Active Surveillance

2 of 14 cores positive at 5% and Gleason 3+3... 2 cores taken from a "protuberance" were "ASAP"

Proton radiation at LLMC May-June 2009

Les

Age 58 at Diagnosis

Oct 2006 - PSA 2.6 - DRE Normal

May 2008 - PSA 4.6 - DRE Normal / TRUS normal

July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C

Robotic Surgery Sept 18, 2008

Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc

Seminal Vesicles and Lymph Nodes clear

Positive Margins Right Posterior Lobe

PSA 5 week Oct 2008 <.05

                   3 month Jan 2009 .06

                   6 month April 2009 .06

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT

Greetings Optimist.  Sorry you have to be here but you have found friends.  Our presurgery stats are very similar.  My urologist who did the biopsy advised me that I had time to make a good decision and to explore my options but he recommended surgery.  He doesn't do surgery so he didn't have a "dog in the hunt" as we say.  I did choose the surgery route mainly because I couldn't stand the thought of having cancer and not doing anything about it. 

As it turned out I had a more agressive form of cancer than the initial biopsy indicated so I was very glad that we made the decision we did.  No I am about 16 months out from surgery and I am doing very well.  My doc (surgeon) calls me his star patient because I have done so well - of course he tells me I'm 15 years younger than most of his patients and that is one reason I have done so well.  Just some food for thought.  Bottom line, you have to be comfortable with your decision.  Best wishes and keep us posted. David

Diagnosed Dec 2007 during annual routine physical

PSA doubled from previous year from 1.5 to 3.2

12 biopsies - 2 positive with 2 marginal

Gleason 3 + 3 = 6

RRP 4 Feb 08

Both nerves spared

Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7

Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16

PSA every 90 days - ZERO's everytime!

Great wife and family who take very good care of me

Welcome.  I am one of the few on this board in active surveillance.  I don't post much.  I got tired of hearing that I was in denial, playing russian roulette, or afraid to face the fact that I have a PCa diagnosis.  Since you've asked for feedback or insights, here goes.

A PSA test does not diagnose cancer.  It's one of the strongest indicators of the possibility of cancer but only a biopsy will diagnose it.  A rise in PSA shouldn't trigger treatment.  It should trigger a biopsy.  A PSA velocity of more than .75 ng/ml in a year is one common measure of when a biopsy should be called for.  A PSA doubling time under 3 years is another common trigger for a biopsy.  PSA measurements can go up or down for many reasons.  Looks like yours jumped quite a bit in six months then went back down some.  Only a doctor should speculate as to the reasons for that.

PSA density is another measure that is used to predict if the predicted size of your cancer favors active surveillance.  The second link that Tudpock provided has a paragraph about the "Epstein Criteria" you should read.  Your density comes out just over .1 by my figuring and the 3 positive cores would consitute what they refer to as an adverse finding from the needle biopsy.  You didn't mention if you got a second opinion on reading the biopsy slides.  Reading the slides is somewhat subjective.  I believe a second opinion is worthwhile and consider it essential.

You didn't mention clinical stage, which is determined by what the doctor feels on the DRE.  He may feel nothing, something on one side, or all over.  A significant finding on the DRE would have tipped me away from AS.

You mentioned urination issues as a cause for concern.  See your urologist.  He can help ease your mind or find the cause, we can't.

Ill tell you what will trigger treatment for me.  A biopsy that has a Gleason sum greater than 6.  More than 2 cores containing cancer. Any single core containing cancer in 50% or more of the core. In addition, if my PSA density increases above .1, if the cancer can be felt on the DRE, or there is a significant rise in my PSA, I will   get a  saturation biopsy or color doppler guided biopsy.  It is absolutely possible for a needle biopsy to miss the cancer or a significant portion of it.  I've had PSA testing and DREs every 4 months and yearly biopsies since my diagnosis.  So far, so good.  Good luck to you in whatever choice you make.

Boo

Jan/08: PSA 2.32

July/08: PSA 4.30

Jan/09: PSA 3.48 / Free PSA 10%

Feb/09 - Biopsy - cancer diagnosed

Age: 55 - Status: Active Surveillance

engineer55 said...
Interesting study, I understand they are also recommending that people to go back to smoking because after 10 years there is not a marked changed in mortality rates of smokers and non smokers.

3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3

Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9

Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 

First PSA Post Surgery   2/9 .05, 5/9 .10 doubled in 3 months, new test in six weeks, then possibly off for salvage radiation

Hello Optimist, et. al,

Many of us were in the same circumstance that you find yourself in, i.e., what to do, if anything. My stats were similar and after reading Dr. Walsh's book and discussing the situatuion including all of the variables you cited, I decided that I wanted it out of me. Once the decision was made, life became somewhat more tolerable as the constant anxiety about what to do was over. After reading many stories on this website, I have very few regrets about the decision. My stats ended up being better than expected (though the surgery and recovery are similar for most of us) but the doc said something that was compelling about the biopsy results: "they could find the needle in the haystack or only the tip of the iceberg."

Keep studying, rely on your wife's perception to keep you objective, make a decision....don't look back.

Best wishes

TeddyG

Age 55, two teens, very fit cyclist (avg 2000+ miles per year) and weight, diet, etc. consistent with good habits. Stressful job as attorney; very supporting wife who is helping me through every stage of this war.

Stats:

2006 PSA - 1.5

2007 PSA - 2.3

2008 PSA - 5.3 (18 mos.)

2009 Jan. 20 - Biopsy 12 samples

        Feb 3 Dx 2/12 samples positive, low volume  (5% and 7-10%)

Gleason 3+4, later downgraded by second opinion at Johns-Hopkins to 3+3, but "it's still PCa" as my Doc said.

Laproscopic surgery April 9,  University of KY Medical Center, Lexington, 3 days in hospital, catheter removal April 21.

Pathology: clear margins, no cancer in prostate: told that this is very rare and Doc has only seen it in 3 out of over 1400 cases; I rearched the concept of "vanishing cancer" and found a tumor classification of tP0 and asked Doc if it applied to me. He said that it was unlikely because if a pathologist had done a much more detailed analysis of the tissue, he would likely find more foci somewhere, and biopsy found "needle in the haystack as opposed to the tip of the iceberg"; Nevertheless, it is a blessing;

Regardless of the science, my family says "miracle."

Now working w/ post-surgery issues....