Active Surveillance

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John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4225
   Posted 3/31/2010 11:24 AM (GMT -6)   
The latest issue of the PCRI Insights has two articles on AS; one by Dr Stan Brosman who details studies by L Klotz, and the other by a patient currently on AS being monitored by Dr Duke Bahn.
 
Only 35% of patients qualifying for AS actually go on AS.
20% of those drop out without any sign of progression because their anxiety is too high.
25% are adivised to start treatment because of progression and all of these showed progression within the 1st 5 years.
The remaining are still on AS.
The long term results of those who sought treatment are the same as those who elected immediate treatment.
Study began in 1999 and median follow up is 6.8 years (50% of patients greater than 6,8 years)
 
Dr Bahn's criteria for AS:
G6
PSA less thn 10; PSA density <.15
Biopsy cores less than 30%
% cores < 50%
PSA doubling time > 2years; 3 years perferred
Tumor neovascularity on Color doppler 1+ or less
Tumor volume on CDU: less tha 1cc
PCA3 test less than 35
Ploidy: Diploid
 
Patient's comments: 55 years old, on AS for 5 years, Dad died of PC at 76.
 
All doctors (4) recommended immediate treatment because of age.
Very little encouragement from support groups and friends.
Was monitored yearly at UCSF by MRIS
Changed monitoring to Color Doppler and Dr Bahn and now feels much more comfortable with decision and monitoring.
PSA anxiety is similar to those in his support group that received treatment. Everyone stills worries about psa rise.
 
JT
 
 

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.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/31/2010 12:01 PM (GMT -6)   
Good info there John. It's a shame then 65% that could be on AS don't, and of those that do, 1 of 5 drop out for mental/emotional reasons.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29

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