Active surveillence (AS) has been a hot topic here and all over the web and it will stay that way. The discussions here have been about
it as a primary choice for low grade small tumors. It has brought into play articles and studies that ask the question "Are we overtreating prostate cancer". This question is applicable after a primary treatment as well. Take my case for example. I had pT3b, N0, Mx after surgery. No doubt about
it, my cancer was spreading outside the prostate and there likely was micro-metastisis but my PSA went to undetectable after surgery before I added adjuvant therapies.
I had to ask do we add adjuvant therapies or wait?
For me it was pretty clear that I had a ten year relapse rate of between 75% and 90% if I chose to do nothing further after surgery, but only 20% in the five year rate. Choosing to do nothing was still a choice, but I didn't like those ten year odds. However I am still in a "controlled" remission and it isn't known if it's because I am on hormone therapy and had radiation as adjuvant therapies, or that the surgery would have been effective on it's own in achieving the same result. I do have some friends here that have already relapsed with smaller tumors and then started salvage therapy. But the question of choosing adjuvant or waiting for salvage therapy is a decision to proceed with Active Surveillence or not. The same is true of intermittent hormone therapy. Do we stop HT and wait or continue it? In any case the question of "overtreating" is real at any phase of treatment.
For the record, there is data in an ongoing study behind my shotgun approach that shows I have improved my chances. But there have been some pretty harsh side effects to go along with my decision. Many here, I presume, would have skipped this part of treatment if they knew what what surgery, HT and RT are capable of doing. I believe that the risks were worth taking...But, please, don't just look at my decision, it is just an example.
Your thoughts appreciated...