someone who is about four months post RARP I would encourage you to wait. The recovery is unpleasant, but not horrible, and the side effects in my case are no fun.

I don't know what treatment you are considering, but they all have side effects and risks that vary from person to person. I wouldn't have gone down the path I did if AS was an option for me.

Talk to your Uro, talk to a RO and understand what they believe the best treatment options are for you. Take into consideration the recovery / side effects and make a decision - but take your time. If it is your style read and learn as much as you can about this disease and the different treatments.

The other argument is that treatments are getting better all the time and waiting probably gives you different treatment options in a few years.

Best of luck, and let us all know what you decide.

Cheers!

Rob
Posted 1/3/2018 7:58 PM (GMT 0)
Your first decision, which only you can make, is whether major decisions in your life are going to be data-driven or emotion-driven.

Post Edited (NKinney) : 1/3/2018 1:06:08 PM (GMT-7)

Posted 1/3/2018 8:05 PM (GMT 0)
I would get an MP-MRI to see if it progressed in the scan as well and if there are more than one lesion and if the pirads score also moved up.
Posted 1/3/2018 8:19 PM (GMT 0)
The gleason 4 cells were in the prostate a year ago already, the needles were just not placed to locate them.

A CTC Test will already show prostate cancer cells in your blood. Nowbody can tell if or when these will result in metastases.

I think you could still live for some time without side effects. You can decide for surgery or radiation any time.

George
Posted 1/3/2018 8:40 PM (GMT 0)

NKinney said...
Your first decision, which only you can make, is whether major decisions in your life are going to be data-driven or emotion-driven.

if data driven...never get married. Especially a second time. tongue
Posted 1/3/2018 8:50 PM (GMT 0)
Paul, before you leave AS — have you had the recent biopsy slide read by Dr. Epstein?

Jim
Posted 1/3/2018 9:02 PM (GMT 0)
Rob: Thanks for the feedback on your experience
Island Time: Yes, the metastatic potential of G4 is really the concern
George_: Maybe/maybe not on the G7 last year... who really knows?
NKinney: Being an engineer, if anything I am probably overly-data driven
ddyss: Yes, the uro said another MP-MRI is the next step if I say on AS
Jim: The slides are supposedly on their way!
Posted 1/3/2018 10:58 PM (GMT 0)
paul I was considering AS but when one core was upgraded to 3+4, I choose to get treatment. I have the assumption that there is more there then less there. I wish you well. Denis
Posted 1/4/2018 12:10 AM (GMT 0)
I followed AS for several years but I had a set of criteria when I would choose treatment. One of those criteria was if any G7 (3+4) showed up in the biopsy. The longevity stats are pretty good with G6 but not as good with G7. Almost 3 years out from surgery things appear to be pretty good with minimal side-effects.
Posted 1/4/2018 12:30 AM (GMT 0)
Paul, a small percent of G4 would not cause me to leave AS.

But, 30 percent would. I would recommend, as Tudpock18 suggested, that you have the slides send to Dr. Epstein for his opinion. If he concurs with the 30 percent number, then I would take action, if I were you.

Types of radiation such as SBRT and HDRBT would be my first choices for treatment, but your choice will be your decision.
Posted 1/4/2018 12:33 AM (GMT 0)
Denis - Thanks and good luck with your HDR in a few weeks.

Dreamer - Honestly, that was my criteria as well... If I get pathology confirmation from JHU, I will likely move forward. Glad things are going OK for you.
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