The real issue here is not the equipment used or even the test performed: it is the quality of the doctor who will read the test. Just as with every other doctor dealing with PCa, whether it is a...
Hi I used Dr Epstein for a second opinion on my PCa biopsy more than 11 years ago. He lowered the Gleason score from 7 to 6 in my case. At the time I specifically asked that Dr. Epstein review the...
Hi, We keep advising people to get a second opinion on their biopsy from Dr. Jonathan Epstein at Johns Hopkins. I too have enormous respect for Dr. Epstein and I too got a second opinion from him...
Hi When I sought a second opinion on my PCa pathology from JHU in 2012 I asked specifically that Dr. Epstein himself do the evaluation. Afterwards I was able to speak with Dr. Epstein on the phone to...
azroadrunner, I also discovered incidentally that I had PCA after a TURP. The urologist who performed the TURP was hesitant to do the surgery because he found, from personal experience, that the TURP...
lapilot, If I were you, I would get a PSA test in the next month rather than wait 6 months. I did that twice and both time the PSA results came down....
Chip, One more thing: I concur with Pratoman that you shouldn't expect your PSa to drop to .05 or below because those people who have that PSA score mostly do not have a prostate. Even those whose...
Chip, I was in the same situation as you almost 10 years ago in April, 2012: after steadily increasing PSA scores and 3 negative biopsies over a 10 year period, my PCa was detected during a TURP. The...
Prato, Your math is off: 5% of 5% is 0.25% (1/4%, not 2.5%). This makes the Gleason 4 percentage very small indeed. Whether this makes a difference in your decision-making is up to you. Good luck...
Hi, The psa numbers generated by benign prostate tissue is addressed by the following paper: https://www.ncbi.nlm.nih.gov/pubmed/9743696 In particular, the following quote from the paper covers the...
Hi, All this "science" dealing with the effect of various factors such as ejaculation and riding a bike on PSA neglects the fact that different people may respond differently to these factors. The...
Geetarman, My situation is somewhat like yours in the sense that after the TURP which found the PCa in the transition zone, my PSA dropped from 9.6 to 1.0 and I'm not even sure there is any cancer...
Hi, In my version of AS I have a 3T-mp-MRI done yearly. So far, the PI-RADS score has been 2, which means they are not finding any significant cancer (GS 7 or higher); consequently, I have skipped...
Hi, I watched the video and two points stood out. 1. The Gleason score was given as going from a low of 1 to a high of 10. Clearly the lowest is 1+1. 2. More significantly, the urologist either...
MK1965, Try not to get ahead of yourself. A TRUS biopsy should be enough. Once you get the information from the biopsy, you can come back here for additional advice. In particular, if the biopsy has...
MK1965, I sent the original TURP chips to Epstein for a second opinion. In my case, the first pathologist graded the biopsy as Gleason 7. This was revised by Epstein to Gleason 6. I never did undergo...
MK1965, The urologist who found my incidental cancer recommended that I undergo radiation because, in his experience, the TURP compromised the prostate body and made surgery much tougher. I then...
MK1965 I had my follow up PSA taken nearly two months after the TURP: the TURP was done on April 4 while the follow up was carried out on May 29....
MK1965, As you can see from my handle (turpt1a), my situation with regard to the prostate cancer diagnosis was very similar to yours. In my case, it was actually worse: I first received a pathology...
According to this study, the metastasis occurred almost exclusively to men on AS with Gleason score 7: "Although the intermediate risk group was at higher risk for metastasis, those with Gleason...
Miki, If I were in your husband's situation I would follow Pratoman's advice and first get a second opinion on the pathology from Epstein at JHU. The reason is as follows. Epstein et al, in a study...
Rowen, If you do decide to consider AS seriously, you should do the following first: 1. get a second opinion on the pathology of the biopsy from Bostwick or Epstein (I used Epstein; I was able to...
Mark1960, You wrote: However, I'm torn since I also don't like the SE risks either and know that there will be some loss of something going forward. But if I know that the PCa is gone for good, then...
Rowen, You are making two wrong assumptions: 1. You are assuming that your cancer will inevitably progress so that you will need treatment eventually. 2. You are assuming that while practicing AS,...
Novembeard, The PCA3 test is a gene-based test carried out on a urine sample. The urologist massages vigorously the prostate before the urine is collected. According to the website www.pca3.org,...
Novembeard, I have been on AS for almost 4 years. In addition to a semi-annual PSA test, I have also been keeping track of any possible significant PCa with annual 3T mp-mri. I also took a PCA3 test....
RickTrin, The size of the PSA number is not always an indication of the amount of cancer present or how aggressive the cancer may be. A case in point is my experience. My PSA number started climbing...
Prat, Great news!! Although we all had faith that a mistake was made....
Prat, A situation similar to yours was reported by Frank Fiore, a contributor to YANANOW. He writes: A very strange and somewhat disconcerting week with my uro. On AS since October when first...
Tom, A radical prostatectomy is not the usual treatment for BPH caused by an enlarged prostate. A TURP, either done traditionally or with lasers, is often used. Also, a simple prostatectomy, which...
I want to add my experience in response to the statement made by Dr. Klotz that men on AS frequently were "ebullient" after being on AS for a few years. In my case, my "ebullence" came about after...
Although the majority of those who responded in this thread are pro AS, the fact remains that a clear majority of those who come here who are diagnosed with low risk disease (Gleason 6 and PSA <...
I want to add that AS would be more chosen as an initial response if the urologists who are first consulted would encourage men with low risk (and especially very-low risk) PCa to consider AS...
In the protocol I use as part of my Active Surveillance of my PCa, I take PSA tests every six months and a 3T mp-MRI every year. My urologist and I have skipped the DRE since it is the least...
I, too, had a TZ tumor that 3 TRUS biopsies missed. The cancer was finally found incidentally when I underwent a TURP to relieve BPH. Although my PSA grew steadily over a period of 13 years from 3.4...
Gunner, You inspire us all!...
suzhtz, When you get your opinion from Epstein, call his secretary and ask to speak to Dr. Epstein. I, as well as Pratoman, found him forthcoming....
The issue of due diligence is more complicated when one has to choose whether to go against the advice of the doctors (as opposed to choosing between the treatments offered by different doctors)....
Hi, I understand that the endo-rectal part of the mri is not necessary if a 3T magnet is used. In my case, my urologist is confident in the results of 3T mp-mri. I have undergone three of those and...
habhammer, Kudos for looking into the AS route. When you do speak to these people, if you are advised against AS, make sure to ask them what they would consider to be appropriate for AS. There are...
Hi, I stopped getting the DRE exam for two reasons. First and foremost, I undergo a 3T mp-MRI every year, and my urologist feels that the DRE is the least sensitive of all the exams (including the...
In addition to a semi-annual PSA test (the last three scored 1.2, 0.9, 1.2) I also have a 3T mp-MRI done annually in June as part of the protocol for my AS program. For the fourth year in a row, the...
In regard to the cost of the Epstein second opinion, let me share my experience. JHU charges $250 for the opinion, and I was asked to provide a credit card number for the charge. I requested JHU to...
Bill Positive, From what I gather, Klotz, in his AS Program at Sunnybrook Hospital in Toronto, accepts men who have G6 biopsies into the program, but will keep them on AS as long as the Gleason score...
Halbert, You wrote: I'm a poster child for this outcome. My 12 core biopsy showed only one side involved at a maximum of 20%, G3+3. Post surgery, I showed 15-20% involvement in all 4 quadrants, G3+4....
island time, Here are the numbers from Klotz's study (Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 33:272–277): Results Among the 819...
island time, The recurrence rate for 3+4 is higher vs. 3+3 even after surgery and radiation. The question is: is the recurrence rate for 3+4 higher if it is treated at a later date because of the...
island time, I'm not sure what you are saying? Are you arguing that QOL is higher for those who undergo radical treatments such as surgery and radiation than for those who use AS?...
Halbert, You ask: This is good stuff indeed. I have one question, being in the 35% who biopsied as G 3+3 and had surgical pathology of 3+4, and that is this: Is there a good, commonly available, and...
JimBear If I were you, I would definitely look into Focal Laser Ablation. In particular, I would have my MRI images examined by a specialist in FLA to decide whether FLA is feasible. One person to...