Active Surveillance - Posting Again

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Regular Member

Date Joined Jun 2009
Total Posts : 35
   Posted 7/30/2009 11:55 AM (GMT -6)   
I am posting this again so it appears as the first entry. I posted it also as a reply to an old thread so it got buried at the end. I am still new to this.
Just got the results of my first PSA test since being diagnosed and going on active surveillance. My PSA has actually dropped a little - down to 3.16 from 3.48 back in January. So I am continuing on with AS with the next follow up PSA test in 6 months - likely to have a follow up biopsy shortly after this. For anyone considering AS I would like to share my initial experience. The wait time to the first follow up PSA test was very stressfull to me in that I was worried daily that I had made a bad decision and that the next PSA test would prove it so. Now that I have made it to my first milestone the relief is tremendous and I now feel much more confident in my decision. So anyone considering AS should factor in the wait time to that first milestone - it can be very stressfull.
Oct/07: PSA 2.63
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

Veteran Member

Date Joined Oct 2006
Total Posts : 1211
   Posted 7/30/2009 12:19 PM (GMT -6)   
Hi Optimist,
Happy to read about your latest PSA test result. Congratulations! Hopefully, it will stay low for a long, long time. The stress of waiting for the next test result is a cross that we all have to bare, regardless whether it is while on AS or a more aggressive attack on the cancer.
Stay well and all the best to you in the years to come.

Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA on the 26 Jan., 09, =0.05; 17 July 09=<0.04

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4849
   Posted 7/30/2009 12:27 PM (GMT -6)   

Good luck to you.

I couldn't do it. Knowing it's not going to go away by itself would bother me too much. And there's the part about that "fine line" between it staying contained in the prostate and getting out.



Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 7/30/2009 12:54 PM (GMT -6)   
Hi Optimist,

Congrats on the PSA test going down slightly since the last test. It sure can cause some anxiety going through the process though. But at least for the time being you are pushing the treatment phase back for awhile. I know that at some point you will need to move forward with treatment, and maybe by that time better treatment protocols will be available.

Not many folks here take this route, so your journey is of interest for all the newly diagnosed men. So very few men actually qualify for AS in the first place and those that do are so very concerned about waiting, end up seeking treatment right away anyhow. Your story would help those folks I believe to slow down and make that important decision only when the time is right.

Good job....keep us posted.
You are beating back cancer, so hold your head up with dignity
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 Apr 2009 .06
                   9 month Jul  2009 .08

Forum Moderator

Date Joined Sep 2008
Total Posts : 4274
   Posted 7/30/2009 3:25 PM (GMT -6)   
Dear Optimist:
Thanks for sharing your AS journey with us and congratulations on meeting your first milestone.  I hope you will meet many more including your biopsy in 6 months.  I'm sure there is stress involved, but I can tell you from reading the many posts on this forum that men have plenty of stress even if they have had treatment as they sweat out the regular PSA tests.
Les said earlier in his post that ..."I know at some point you will need to move forward with treatment...".  On a more positive note, that is not necessarily true.  In the ongoing Johns Hopkins AS program, only 30% of the AS patients have found further treatment necessary.  Now, they have only been at this for ten years so the numbers may rise but, the point is that you may NEVER have to have treatment as your cancer may be so slow growing that something else will kill you first.
Anyway, I would have chosen your route if my numbers would have allowed and I think it's a great choice for men who qualify.  Please stay with us and let us know how you progress because we don't have many posters who have chosen this route. It would be great to have someone who could speak knowledgeably and firsthand on the subject and who could advise/support others who may be considering it.
Best of success,
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 7/30/2009 4:08 PM (GMT -6)   
Let me add my support to your decision. You need only scan this site to see that treating prostate cancer can have serious quality of life issues. The current medical literature strongly supports your decision because our modern tests can detect cancer which will never be life threatening. Thanks for being here.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 7/30/2009 4:24 PM (GMT -6)   
You don't mention the Gleason score, or number of cores etc. in your signature. I assume your URO has determined it is fairly low grade. If it is higher than a Gleason 6, then probably 3 months would be a better interval.

Meanwhile, enjoy your sex life as often as you can. It's one of those things older guys take for granted, but when it's gone, man do we miss it !
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)

Uncle Harley
Regular Member

Date Joined Feb 2009
Total Posts : 85
   Posted 7/30/2009 5:10 PM (GMT -6)   
Optimist, I'm with you in the AS club. It's a decision not everyone can live with. I know I was really upset following my Dx. But after I read about PC & followed the forums here, I made my decision. The potential for loss of quality of life just isn't worth the risk to me at this point in time. If things change, then I'm prepared to make another decision to be rid of this devil. Feel free to contact me any time to discuss further our somewhat unique situations.
PSA History
3/99 1.2
3/00 1.04
3/01 1.16
7/02 1.24
2/06 1.59
3/07 1.79
3/08 2.54
8/08 2.3
4/09 2.3
7/09 2.6
12 needle prostate biopsy Jan 09
Dx of (1) core adenocarcinoma 20%
All other cores benign
Gleason 3+3 T1C
Currently in Active Surveillence
Age 60

Veteran Member

Date Joined Apr 2008
Total Posts : 847
   Posted 7/30/2009 8:09 PM (GMT -6)   
Optimist and Uncle Harley: I too applaud your decisions to go with AS. It's one that I would have taken myself had my numbers been different. There has been a lot of publicity about over-treatment for PCa, and let's hope you join the ranks of those who never need extra treatment.

I hope you both stick around and keep us posted.
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
After a learning curve, Bimix injections (0.2ml) are working well. VED also works but we find it inferior to Bimix.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 7/30/2009 8:52 PM (GMT -6)   

The more I research the more I support AS. Like Tud said there is a lot of new information indicating that this is a very safe approach with minimal risks if you have the right stats and have a good doctor that is following it closely.
PC is the only cancer that is run by surgeons rather than oncologists: I find this really strange. The recommendation to treat every case of PC is someday going to go the way of radical masectamies in Breast Cancer as doctors and patients get more informed.

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


Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 7/30/2009 9:43 PM (GMT -6)   
If I had been a low grade Gleason 6, with slow to normal psa velocity, I would have loved to have had the chance of AS. My hats off to you men who meet the criteria for AS.
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, again

Regular Member

Date Joined Jun 2009
Total Posts : 131
   Posted 7/30/2009 10:35 PM (GMT -6)   
I also joined the AS club this year after researching every treatment option and meeting with numerous doctors. My numbers were low enough to fall into the AS criteria and I go for my six month PSA in August. Hope my numbers are as good as yours. :-) Hang in there, buddy.
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