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When I say If I have time, I am referring to progression of the cancer, not to mortality. I figure at 56 I should have 30-40 years or so, I am not worried about PC getting me. As far as the cancer. if it starts to take off then I will have to look at options, hopefully that wont be for awhile hence if I have time.
through about 8 years of PSA ranging from 4.2 in 05/97 to 6.3 in 05/04. During the time I had four biopsies and the first was similar to yours (found 3% cancer involvement in only one of 15 samples) but a higher Gleason, and my Urologist recommended waiting while getting PSA done every 4-6 months. When the PSA elevated a bit I repeated the biopsy. Did that twice as PSA went up and down and both biopsies were negative in all 12 samples. Finally, in 11/04 & 12/04 I had the PSA with results of 9.0 and 10.5, Gleason 3+4=7, again only a 3% involvement in one area Left Apex. But given the PSA finally went up 3-4 points my very well thought of Urologist with conservative treatment views (he doesn't over operate and is open to other treatments) felt it was time to stop the waiting and treat the condition. He recommended IMRT (said he would do the operation if I elected to do so) and also recommended I get a second opinion. A radiation oncologist out of Fox Chase (cancer center of expertise in Philadelphia) agreed I was a good candidate for IMRT. So, I went with the IMRT (40 doses), which were completed in 05/05. My PSA has gone down but I still have not reached a nadir of below 1.0, perhaps it will not go there but my Urologist told me that many men do well with a nadir above 1.0 after IMRT as long as the PSA doesn't double or rise rapidly. And, given it has not elevated except for .5 over two PSA's and then dropped .3, we have not elected for adjunct follow-up ADT.
I wish you good luck in your choice. I believe you have time to wait if you are careful and get PSA's done frequently and if the PSA elevates much get another biopsy. But again there are no assurances in our fight. Just remain positive and take it from there. Waiting certainly preserves quality of life - it did for me for several years.
Sorry to say I'm in a bit of a hurry this morning, and in any event I was pleased to see that you are calmly examining your options.
Can I suggest that you go along to http://tinyurl.com/223wgh and print off this excellent piece on Active Surveillance which may help your good lady wife to be a litt;e less apprehensive, although my experience is that even after the best part of 12 years my wifer is still concerned.
Thanks for the information. I have a PSA recheck next week and I will see how it goes. I dont think the PSA will change to any great degree and if so this will help things at home. I told my wife I will look at options closer should PSA rise to about 9. Since it has been 4-5.5 over the last several years, I believe it will be quite a bit before I have to worry too much about it.
Here is another side of the coin. At age 59 I had a psa of 4.1 (Dr. sent me to a urologist for a consult). He recomended a biopsy. Report came back positive for PC. I had no symptoms and a negative rectal exam.
Dr. thought surgery appropriate and after investigating my options we went ahead. "Thank-Goodness"
Final path report showed seminal vesicle invasion.
Have also had some salvage radiation. I can only imagine what would have happened if I had waited. Turns out the cancer was more aggressive than the biopsy showed.
Just something to think about.
Best of luck.