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My first month on active surveillance

I've gotten more comfortable with active surveillance since diagnosed a month ago with Gleason 6 in 1 out of 12 cores--approximately 10% of the core with no perineural invasion identified. My urologist was OK with AS too. Quarterly PSA tests are in my future as are annual biopsies--though I may push my next one to 15 months because of how my insurance works. I'm 56 and meet even the strict John Hopkins criteria for AS except for my relative youth (no health issues to speak of).

My concern is this. In looking at the pathology report, it shows other things to think about in addition to that one core:

1. One sample "suspicious for cacrinoma" with "small focus of atypical glands" next to sample with carinoma.

2. One sample with high grade prostatic intraepithelial neoplasia--is this what we would call a Gleason 2+2 or 2+3?

3. Many samples with "atypical glands" and "atrophy" including one that shows a "small focus of atypical glands" adjacent to a nerve "which may represent partial atrophy in glands adjacent to a nerve", however "the possiblity of perineural invasion cannot be entirely excluded."

It seems to me that I have a pretty unhealthy prostate and have for years. I know atypical glands can be caused by prostatitis (and BPH?) and it has been confirmed that I have all three prostate ailments--BPH, Prostatitis, and PCa.

I'd like to have a couple of years before treatment. Am I safe doing that if I have a biopsy rougly in the middle of those two years with quarterly PSA tests?

Re: My first month on active surveillance

G'day Jack.

I think you are right on the button when youj say upir prostate gland may be unhealthy, but that doesn't mean that prostate cancer is inevitable.

Atypical cells are a long way from being adenocarcinoma and there are many lesions, some of which may be labelled as pre-cancerous and some which may even be misidentitfied as cancer. I don't know if you have been theough the site and especially DIAGNOSIS? If you go there and page down to the section dealing with Biopsy you'll find some links there to more information about these lesions.

Good luck - if you've got the folk at Johns Hopkins keeping an eye on you, you're in a good place.

All the best
Terry in Australia

Re: My first month on active surveillance

Jack,
One thing I like men to remember that barely have prostate cancer (like yours)is that it will be at least 10 years before it might become life threatening and by that time there will be better treatments with lesser side effects.

Re: My first month on active surveillance

Thank you, Terry. I don't have JH folks watching me, I just looked at their criteria for AS which are the most stringent. And my age would knock me out of their criteria because I am too young. I guess that means that there is a possibility that PCa will catch up with me before I die a natural death--which according to the acturial tables is 25-30 years away. I'll catch it before that happens through PSA tests and a biopsies every year or two.

I followed your elections. Switching PM's like that was not good for Labor. I'd vote Liberal anyway if I were Australian.

Re: My first month on active surveillance

Jack you say .... I am too young. I guess that means that there is a possibility that PCa will catch up with me before I die a natural death...

Of course there is always that POSSIBILITY but all the statistics show that as a PROBABILITY it is unlikely. Whenever this subject comes up people rush to point out that statistics do not apply to individual cases and of course that is so, but with PCa deaths accounting for about 3% of male deaths and more than half of those deaths occurring in men over the age of 80, the odds are in your favour to my way of thinking.

I've been meaning to write a piece entitled "What's Age Got To Do With It." Must do that sometime.

All the best

Terry in Australia

Re: My first month on active surveillance

welcome to the world of AS!!!! :-)

I'm on AS since May 2012. Do yourself a favor, and give yourself the best fighting chance you can by altering your lifestyle! Make sure to get lots of exercise, get to a good weight, and eat right.

Read up on anti-cancer diets and eating choices. Keep that immune system in tip-top fighting condition.

Best of luck to you Sir! :)

Re: My first month on active surveillance

Walt,

That's damned good advice for every visitor to this site. For those of us on ADT there's an extra influence which tends to put on weight. Every so often I have to remind myself to drop half a stone to my fighting weight.

OC in England

Re: My first month on active surveillance

why thank you Sir!!

Re: My first month on active surveillance

I've looked at one other criterion that I don't know one way or another for active surveillance. Should I get an MRI to confirm that their is no extension? To be in Skyblue according to this chart, I should get confirmation of that? Or is it so unlikely with my grade being so low that it isn't with the expense?

http://pcribc.org/pages.php?pageid=8

Re: My first month on active surveillance

Jack,

The definition of SkyBlue is They have PSA levels less than 10, a Gleason score less than 7, no nodule or a very small nodule on digital rectal examination, three or less biopsy cores positive for cancer and no single biopsy core more than 50% replaced with cancer. THere is no mention of an MRI, presumably because the chances of there being anything outside the gland which is discernible with current equipment is so small it would indeed be a waste of time. Rejoice in your SkyBlue status!!

All the best
Terry in Australia

Re: My first month on active surveillance

Thanks, Terry. That's what my stepson tells me who is completing his residency next year.

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