Right treatment plan?

Hello Raindog and welcome to Healing Well. Please feel free to ask any and all questions and we will help you as much as we can.

With your stats a plan of "Active Surveillance" seems reasonable. This is where you watch the situation but ACTIVELY monitor and test at regular intervals to make sure the cancer has not gotten worse. If it does get worse then active treatment via surgery or radiation is in order but you are far away from that with your results so far.

The important thing for you right now is to make sure you have a doctor or a practice that is experienced in handling patients under active surveillance protocols. If you want to learn more about those you can see some expert protocols from the Johns Hopkins or MD Anderson web sites...or many other sites just by Googling the term.

As I said, this seems to be a reasonable approach for you at this time but make sure your docs know what they are doing. You also might request a second opinion on your biopsy slides from Dr. Epstein at Johns Hopkins just to make sure that your current diagnosis is as correct as it can be.

Good luck to you.

Jim

Tudpock18 said...
Hello Raindog and welcome to Healing Well. Please feel free to ask any and all questions and we will help you as much as we can.

With your stats a plan of "Active Surveillance" seems reasonable. This is where you watch the situation but ACTIVELY monitor and test at regular intervals to make sure the cancer has not gotten worse. If it does get worse then active treatment via surgery or radiation is in order but you are far away from that with your results so far.

The important thing for you right now is to make sure you have a doctor or a practice that is experienced in handling patients under active surveillance protocols. If you want to learn more about those you can see some expert protocols from the Johns Hopkins or MD Anderson web sites...or many other sites just by Googling the term.

As I said, this seems to be a reasonable approach for you at this time but make sure your docs know what they are doing. You also might request a second opinion on your biopsy slides from Dr. Epstein at Johns Hopkins just to make sure that your current diagnosis is as correct as it can be.

Good luck to you.

Jim

Thank you for taking the time to reply.

My perceived lack of urgency through the whole process didn't help matters but I'm learning that this may be the nature of the condition.

The biopsy procedure is so invasive and painful (for me anyway because I have a high tolerance to local anesthesia) that I was questioning why the need for 3 within a 2 year period but I will keep reading the posts here and try and figure if that's the norm.

I should have started researching more at the beginning but was told by Urologist and GP that I had plenty of time. Neither Dr. suggested any kind of dietary or lifestyle changes which surprised me.

I know that most here are worse off than myself so I won't clog up the board but appreciate the advice and will learn from other posts.

Just so you are well-informed, here are the new American Urological Association guidelines for the treatment of prostate cancer. Active surveillance is the preferred treatment for low risk men, based on level A evidence from several studies. While seeking other opinions, be wary if they propose any interventional treatment.

https://www.auanet.org/guidelines-and-quality/guidelines/clinically-localized-prostate-cancer-aua/astro-guideline-2022

Raindog, whatever interval you ultimately choose, there will likely be future biopsies. If you find these painful then the option of IV anesthesia is always there (depending on your doctor). I only had one biopsy but my urologist chose IV anesthesia because he felt that there was no need for unnecessary pain for his patients. Then he also could take his time. Worked like a charm for me...nice nap and then it was over.

Jim

Jack64 said...
Raindog, sorry you are here, but glad you decided to post. It seems strange that both a scan and biopsy found cancer, yet the second one found none. I would think that he missed the area where the cancer is and is perplexed that none showed up. Therefore the reason he wants another one done in a year. I would not hesitate to follow his direction. I started with GL-6 after a TURP. Was told to watch and wait. Waited for URO to do a biopsy which was long time. By then I was GL-7. Not knowing about this forum or much about PC, I followed his direction to wait again for another biopsy. A new URO was sought out after a year went by and he immediately did a biopsy. That result was GL-8. My advice is to get regular PSA checks and at least in a year if not sooner another biopsy. It is said that PC is slow growing, I found out that aggressive PC is not. You did the right thing by coming here even with GL-6. Hopefully you will have many years of watchful waiting. That term does not mean do nothing. My best to you.
Jack

Thanks for the reply. I keep going over the 2nd biopsy in my head and one thing that was strange was that after the 2nd biopsy when we met for results the Dr. said we need to get you an MRI. I said I already did isn't that how you knew what area to look for when doing the 1st and 2nd biopsy? He says oh yeah, I see that here now in your chart. I'm not sure if he didn't view the MRI prior to the 2nd biopsy or if he just didn't have that in his notes. I don't know what to do. My GP said because it was so small it's like trying to locate a seed inside a lime with a needle and that I shouldn't worry but I'm thinking on the other hand if he didn't reference the MRI before the 2nd biopsy I could have advancement and not know it. I kind of got on his bad side at the beginning questioning my perceived lack of urgency regarding the whole process. Not sure if I should ask for another appointment to discuss, geta second opinion or just change Dr.

Heres that link from above, clickable
https://www.auanet.org/guidelines-and-quality/guidelines/clinically-localized-prostate-cancer-aua/astro-guideline-2022

Wingin it, keep the faith!

My biopsy s were under anesthesia. First one I was kinda awake the second time I was out cold. You can request this.
I was grade 6 at the first biopsy the second showed more volume and one core was upgraded to G7 so I had SBRT.
What's important is the time frame which was early 2019 to late 2021
My point is that you have time on your side.
Test PSA and get the biopsy when appropriate and try and relax.
Please let us all know what you choose as it's helpful for all who come here.

Glen