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*Optimist*
Regular Member


Date Joined Jun 2009
Total Posts : 35
   Posted 8/5/2010 8:19 AM (GMT -6)   
For those that are interested I went to see my Urologist on August 3rd and although he said the latest PSA rise was not overly concerning he did feel the time was right to get a follow up biopsy to see if there is any change in the cancer grade / volume. I am now scheduled for September 1st. I have to say over the last year and a hald I have been pretty relaxed about being on AS but the pending biopsy has me worrying again like I did when I was first diagnosed. I will know the results mid September and will post the outcome.
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
July/10: PSA 3.96
 
Current Age 56
 

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4849
   Posted 8/5/2010 8:24 AM (GMT -6)   
To me - that's the downside of AS...You know you have cancer - you just don't know how bad...
Age 55   - 5'11"   215lbs
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
11/20/09 - 18 Month PSA -> less then .01
05/18/10 - 24 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3895
   Posted 8/5/2010 10:09 AM (GMT -6)   
Optimist. You have cancer. You are 56 years old..The cancer is not going to go away by itself. It can only get worse. Why wait until a very treatable, very curable condition turns into something really ugly?? AS works GREAT for Gleason 6 guys who are 70 but you are too young to make it another 20 years without treatment. IMO, the sooner you start it the better...
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/5/2010 10:35 AM (GMT -6)   
Optimist.
Your psa doubling time looks OK. As long as it stays greater than 3 years it is a good sign. Your stats are on the upper end of AS, but you still have an excellent chance of remaining on the protocol. There is an overwhelming amount of evidence that only 30% of low risk PC will progress and that if it does the cure rate is similar to be treated immediately.
Surgery has a 21% to 30% reoccurrance rate, about the same as AS, yet those telling you that AS is dangerous won't hesitate to have surgery. The worse thing that can happen is that you will be treated somewhere down the road.
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


*Optimist*
Regular Member


Date Joined Jun 2009
Total Posts : 35
   Posted 8/5/2010 11:00 AM (GMT -6)   
Thanks for the comments. I agree with John T that statistically I am taking a path that is not unreasonable assuming the next biopsy confirms I am still a Gleeson 6 with low volume cancer. Any progression and I will go for treatment. I will update with biopsy results in mid September - hopefully to say I am continuing on AS.
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

July/10: PSA 3.96



Current Age 56

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 8/5/2010 11:17 AM (GMT -6)   
Optimist,

I don't see any reason that you can't safely wait till that next biopsy. How many cores will it be, if you know? The results of this next one should indicate if you can still safely follow your AS plan. The whole point of AS, is not to get psyched into a panic mode to rush into something, and sounds like that is not the case with you. Yes, you have PC, but you already knew that before you started AS. You have already bought some time that some of the guys here wished they may still have had. I am sure when/if the stats change badly, if they do, you will still have time to plan out a treatment.

I didn't have your choice of AS, so I like to watch cases like yours where its a possibility.

Good continued luck

David in SC
Age: 58, 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, 4/8 .04, next one: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4278
   Posted 8/5/2010 11:59 AM (GMT -6)   

Dear Optimist:

I certainly agree with JT and David and believe you are following a logical path.  Those who try to panic you into treatment are not doing you a service, IMHO.  Yes, you MAY need treatment at some point in time but maybe not...in the meantime, since you are following a good plan, your chances of having a "bigger problem" are minimal.

And, if you read this forum much, you can see that even those who have had surgery or radiation still have anxiety when it's time for their PSA testing.  So, treatment does not eliminate worry.

Good luck and please keep us posted.

Tudpock (Jim)


Age 62, Gleason 3 + 4 = 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 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 8/5/2010 12:28 PM (GMT -6)   
Optimistic PCa brothern- My brother is doing A.S. for 5 yrs., but has lesser stats that are within the indolent PCa definition, so far appears sane. But, your stats are little different, I was diagnosed late into high risk land because of urinary total blockage (gee a real clue??-age 52 then 2002). So never saw the luxury of waiting at all.

I suggest you read page 39 of Dr. Strums book- A Primer on Prostate Cancer (2nd edition) mid page about the correlation of non-confined PCa and fPsa levels....something to think about or consult with PCa specialist about. Just trying to keep you in a heads up in your decision making, never easy enough decisions in this stuff. You got my support anyway in whatever you decide.
You might want to contact Terry H. co-founder of www.yananow.net on their forum board and ask his advice, he has done this(for awhile) and has seen many other scenarios having done this...tell him all your stats and see what he may say, he will give an informed likely unbiased opinion for free as educated layperson if you want another perspective to look at. 

Post Edited (zufus) : 8/6/2010 7:25:46 AM (GMT-6)

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