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Re: Window of opportunity

G'day Pete,

I am the planet's leading believer in active surveillance, and I know you are only Gleason 6 with a relatively low PSA, but I kind of think that more than 50% in 7 of 12 cores changes the perspective on AS a bit.

Although a healthy diet is a good idea generally, I don't believe that diet and lifestyle alone can really turn this thing around.

I wouldn't have radical treatment without another biopsy, and I am a believer in a trans perineal biopsy of at least 20 cores to get better sampling of the entire gland. Then if this showed significant % of cancer, even if only Gleason 6, I would be very reluctant to sit around much longer, especially at your age.

All the best with whatever you choose.

Brian in Australia.

Re: Window of opportunity

I'm not a doctor but at your tender age with those concentrated findings I would suggest ( 1 ) find the top urological surgeon in that area and have it removed or ( 2 ) investigate the radioactive seeds ( brachy ) as this process I have heard is now yielding pretty similar results. My radical procedure was pretty well pain free afterwards and took less than an hour - although my sex life ( I'm 63 ) is now not as good and Viagara is necessary to gain erections. I personally think that your age is a key consideration.If you were over 70 y.o. perhaps active surveillance would suffice.

Re: Window of opportunity

Don't forget to check out proton therapy while investigating options. UFPTI has some good results while low risk (GS6) with minimal side effects. But since you are too young for Medicare, you would have to check with your insurace carrier for coverage.

Re: Window of opportunity

I second the motion for you to consider proton beam therapy (PBT), which is a form of external beam radiotherapy (EBRT). Had it done one year ago at MD Anderson and have never regretted it for a moment. All systems have been "go" right through the treatment period and beyond. I'm also a bit younger than you are, so continence and potency were very important to me in addition to the cure.

Re: Window of opportunity

Pete,

There are some aspects of your diagnosis that are a puzzle to me.

Specifically,

1. You say you were diagnosed in February 2011.
2. You say you were staged T1c – so that would mean you had a negative DRE (Digital Rectal Examination) and in terms of the definition of T1c staging your “…. tumor was found in a needle biopsy performed due to an elevated serum PSA”
3. You say that you got sloppy with your diet from December 2012 (still to come in most parts of the world!, so presumably December 2011) and your PSA hit it’s highest point ever some time after July (presumably tht is last month) when it reached 2.8 ng/ml.

If I have read this aright, my first question is a simple one – why did you have the biopsy in the first place? A PSA below 2.8 ng/ml and a negative DRE do not usually trigger off a biopsy procedure. So, did you have some other reason or symptoms for choosing the biopsy?

I’m with Brian in expressing some concern about the apparent volume of a tumour you may have (although I would dispute his claim to be the leading believer in active surveillance !!) but would enquire whether you had your pathology results checked by a RECOGNISED EXPERT PATHOLOGIST ? I ask because there was still a deal of confusion last year about some aspect of the new pathology protocols when many Gleason Score 5 cases were upgraded to GS 6. May I suggest that you have this done as a first step as part of the recommended path of assessing status before determining strategy – see SURVIVING if you haven’t been there before.

I think you need to do a deal more investigating before making your decision.

All the best

Terry in Australia

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