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This forum is for the discussion of anything to do with Prostate Cancer.
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Active Surveillance or Radical Prostatectomy?

First post on forum.

I was diagnosed with prostate cancer on 2/19/15. When my uro told me I had 3+3=6 gleason in one core <10% it hit me hard. Hardly heard anything else after he told me I have cancer. Uro told me I have two options; 1) Active Surveillance or 2) Prostatectomy. My wife also said he mentioned radiation but I didn't pick up on that. He said based on my age (54) that he would have a prostatectomy. Going to see Dr. Leonard Marks at UCLA for a second opinion on 3/3/15 before I make a decision on treatment.

Most Recent PSA results:
2/13 - 2.76
3/14 - 3.12
5/14 - 3.4
7/14 - 3.5
1/15 - 3.46

Re: Active Surveillance or Radical Prostatectomy?

Robert,

There is little difference in the success rates of the major prostate cancer treatments and I will not urge you in any direction, but will tell you how I reached my decision. I originally chose Active Surveillance based on a Gleason 6 score, but made a decision for Da Vinci surgery five years later when the fourth biopsy revealed Gleason 7. Surgery was my choice for two reasons. My prostate had a strangle hold on my urethra and I was afraid that a fried prostate might make urination worse. The second reason was that I wanted to know if the cancer was contained in the prostate or escaped and the only sure way of knowing is for the pathologist to have the whole prostate to examine. Take your timer and good luck with your choice.
G. Furey

Re: Active Surveillance or Radical Prostatectomy?

It is difficult taking my time to research the different treatment options. My doctor recommended prostate surgery due to my age. Still in the process of researching IGRT and CK. Has anyone heard about focal laser ablation? Mark who is a YANANOW member said that may also be an option.

Thank you.

Re: Active Surveillance or Radical Prostatectomy?

.In general the more research you do now, the more likely you are to make a good decision for yourself. Also the more research you do NOW the better prepared you will be to ask good questions of the various practitioners you encounter along the way (including you upcoming meeting with Dr. Marks).
Your research effort should include the following book by Bob Marckini..."You Can Beat Prostate Cancer". His detailed discussion of the advantages and disadvantages of the most common methods for treating prostate cancer is especially informative. This book is readily available, an easy read an well worth its modest price.
Best wishes Don O.

Re: Active Surveillance or Radical Prostatectomy?

Thanks for the heads up on the book. Hope to have it by Monday.

Re: Active Surveillance or Radical Prostatectomy?

Robert,

Deep breath.....You have plenty of time to sort this out. I like the second opinion strategy. I would suggest getting an mpMRI (muli parametric). This technology can locate higher risk tumors that might be missed by Ultrasound. If your mpMRI is favorable, I think AS is a reasonable choice. I'm sure I don't need to tell you about the permanent side effects of surgery or radiation so if you are good candidate for AS and you are followed closely, I believe this can be done safely.

Fred

Re: Active Surveillance or Radical Prostatectomy?

Hi Robert,

Sorry to read that you have become a member of the club that no one wants to join (as our founding father and mentor, Terry Herbert, use to say).

To help you weigh AS (at your age) against RP or RT, I suggest that you scroll to “index” at the bottom left side of this forum page, click on it and go to page 3. There you will find a December 18th post by Roger Carnell entitled “Another Report on Active Surveillance”. Click on that and, not only will you be able to read the report, you will also have access to 25 other posts on the subject that cover both sides of the debate. This thread is a thorough discussion at your fingertips that will be a good start to the research that you really need to do. It will also have the added benefit of saving the forum readers from having to read repetitive posts on this well covered subject.

Also, if you have a penchant for long stories, you can read mine on AS. To find it, go to “Survivor Stories”; there you will see “Click Here to View the Contributors’ Stories”. Open the link and it will take you to a search engine where you can type in Alan Murphy. I was 51 when diagnosed.

Good luck with your research and decision.

Alan M in the USA

Re: Active Surveillance or Radical Prostatectomy?

Sounds like low grade cancer. The radical will pretty well get rid of the cancer, but it 'may' impact your sex life. Tough trade off. Like the others say, it's early for you it would seem.

Re: Active Surveillance or Radical Prostatectomy?

I replied previously, but it appears not to have gone through. I'll Try again.

I'm a physician survivor, diagnosed with a Gleason 9 in 2009. In the course of 50+ hours of medical library research I learned a great deal about prostate cancer. A Gleason 9 was highly motivating.

A one core Gleason 6 generally qualifies for wait and watch. About 70% of these tumors will just sit there for the rest of your life and do nothing. About 30% will eventually go bad, which is why you need to keep an eye on them. Why treat something which MIGHT need treatment later?

And it seems that your urologist failed to mention radiation (they usually do). For low risk tumors surgery has about as about the same cure rate as radiation, though the adverse effects are very different. If you do decide to treat it, I recommend that you consult a radiation oncologist, preferably at a university hospital, before making any decision.

Brooke Jennings, MD

Re: Active Surveillance or Radical Prostatectomy?

P.S. See my Survivor Story for my experience with surgeons. I had a very bad experience at UCLA (not detailed in my Story). Do not trust them without talking with a rad onc first.

Re: Active Surveillance or Radical Prostatectomy?

Active Surveillance.

What you have should be called pre-cancerous. A lot of research is going on with the best way to manage active surveillance, like how to do away with the biopsies, genomic studies and when to get treatment. The prostate cancer center I was treated at (one of the top ones in the world) will even put some low intermediate cases on AS.

Re: Active Surveillance or Radical Prostatectomy?

Frank,

Thank you for your recent reply but my condition has now changed.

Spoke to UCLA this morning and their pathologist looked at the slides from USC ( 1 core positive <10% gleason 6) and have upgraded to 4 cores positive. Here is the breakdown:

Core 1 - <10% gleason 3+3

Core 2 - < 5% gleason 3+3

Core 3 - < 15% gleason 3+3

Core 4 - < 25% gleason 3+3

Very concerned about these results. UCLA said I was still a candidate for Active Surveillance but this doesn't seem right to me.

--------------------------------------------------------------------------------

PSA

Jan 2013 - 2.76

Mar 2014 - 3.12

May 2014 - 3.4

Jul 2014 - 3.5

1/30/2015- 3.46

Color Doppler Biopsy 2/12/15 - 12 cores. 1 core Gleason 3+3 <10

Re: Active Surveillance or Radical Prostatectomy?

You've got low PSA and a Gleason 6. You are still a prime candidate for active Surveillance. The longer you can wait the better the treatment will be when/if you need it.

The fact that one pathologist is calling it Gleason 6 and another is saying the cells are not quite cancer yet also tells you that so far the cancer is not getting aggressive and you are at the low end of Gleason 6.

Re: Active Surveillance or Radical Prostatectomy?

Frank,

Thanks for your reassuring response. I would prefer to stay in the active surveillance protocol and hopefully still can. I spoke to my urologist tonight and he sort of echoed what you are saying. That it is still gleason 6 and that I'm still a candidate for AS. I have a multiplanar MRI Artemis with targeted biopsy scheduled in June to confirm biopsy from USC. Wanted one sooner but do wants my previous biopsy to heal.

Re: Active Surveillance or Radical Prostatectomy?

If it's not too much trouble could you share the name of the surgeon at UCLA?

Re: Active Surveillance or Radical Prostatectomy?

Robert,

Our circumstances and experiences are somewhat alike. So, if you want to read about 7 years on AS that started at age 51, including my experience with 4 cores, CDU and MRI scans, etc., then look up Alan Murphy under Survivor Stories.

Best wishes,
Alan M in the USA

Re: Active Surveillance or Radical Prostatectomy?

Alan,

I read your story and it inspires me to continue thinking that AS is a good option for me. I made an appointment with Dr. Leonard Marks at UCLA on 3/3/15 and he assured me that AS was a good option for me too. I also gave him the biopsy slides for a 2nd opinion. The UCLA path's opinion is that there are 4 cores from 5-25%. How does that happen when USC said only 1? Anyway Dr. Marks called me to talk to me about the 2nd opinion on the pathology and still said I am a good candidate for AS. Talking to him made me feel better about AS.

I noticed you had a CDU which I had at USC and the uro didn't find anything to be concerned about just like you. Wondering about the MRI with endorectal coil though? Not sure what this is. UCLA is going to do a multiplanar MRI on me in June. Is this the same thing?

Thanks

Re: Active Surveillance or Radical Prostatectomy?

Hi Robert,

I am glad that my story was of some use to you. Also, I am writing to answer your questions. First of all, you asked "How does that (meaning a four core finding) happen when USC said only one?" I am not sure if you meant the question to be rhetorical; so, I will go ahead and answer it this way: To a certain degree, the grading of your cancer cells is subjective, in that the opinion of one pathologist may differ from another (which is why it is always good to have your slides checked by another lab). After all, one pathologist could determine that you are a Gleason 3+3, and another could find that you are a 3+4 or worse. In determining whether or not your circumstances make you a good candidate for AS, a Gleason 3+4 finding would be a game changer for someone your age. That being said, I agree with Frank when he said: “The fact that one pathologist is calling it Gleason 6 and another is saying the cells are not quite cancer yet also tells you that so far the cancer is not getting aggressive and you are at the low end of Gleason 6.” Therefore, I further agree with Frank, and Dr. Marks, in believing that AS is a good option for you.

As far as your other question is concerned, unfortunately I do not have an answer. I googled ‘multiplanar MRI vs. MRI with endorectal coil’ for information, and I came away with no easy to understand answer. So, whether or not they are the same thing is an excellent question to ask your doctor when you go in for the scan, and I (along with, I am sure, others on this forum) would appreciate knowing what he has to say.

Lastly, when you said that my CDU doctor did not find anything to be concerned about, that is only partially true. The scan did detect a tumor, and the targeted biopsy revealed it to be a Gleason 6. So, you are right when you say that the Dr. wasn't concerned…about that. However, I asked him to also biopsy the common pathways out of the gland, and what he found disturbed him; enough for him to qualify his support for my AS decision. In fact, I have been back twice and each time he has brought up the risk involved in that finding.

I wish you all the best on your journey and if, anywhere along the line, you want to talk, then go back to my story to find my e-mail address.

Be well,
Alan M in the USA

Re: Active Surveillance or Radical Prostatectomy?

Robert,

I agree with all of Alan M's comments. I believe a multiplanar MRI is simply 3 views, sagital, coronal, and oblique. I would suggest you try to get a 3T multi parametric MRI if one is near you. This is probably the best imaging of the prostate that is available.

I would suspect that the mpMRI will not find the low gleason, low volume tumors that your biopsy has identified. That is normal and should not be of concern. The mpMRI can find more aggressive tumors that the CDU may have missed. If your mpMRI is unremarkable, you should feel confident that you can safely go on active surveillance.

Fred

Re: Active Surveillance or Radical Prostatectomy?

Fred,
I am having an MP MRI Artemis at UCLA under the direction of Dr. Leonard Marks. My thought was that the MP MRI would find those spots that were identified in my biopsy using CDU and they would be targeted again.

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