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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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