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Active Survailance vs radical prostatectomy

Hello,

Dec 2016 PSA before 3t MRI 9.6 from 2.8 in June 2016
MRI found two suspecious areas.
PSA came down to 2.3 Jan 6th
and again to 1.87 Jan 19th 2017
DRE clear
MRI guided biopsy 20 cores with 6 cores from each suspecious area Jan- 31 2017
Gleason 6(3+3) tumor involves <5% of overall specimen (1 of 6 cores) left lobe
Gleason 6(3+3) tumor involves 5% of overall specimen (4 of 4 cores) left apex

Radiologist and surgeon both suggest nerve sparing laproscopic prostatectomy based upon age 57 years and family history (younger brother with gleason 9).

Urologist is of the opinion that I could go with AS.
On one hand waiting may give me a few good years without any potential side effects but age will not be in my favor later.

Not sure what to do??????

Re: Active Survailance vs radical prostatectomy

Jim:

You are confronted with a very difficult decision. Fortunately with a Gleason Score of 6 (3+3), you have time to research your options. In this respect you may find the following book by Bob Marckini helpful: "You Can Beat Prostate Cancer..." His chapter on the advantages and disadvantages of several methods for treating PCa is usually of particular interest to the newly diagnosed. This book is readily available, an easy read and well worth its modest price. Although this book is nearly ten years old much of his information remains relevant.

In general the more research you undertake at this point (be sure to include up-to-date material) the more likely you will be to make a good decision for yourself. Your research will also enable you to ask good questions of the various clinicians you are bound to encounter as you proceed.

If you decide on AS I suggest you closely monitor your PSA until you decide on a course of action. Monthly blood draws would be none to frequent

Best wishes Don O

Re: Active Survailance vs radical prostatectomy

Thank you Don, I have ordered the book, it should arrive in the next couple of days. At this point I am leaning towards surgery but continuing my research. I hope I make the right decision.

Jim

Re: Active Survailance vs radical prostatectomy

Jim,
The longer you wait (probably won't need treatment for ten years if ever) the better the treatments will get and with fewer side effects. What you have right now is probably what most men of your age would have in their prostate if they got biopsied. Some oncologists would call it pre-cancerous. You are a prime candidate for AS.

If I was in your situation I would get a DNA test from 23&me or some other testing lab (your urologist might be able to help you get it done) to see if you have some bad genetics for PC. If you do have some bad genes then the urologist would probably recommend getting treatment sooner. Genetic testing is moving ahead very quickly.

Make sure to keep getting your PSA tests every three months.

Re: Active Survailance vs radical prostatectomy

Hi Frank,

Thanks for your response. I am reading and researching still, it is indeed a very difficult decision. Here is how I am looking at it so far:

Why Surgery now:

- Becuase I will find out with certinity that I have an aggressive Cancer or not.
- It gives me a chance to be cancer free
- No more biopsies
- I am younger and healthier than I would be in the years to come
- Better chance of avoiding side effects, and risk of growing cancer.

Why Active Survailance (Wait and see)

- I may not ever need intervention (very slow growing)
- I can get treatment when needed
- Keep my quality of life for as long as I can
- Newer technology may become available that could either predict better or keep it dorment

Here is a history of my PSA readings:

DATE Total PSA Free PSA

08/19/2013 2.28
09/02/2014 3.32
06/14/2016 2.87
12/21/2016 9.69
01/072017 2.36
01/19/2017 1.87 0.42

3T MRI done on 01/16/2017 (found suspicious lesions)
Biopsy done on 01/31/2017 (found 3+3)
Waiting for another PSA in 2 weeks.
Surgery currently scheduled for May 4th
Waiting for Genetic test results on biopsy sample to see if cancer is aggressive or not.

Best wishes

Thanks & Regards
Jim

Re: Active Survailance vs radical prostatectomy

I am agreement that Active Surveillance should be considered. I would be interested in a more complete history of PSA results. Please feel free to direct email me at carnells2@gmail.com

Re: Active Survailance vs radical prostatectomy

Jim,

Sorry about your diagnosis. Your age and symptoms appear very similar to my own. My survivor profile is Dennis K if you care to read it. Number one thing I would advise is do not panic. You have time to make decisions regarding your treatment. Maybe find a support group. I have talked to members here on Yananow and they were very helpful. Contact me if you want to discuss. Good luck.

Dennis

Re: Active Survailance vs radical prostatectomy

G'day Jim,

Firstly, the PSA of 9.6 in December 2016 could not have been from prostate cancer if it was 2.8 six months earlier and back down to 1.87 one month later. It must have been from some other cause, such as an infection or lab error.

So basically you have a PSA of 1.87 and some cores of 3+3=6 with 5% or less involvement. To me, that has active surveillance written all over it.

In my case I had two biopsies (21 months apart) each with a 3+3 diagnosis. The first was in 2006 when I was 61.

I had a total of six unreal years of active surveillance with 6 monthly PSA tests showing a stable situation. Then in 2013 my PSA started to trend up, so in 2014 I had an MRI scan, a 4+5 biopsy and a subsequent robotic surgery. From original diagnosis to surgery was almost eight years.

Looking back now, I would not have traded those eight years for an early surgery, not with a 3+3=6 diagnosis. Back ten years ago I was caught up with the crowd who believed "get an early diagnosis, and be thankful that you found it early, so you can get early treatment and be cancer free."

Now, with the experience of radical surgery, and the life thereafter, I would suggest that you wait as long as possible. You will treasure those extra years. No matter how well you go with your treatment, your life will never be the same afterwards.

Please don't fall for the belief that you will do better if you are only 57. Look at the other side of the argument, which is "because you are only 57, that is even more reason to enjoy those extra few years of full function".

Jim, good luck with what ever you decide, but a 3+3 cancer with a 1.87 PSA does not need immediate treatment.

Brian in Aus.

Re: Active Survailance vs radical prostatectomy

Hi Brian,

Thanks for your advice. After another opinion from a Urologist I have cancelled my Surgey and decided on active survailence. They have asked me come in for another MRI in six months and based on the results maybe do another MRI guided biopsy.

I have been told that a Gleason 6 tumor itself does not usually grow to a higher grade. Was that the case with you or did they find another tumor with a higher grade?

Thanks & Regards
Jim

Re: Active Survailance vs radical prostatectomy

G'day Jim,

They found another tumour with Gleason 9.
I made sure to ask whether this was a G6 that had deteriorated into a G9, but was assured by urologist and surgeon that it was a new tumour, and as you say, G6 tumours don't change into G9 cancers.

I'm glad you decided to sit back and take it easy for a while.

Brian

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