Gimpy and others,
Upgraded Gleasons are about
30%; progressions on AS are about
30%. I don't think that this is a coindence. The vast majority of progressions I believe are due to initial biopsy error, not PC growth.
If knowing for certain didn't have a price I would be all for it.; but the price to know if you have an upgraded gleason is severe. 10% chance of severe incontinence, 70% chance of leaks after 2 years. Very high probability of ED and about
a 90% chance of a somewhat reduced sex life and a major invasive surgery. If this added to survivability it might be worth it; but it doesn't.
Now that you found out your Gleason was upgraded what decision do you make, NONE, you just get psa tests every three months like everyone else and hope for the best. There is absolutely nothing you can do if your gleason is upgraded from a 6 to a 7.
Tud said if perfectly, get a doctor that is familiar with AS and if your initial biopsy was wrong it will be known within a year or 2 and you can be treated with the exact same cure rate. I know this is a difficult concept to grasp that the cure rates are the same if you delay treatment for a couple of years, but all of the data is consistant.
I myself would never go on AS without getting a color doppler ultrasound biopsy. It is non invasive and highly accurrate in spotting any cancers that are dangerous and can confirm an insignificant cancer. It can also be used as a baseline to identify any future progression.
In no way am I advocating that a G7 or a large volume G6 not be treated. But again a clinical pathology from surgery will result in more knowledge, but what do you do with that knowledge. Your psa will either remain stable or rise regardless of your clinical pathology. You make a decision on your psa rise not on the pathlogy, same as if on AS. In some cases as in a high volume G8 or G9 a clinical pathology can result in an immediate decision to do adjuvant radiation, but these cases are rare and not applicabible in G6 cancers.
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.