Thank you for the article and the reference to footnote 6. It is interesting because other respected institutions like John Hopins do not recommend watchful waiting for younger patients. But its good to rfead another opinion.
I know Jim that you do not approve of many of the August surgery patients being operated on partly because you have made different choices. But their choices may not be wrong for them.
Look at what the article in footnote 6 says about
watchful waiting (copied below). Having biopsies at this rate would mean 9 biopsies till the age of 80 and over 60 DRE and PSA tests. Given the Sloan Kettering rates for indolent cancer are 31% in his case then the chances are that he would never get to 80 without treatment. And if he does get biochemical progression at the age of say 60 then he older and able to tolerate the surgery less easily than at 52. Maybe some people would prefer this approach but it's quite reasonable not to like this approach even given the incontinance and potency issues associated with surgery.
I know my husband. If he had to religiously follow this follow up schedule the stress and the burden of it will have him having his prostate out in a year or two even if his psa hovered arount 2-4. Also weighing on him is fear, his uncle and his grandfather who died of the disease.
There are no black and white clear answers in this unfortunate game of PC. And there's no winning. If his prostate comes out with a small amount of cancer, those people who don't like surgery would say he was too quick and his surgery was not needed. If it turns out that the margins of his prostate were positive, then people who don't like surgery would say that he would have been better without it and that he should have stuck to seeds or radiation. But if my husband has no cancer after this surgery, if he regains his continance and if we can make love even with needles or with Viagraor even not at all, I think it will be a win for us.
Gleason score 6
T1c to T2a
For men with > 15-year life expectancy, < 3 cores involved, < 50% of any one core
PSA, DRE every 3 months x 2 years, then every 6 months assuming PSA is stable
10-12 core biopsies at 1 year, and then every 3 years until age 80 years
Optional: TRUS on alternate visits
Husband's age: 52. We live in Sydney Australia.
In 2007 my husbands PSA level was 2.5.
In Feb 2008 it was 1.7
In Oct 2009 it was 3.67 with a free PSA ratio of 27
In Feb 2010 it was 4.03 with a free PSA ratio of 31.
In June 2010 it was 2.69
Biopsy 28/4/2010: results, negative for a diagnosis of PC however 3 focal ASAPs on left side of prostate at base, apex and at transition resulting in the conclusion "...small acinar proliferation is suspicious but not diagnostic for prostatic adenocarcinoma."
Review of biopsy by experienced pathologist, results,
1 out of 12 core diagnosed with 10% of Gleason score 3+3 cancer (left transitional)
1 out of 12 cores with ASAP (left apex), suspicious but not diagnostic of cancer
Next steps: Nerve sparing RP on 20th August 2010.
My husband's maternal grandfather died of prostate cancer at 72. His maternal uncle died of prostate cancer at 60. Because he is the third generation to be diagnosed he has hereditary PC.
Post Edited (An38) : 8/14/2010 7:23:03 AM (GMT-6)