Fiftieth PSA test? Wow! I’ve had about 33 since entering Johns Hopkins’ active surveillance program in 2009. Why were you having quarterly tests? I recall that you are also a long time member, but,...
My PSA bounced from 4 to 116 back to 3. And, it was caused by acute urinary retention and a UTI, both brought on by BPH. Nothing to do with prostate cancer. Aquablation fixed the blockages. So, while...
I was diagnosed with three cores of Gleason 6 in 2009. Enrolled in Johns Hopkins’ AS program that same day. Nine MRI’s and eight biopsies later, no prostate cancer has been found since 2019. At this...
The less than sign means that his result was below that machine’s capability to analyze. Good news!...
I am a long time participant in Hopkins’ Active Surveillance program, and receive their urology updates. Their emphasis is on surgery. That is their strength. I rarely hear anything about radiation....
I share DJin’s concern with this biopsy finding six positive cores bilaterally. That raises your risk from very low to low, providing more motivation for additional data such as a genomics test....
After three years of AS as a Gleason 6, I had a biopsy showing three positive cores, bilaterally, with involvement between ten and twenty percent. This caused concern, and my case was the centerpiece...
That trend makes sense because of the need for surgeons to find new patients to compensate for the loss of low risk patients to AS and focal treatments. They appear to be increasingly including ADT...
I requested a transperineal biopsy guided by a the ExactVu microultrasound in real time. This was at Johns Hopkins. I have heard that I am the only patient who had this done. The head of Urology had...
An update fourteen years into my active surveillance. My “benign” prostate problems recently became serious with causing acute urinary retention, and I needed to clear the blockages. I chose a...
The USPSTF has since moderated their stance against PSA testing, but I firmly believe that testing should be lifelong. My neighbor religiously had testing until he was about 70. He stopped because of...
Probably because he’s moved on, and is comfortable with AS, and not having anxiety about his situation....
As I and others have noted, what they called active monitoring then is nothing like the protocols used today. First, Gleason 6 does not metastasize, so those guys had one blind biopsy, probably with...
I am a long time advocate for active surveillance, and have always been concerned with how AS was defined in that study. Those men made their choices before 2012, and almost all had only a...
I believe that Percent Free PSA has value in undiagnosed men to decide if a biopsy is needed. I don’t think that it has relevance once diagnosed and treated. Johns Hopkins used it before I was...
I am familiar with the one-eighth of AS men who experience high anxiety, which is often due to relatives’ cancer experiences and current pressure from relatives to get treatment. Some of those men...
I think that those regretting doing AS are those who found higher grade cancer on their next biopsy. At least, those are the people most bitter towards AS in various discussions I’ve been in. I get...
I did ask The aquablation surgeon if this procedure could coincidentally remove my small amount of Gleason 6 PCa. He said that it was possible in theory, but not an intended result, and not to expect...
That is not true for this practice, which has performed about 470 aquablation procedures. The surgeon told me that he always sends a part of the ablated tissue for a pathology report....
I am in similar situation where I have had Gleason 6 prostate cancer since 2009, but now have no choice but to deal with my BPH. Potomac Urology has recommended doing two BPH procedures within a week...
Just another case of famous people immediately choosing surgery while overall NIH statistics show that slightly more men have chosen radiation as their primary treatment for prostate cancer in recent...
As a long time Gleason 6, I totally agree with this article. We need to continuously monitor men with low risk prostate cancer because our existing diagnostic tools are still imperfect. Also, higher...
Several advocacy groups for active surveillance of prostate cancer in low risk and favorable intermediate risk men have designed and published a poll to gather the opinions of men currently or...
The finding of cribriform morphology is another risk factor. As with others, it does not mean that the cancer has spread, but increases the risk. Expect that radiation, and possibly ADT, may be...
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...
Hi Clocknut, I went through the same scenario as you, about a year earlier. But, while prostate cancer was diagnosed, no urologist, including Patrick Walsh, ever suggested that I needed any...
Thanks for this. Sounds like progress.if these results can be repeated in a larger trial across multiple institutions, then this treatment could become a real alternative for intermediate risk men....
The initial diagnostic biopsy is used to sort men into two lanes, AS or treatment. Once AS is chosen, then they must have an MRI followed by a confirmatory biopsy within six months. If they are...
Thanks for this, DJin. I belong to several groups of activists against overtreatment, and am distressed at how extreme some of their opinions have become. Many want to stop PSA testing altogether. I...
A favorable Decipher test is required for favorable intermediate risk men to enroll in Johns Hopkins AS program. But. they seem pretty certain that the existing tests are sufficient for the low risk...
A Gleason 6 with a high PSA is not low risk. Actually, PSA Density is more definitive than total PSA. But, if those are not low risk, then point 2. would indicate that the clinician could selectively...
The risk categories are defined in Table 3. They decided to combine very low risk and low risk because the recommended treatment would be the same. Very low risk is a category that Drs. Epstein and...
The American Urological Association and the American Society for Radiation Oncology (AUA/ASTRO) just issued new guidelines for the treatment of localized prostate cancer. There are major changes for...
Here are the recurrence stats for SBRT, which aren’t 1 percent, but still twice as good as any surgery results I’ve read: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2723641...
In comparing treatments such as HDR-BT and SBRT, it is useful to note that SBRT was specifically designed to deliver the same radiation dosage effect as HDR-BT, but by external beam, rather than...
I’m quite extroverted and am frequently out meeting up with both regulars and new friends. I only bring up prostate cancer if someone else mentions it. When it is being discussed, I interject that I...
It was true that radiation caused some secondary cancers, but that has been minimized with the new age of radiation technology, which began about 2004. Anytime I hear about secondary cancers from...
A urologist is not the expert on ADT, a medical oncologist is. I have found that uro’s, many of whom I have spoken with on cruises and other travels, are often shockingly uninformed on radiation and...
The latest statistics form the National Cancer Institute's 400,000 man SEER prostate cancer database show about 27 percent of men choosing surgery, and about 29 percent choosing radiation. The others...
Keep in mind that the biochemical recurrence criteria for radiation patients is based on "rise above nadir", rather than any fixed number. The 2 point criterion is not a test result, but rather a...
And, on the other hand… https://pubmed.ncbi.nlm.nih.gov/32307329/ I have used Atenolol, a selective beta blocker since 1995 and there has been zero progression of my low risk PCa over twelve years....
You might also consider brachytherapy boost therapy, which is IMRT followed by a session or two of either low or high dose brachytherapy. Lately, some SBRT sessions are are being substituted for the...
The Precision Point transperineal biopsy device is a free-hand biopsy system that is standard protocol at Johns Hopkins, MSKCC, and UCLA, and others. It has had near-zero infections and does not...
EBRT as a monotherapy for high risk PCa? I stopped reading at that point. Brachytherapy boost is what is needed to treat high risk cases....
Ask if they can use the ExactVu micro-ultrasound instead of an MRI. I have had nine MRI’s and lost functioning in one kidney years ago due to an accident. Because of my history, Johns Hopkins agreed...
Mumbo, Totally agree. Studies take years from the last treatment to being able to publish any conclusions with confidence. I would love to see very recent SEER data on treatment choices, as that...
I have been viewing those graphs for several years. The obvious reason why I don’t place much weight on them is because the studies are retrospective and mostly involve men treated many years ago,...
In my twelve years of researching possible treatments (I am a Gleason 6 on active surveillance), I have never read any large scale, peer-reviewed, multi-institutional study that showed another...
I’ve been a JH urology patient for fifteen years, and receive their publications. He is very prominent and accomplished. He was not hesitant to learn and perform robotic surgeries. I have been...
There are studies with percentages of recurrence by Gleason score, staging, and probably other variables. But, I think that there is wisdom in this above statement by ShawsUnprostatedMan: “ ….even if...