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1. If one is interested in active surveillance, how do you find a doctor who might aid you in your monitoring? You keep looking until you find one. I saw about thirteen doctors of various specialities while I was doing my initial investigations and coming to the conclusion that it might be in my best interests not to have immediate aggressive treatment. I finally found one – an oncologist – who didn’t exactly think it was a good idea, but agreed to go along with it. If you use the QUESTIONS as a matrix, you should get some pointers as to whether the choice of Active Surveillance is good for you – and which medico might support you in this choice.
2. My understanding is that they are still finding the same amount of cancer at 2.5 as they were at 4.0. Does this mean the need to lower the psa alarm value to say 1.5 or 1.0? Then what? PSA is NOT prostate cancer specific and its value is greatly diminished by that fact. The Stranger has posted links to a paper what appears to demonstrate that the incidence of PCa is similar in all men of a certain age and that if you biopsied every man over 50 you’d get about the same percentage of men (maybe more) with a PCa diagnosis as you do now using 4.0 ng/ml or 2.5 ng/ml.If you haven’t read PSA 101 you may find it useful to do so.
There are no definitive answers as to what action is “right” or “wrong”. We all have to educate ourselves as far as we can and then do what suits us best, never looking back and asking “What if….” Life is for living.
I didn't reply to this thread before because the only thing I have to offer has been said many times, but maybe you haven't seen it so I'll post it again.
The problem is, it's a very personal decision to watch and wait and the doctors (for the most part) don't want to help. I'm not sure if it's the fact they earn a better living by treating people or they truly believe everyone with prostate cancer must be treated. None the less at least one very prestigious doctor speaks out about PSA and what to do. I'll put a quote from him below and you can do an internet search on Dr. Thomas Stamey to find several articles by him. Dr. Stamey is Professor and Founding Chairman of the Department of Urology at the Stanford University School of Medicine.
Dr. Stamey
Prostate cancer is so common that virtually every man gets it if he lives long enough, said Dr. Thomas A. Stamey, a professor of urology at Stanford. Yet only rarely is it life-threatening. Screening, Dr. Stamey said, fueled by a false sense of confidence in what is normal and what is not, has led to far too many biopsies, far too many discoveries of cancers that pose no danger, far too many prostates removed or destroyed.
To me, the biggest issue is that we need to recognize that we all get prostate cancer, but that the death rate is only 226 per 100,000 men over 65 years old. Any excuse you use to biopsy the prostate — and we've been using PSA as an excuse — you're very likely to find cancer.
