Is waiting any amount of time really safe

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Regular Member

Date Joined Mar 2010
Total Posts : 208
   Posted 3/25/2010 7:12 AM (GMT -6)   
Hi All,
A few responses to my original post and reading numerous posts here has led me to this question: With a psa 4.7 and a gleeson 6 do you really have time to wait.  A couple of people said that with these numbers my husband has plenty of time to decide, but another responder said her husband's  pre-surgery gleeson was 6, after 8.  I've noticed that a lot of men's post threatment  gleeson was higher and I've read that some labs scores are lower than is actually the case.  I'm worried that the time between the biopsy and threatment-which can be several months-could be dangerous for my husband.  Advice, Please!

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2209
   Posted 3/25/2010 7:28 AM (GMT -6)   
Welcome rhb

I was diagnosed in April 2009 and operated on in July 2009 and yes my post op Gleason was higher than my biopsy Gleason. But I do not think it changed in between April and July.

In all but a very few rare cases prostate cancer is slow, growing, very slow.

With prostate cancer the idea about taking your time does not mean you do nothing for months on end and don't make any plans it simply means you don't rush.

It is all relative. I for instance know of someone who after lung cancer was detected was admitted to a ward immediately from the doctor's office on the day she was told the test results.

Another friend who was diagnosed with breast cancer was told to cancel her vacation, and was in hospital having treament very soon after diagnosis. However with me I had a vacation booked last years for June and my urologist told me to go away and do my best to enjoy it.

Another indicator about the speed of growth of Prostate Cancer is that you will find very little mention of Chemotherapy in relation to PCa. Chemo works by killing the cells in your body that are growing quickly (Which is why hair loss is one side effect) but PCa cells don't react to chemo because they dont grow fast enough.'

So Yes cancer is nasty, even PCA, with PCa you can merely take longer by comparison with other cancers.


Veteran Member

Date Joined May 2009
Total Posts : 2691
   Posted 3/25/2010 7:51 AM (GMT -6)   
I think Alf said it quite succintly.
All of us have the initial reaction, I 've got cancer, get it out of me now!  In fact, your husband probably had cancer for several years.  It takes a lot of cancer cells to produce enough PSA to register.  Many men will die of old age with PC never knowing they had it.
If you have another PSA test in a couple of months, you can judge for yourselves how fast it is growing, but most Gleason 6's are not aggressive and according to studies, have a low probability of causing death.
That said, we are not suggesting you ignore it and check it again next year.  Active survelliance means just that.  Getting a doctor to work with you, regular PSA tests, and perhaps DRE's, as well as getting second opinions, and researching the best options for you.
Surgery is a very final step.  Once it's gone, it's  gone, and then the side effects that many have to deal with.  Radiation is no walk in the park.  Brachytherapy is promising for low Gleason scores, as well as cryo, HIFU, and proton.
Good luck, and while thereis urgency, walk, don't run to the best treatment option for you.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01

Veteran Member

Date Joined Jul 2006
Total Posts : 669
   Posted 3/25/2010 8:19 AM (GMT -6)   

The majority of men with diagnosed prostate cancer DO NOT NEED TO RUSH INTO TREATMENT.  In fact in most cases it is best to STOP and look around before following a treatment plan. I took seven months between discovery and treatment.  In fact it was four months after my biopsy discovered an agressive gleason 8 cancer.  My urologist advised to to slow down and take a big breath.

My inclination with a Gleason 6 diagnosis would now be to do nothing for quite a while.  In other words, try to accept where you are and take some time to learn more.

PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941

Regular Member

Date Joined Oct 2009
Total Posts : 310
   Posted 3/25/2010 10:17 AM (GMT -6)   

Take your time.

I agree with goodlife: "Walk, don't run, to the best treatment option for you."

I would only add: "Run, don't walk, away from any doctor who tries to rush you."

Good luck!
No family history of PC.  PSA reading in 2000 was around 3.0 .  Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.   
Urologist advised a repeat PSA reading in six months = 4.0 .  Diagnosed May 2008 at age 56 as a result of 12 core biopsy.  Biopsy report by Bostwick Laboratories = Gleason 3 + 3. 
Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3. 
Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist.  Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.   
Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008.  Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear.  Gleason = 4 + 3. 
Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances. 
PSA readings: 
November 2008 = <0.1 ["undetectable"]
June 2009 = <0.1   
December 2009 = <0.1

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4170
   Posted 3/25/2010 10:37 AM (GMT -6)   
Gleason 6's don't just turn into G7s or G8s. The reason that so many are upgraded after surgery is due to the inaccurracy of the biopsy that missed the higher grade cancer. If you truely have a G6 or even a G7 it is perfectly alright to wait.
Many PC patients are not properly staged, that's why the upgrade in gleasons occurr. If you go to a doctor that is experienced in staging he will do a PCA3, a PAP and use tools that estimate tumor grade and volume corollated to your gleason grade, prostate size and psa. Color doppler is also used to confirm staging. None of this is 100% accurate, but is much more accurrate than just one biopsy.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


Regular Member

Date Joined Mar 2010
Total Posts : 208
   Posted 3/25/2010 2:53 PM (GMT -6)   
Thanks, guys-Guess you can see that I'm the worrier in our family. I'll slow down, keep reading, and feel very thankful that I found this site. Believe me, my husband is in no rush! We go back to the uroligist next Wed.-I'll post his numbers when we get a copy of his path report.

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 3/25/2010 3:04 PM (GMT -6)   
Rhb, I understand your concern. When you and your husband meet with the urologist next week, you will have a better feel for your hubby's situation and what the options are. We opted for surgery and had to wait about 5 weeks from biopsy to surgery - this was told us by the urologist to allow the prostate to heal. My husband's biopsy was February 4, 2008, two weeks later he had a CT scan followed immediately by a consultation with the urologist. Once it was decided that my husband wanted surgery, the urologist told us to call his surgical scheduler and set up the date that worked best. March 18, 2008 was D-Day.

Come back after you've met with the doctor and let us know how things went. Good luck!
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!

Regular Member

Date Joined Jun 2009
Total Posts : 35
   Posted 3/26/2010 3:04 PM (GMT -6)   
I was diagnosed in Feb 2009 with PC. I opted for active surveillance which I have been on now for a little over a year. Two subsequent PSA tests since the biopsy have actually seen my PSA level drop. I expect I will have a follow up biopsy later this year to see if there are any changes in the results. I will act if there are any significant changes but if I can go many years or possibly the rest of my life with out treatment I will take the risk. The side effects of treatment can be substancial. You should at least raise the question of active surveillance with your doctor to see if it might work for you. Best of luck whatever you decide.
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
PSA at time of Biopsy - 3.48
DRE: Nornal
Trus volume: 34cc
3 out of 10 cores positive
one core @ 15%
One core @3%
one core @ 5%
Overall percentage of tissue involved - 2%
Gleeson 3+3
Now on Active Surveillance
July/09: PSA 3.16
Jan/10: PSA 2.77
Current Age 56

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 3/26/2010 3:12 PM (GMT -6)   
It is possible to wait alot depends upon the parameters known, as Dr. Strum mentions in his book and even on website...Active Surveliance or whatever label you wish to use is not insane, under the correct parameters, like the Brady of Urology Dept of John Hopkins defined the parameters of "indolent PCa" google or someone else can post link. If your parameters are within this or perhaps close to it you likely can wait, successfully for some period. My brother was diagnosed about 5-6 yrs. ago now just about the defiinition by Brady Urology...has only monitored psa and watched diet some which he did before too and no change in psa's during this time period, he is in no rush to get surgery...his choice and so far looks sane enough. I don't advise him on anything to chose, he has Dr. Strums book, yananow and prostate-help websites and can make his own decisions, he is my big brother too....but I am not worried about being beat up at this age. (HA)

Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 3/26/2010 6:34:30 PM (GMT-6)

Red Nighthawk
Regular Member

Date Joined Oct 2009
Total Posts : 289
   Posted 3/26/2010 5:18 PM (GMT -6)   
I know a guy who has been on AS for 6 or 7 years now. He is the picture of health, especially for 67 years of age. Once we was diagnosed (Gleason 6) he radically changed his diet away from red meet, sugars and fats, which I am told feed cancer, to a healthy diet heavy on vegetables. He drinks tea instead of coffee, and is extremely careful about what he eats. I would research AS seriously and how food is related to cancer.

Personally, if I were a Gleason 6, that is the strategy I would do because treatment has serious side effects. However, since I was a gleason 7, I don't regret my decision for surgery for one minute. Best of luck.
Age: 62
Pre-op PSA: 4.1
Post-op pathology:
Gleason grade: 3+4=7, present in both lobes, at least 1.1 cm, and occupying less than 5% of prostate by volume. pT2c NX MX
No lymphatic/vascular invasion present.
Seminal vesicles and extraprostatic soft tissue free of tumor.
Inked margins are free of tumor.
High grade prostatic intraepithelial neoplasia is present
Robotic RP: Sept. 15th, 2009 1 day in hospital, cath out on 9th day
Post-op PSA: at 4 weeks ---> .04
three months -> .03 (the trend is my friend!)
ED: Improvement is very slow but there are positive signs. Doc has NOT put me on ED drugs yet.
One pad/day for the first six weeks. Two pairs of underpants now just to play it safe.
Surgery: Dr. Jim Hu. Brigham & Women's Hospital, Boston

Regular Member

Date Joined Jun 2009
Total Posts : 292
   Posted 3/27/2010 11:13 AM (GMT -6)   
"Take your time, but do it quickly" was Wyatt Earp's advice for being in a gun fight. I interpret this to mean that you take all the time you need but no more. I had fairly aggressive PCa, as near as I can tell, but knew I was unable to have surgery for several months without going out of business. I delayed but got a shot of Lupron to ease my mind, if not my cancer, while I waited. So far it was the right choice. Had things been less aggressive I'd have skipped the shot. AS can tell you when you've waited long enough. Others are told that by their first biopsy.
Diagnosed at 54
PSA 8.7 Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7 Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09 Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5
Catheter out at 2 weeks no nighttime incontinence Pad free week 5
PSA 6/6/09 <0.1; 9/10/09 <0.1; 3/11/10 <0.1

Veteran Member

Date Joined Sep 2009
Total Posts : 639
   Posted 3/27/2010 7:11 PM (GMT -6)   

This is just one of those questions that is very difficult to answer, and the answer can be quite misleading in both directions. Up front I pushed it to the max to get the darn thing out (I‘d do it all the same again). BUT…that was just how I looked at things. Here is the basic problem. We are told that this type of cancer CAN grow very slow, we are told that some CAN take off like a rocket. Friend Zufus sent me some info on an aggressive prostate cancer that can be raging in your body with little or no elevation in the PSA. I went to the operating room with a G-6 and postoperative I have 4+3=7. All of this is just very frustrating. A good friend once old me that cancer is never an emergency. He obviously didn’t have Cancer. My “take it out now” attitude isn’t better or worse than the “take your time” camp.    It is what it is…Can you…should you… take a reasonable / prudent amount of time ?...Yes. Obtain knowledge, make a plan and proceed with purpose


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate.  Negative surgical margins
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. No prostate extension
Post-op PSA 12/10/2009, Undetectable
12/12/2009, Pad Free and Started jogging.

Regular Member

Date Joined Dec 2009
Total Posts : 154
   Posted 3/27/2010 7:56 PM (GMT -6)   
I gotta tell ya folks, my numbers showed a very low risk issue but after the surgery and seeing exactly where the cancer was located in me i would have been a fool to wait much longer. This deal could have had a much different outcome. I am most thankful for going ahead.
Dx at 50 in 12/09 Merry Christmas its cancer....
3 of 12 positive, right side only, psa at dx 2.6 free%14
gleason 3+3=6
routine physical, no symptoms
Da Vinci performed Feb 2k10 by Dr Marc Milsten [hes got mad skills]
99% continent from cath out, mr happy fully functional at 2 weeks out!
path showed same gleeson with no other blips other than one slight margin, organ confined 20% right, 5%left, 34grams

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 3/28/2010 2:39 PM (GMT -6)   
rhb47 said...
Hi All,
A few responses to my original post and reading numerous posts here has led me to this question: With a psa 4.7 and a gleeson 6 do you really have time to wait.  A couple of people said that with these numbers my husband has plenty of time to decide, but another responder said her husband's  pre-surgery gleeson was 6, after 8.  I've noticed that a lot of men's post threatment  gleeson was higher and I've read that some labs scores are lower than is actually the case.  I'm worried that the time between the biopsy and threatment-which can be several months-could be dangerous for my husband.  Advice, Please!


Hi, I don’t know what your “original post” said, so I’ll provide a response which is based only on the information you have provided here.  You provided two pieces of information:  (i) that your husband’s most recent PSA was 4.7 ng/mL, and (ii) that his biopsy Gleason score was 3+3=6.  With only that little bit of information, the correct answer is “probably.”  Those two pieces of information, as a starting point, are excellent indicators for what may be a very low risk case of prostate cancer…but more information would be needed to truly classify his case as low risk or very low risk.


With low risk cancers, it is possible that your husband may forego immediate treatment-for months, years, or maybe forever-in favor of regularly scheduled testing and clinical examination to closely monitor the disease.  As you’ve seen is some of the other responses, many men “live strong” with low risk PC and avoid the definitive treatments (commonly, surgery or radiation) which may be life-altering.


I said that more information is needed to better understanding the probability/safety of waiting; it is possible that you already have some of this information.  For example, the clinical results of a recent DRE, the digital rectal exam, is one of the most important data points, and one the you probably have but did not mention.  If nodules or hardness was noted in his recent DRE, then he would not be considered low risk.


Another important indicator of low risk is the number of cancerous cores from the biopsy.  You mentioned having a Gleason score, but you didn’t mention cores or the percent of cancer.  It is very common for 12 core samples to be drawn during the biopsy.  If only one or two cores were found to include cancerous cells, and if the percent of cancer in those cores was less than 50% (especially if it was far less than 50%), then these are more indicators of low risk.  On the other hand, if numerous cancerous core samples were found, or if they had a very high percent of cancer, then he would not be considered low risk.


PSA density (PSAD) is another important indicator for aggressiveness which you may already have information on, but didn’t mention here.  PSA density is the PSA level divided by the size of the prostate.  A larger prostate naturally produces more PSA, but a high PSA density means that a relatively small volume of prostate tissue is making a lot of PSA.  Almost without exception, during the biopsy the doctor will have used the ultrasound to gather dimensions and will have calculated the size of the prostate; your husband may have been provided with the size results.  Some Active Surveillance programs use PSAD (in The Epstein Criteria) to assess whether only a small amount of cancer is present, and set a threshold at 0.15 ng/mL/mL (maximum).  If the PSA density is lower than 0.10 (plus the other indicators I listed above), studies have shown there is 70-80% probability that the PC is smaller than an eraser tip. 


Did your husband have a “free-PSA” test (which is simply another blood test, often tested at the same time as the PSA test).  The most typical use of the free-PSA is to judge whether someone with high PSA should go forward with a biopsy or not, but it can also be a useful indicator on aggressiveness.  Several separate medical studies with very different designs have concluded that percent free PSA is predictive of the biology of the tumor.  Based on these data, some AS programs remain enthusiastic about men who have a percentage of free-PSA that is consistently greater than 10-15.


So, the answer to your question, based only on the information you provided, is only “probably”; however, you may also have information at your fingertips to make a much more conclusive judgement.  If, by chance, you look further into Active Surveillance, a Color Doppler scan will likely be appropriate to solidly confirm the staging of the tumor.


Many men rush into a decision to aggressively “treat their PSA”, rather than treat their prostate cancer…the fact is that their prostate cancer may not need aggressive treatment.  It is important to “understand your enemy” (your husband’s PC) so that you make the best decision on next steps.  I hope that you will use the data you have or could easily obtain to make sure you understand your husband's PC to pick the best course of action.





New Member

Date Joined Feb 2010
Total Posts : 19
   Posted 3/29/2010 9:03 PM (GMT -6)   

WHY WAIT??? I never understood that tactic.  True you can walk and don't need to run as PCa is veryyyy slow growing, normally.  My psa was 4.0 in August and 4.4 one month later in September. 6 weeks later my biopsy was done and I waited 10 weeks for my surgery only because it was the holidays.

My Gleason was 6 before and after,  and my margins were clear.  Could I have waited? Who is to say when the margins would no longer be clear. MY very humble opinion is that the cancer WILL not go away on its own and it WILL continue to grow, AND you really don't know what is going on in there until pathology looks at it.

You can walk, but I would do it at a steady clip.

2/97---Total colectomy with J Pouch surgery. stage 1 colon cancer. Total removal, no chemo or radiation was needed.
8/09---routine physical, 4.4 psa
11/5/09---diag: 1 out of 12 cores positive 3+3 Gleason
1/26/10 robotic prostatectomy. 3+3 Gleason, Clear margins
 3/9/10---psa <0.1
3/26/10---2 month post op.  This week for the first time felt stirrings of an erection. Long ways still to go though.

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 3/30/2010 9:32 AM (GMT -6)   
Runer said...

WHY WAIT??? I never understood that tactic. 

Runer, the answer is really quite simple, but takes some understanding of prostate cancer. 

Prostate cancer is most commonly very different from other cancers, where we have been programmed to “get it out fast no matter the cost.”  That type of programming has led to (may I call it an epidemic of) overtreatment of very low risk prostate cancer patients. 

The overtreatment can be life-altering surgery or radiation.  In some cases, the overtreatment side effects may have a more significant impact on the quality of life than the (relatively simple) change of exercise, diet and supplements regimen which might have otherwise kept the indolent PC “in check” for many years or forever.

Unfortunately, some doctors irresponsibly hustle low risk patients into surgery or radiation before they (the patients) are able to fully absorb and understand their own situation.  It takes some time to educate oneself about how the “get it out fast” mentality may not be universally appropriate.  Someone who has signs of an aggressive cancer…then I agree with your question “WHY WAIT???”  But someone who has indications for low risk cancer, the best advice I can give is “slow down” and make sure you understand what you are getting into...because you may not really need to jump into a radical treatment.

We need to aggressively treat the aggressive cases of prostate cancers, and not aggressively (over)treat cases that don't need aggressive treatment.

Veteran Member

Date Joined May 2009
Total Posts : 2691
   Posted 3/30/2010 9:47 AM (GMT -6)   
I think the answer to why wait is fairly obvious.  We are all going to die someday, so why wait ?  Beacuse it is a pretty permanent deal.
Most of us men are in our 40, 50's and 60's.  If we could get another 3  or 4, maybe 10 years for some guys of a normal sex life, no continence issues, and make no difference on the ultimate outcome, why not wait ?  If David in SC could have waited to have all of the problems he is experiencing, waiting would have been a wonderful thing.
Some of us had no option as far as waiting.  Some men do.  John T routinely points out the statistics that a very low percentage of PC victims would die from it with no treatment at all.
Plus, the waiting is so important in getting educated, and making the right treatment choice.  There are no do overs in this game.  Many men on here have made treatment choices that impacts them for the rest of their life, that were probably not necessary.
Occasionally we read of guys who have had surgery and no PC is found, altho the biopsy found some cells.
I'll say it again, walk , don't run.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01

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