Safety of Active Surviellance

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John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 9/2/2010 9:17 PM (GMT -6)   
I know there are some that no amount of evidence could convice that going on AS for low risk cancer is not dangerous.
Another study from UC Davis looking at men that were treated after an average of 18 months on AS to those that were treated immediately. This is pretty consistant with the Hopkins data.
CONCLUSIONS The present analysis did not show an association between RP after a period of AS and adverse pathological features for men with low-risk disease.
Pubmed 20804478.
Dr Peter Carrol, a noted surgeon from UCSF, chaired the 1st conference on AS in 2007. His belief is that as long as low risk PC is still called "cancer" there would never be a lot of progress in convicing men that low risk PC should be treated as a cronic condition and not with a radical treatment. A name change was recommended, but never accepted.
JT

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 9/2/2010 9:26 PM (GMT -6)   
Short of a pathology report with second optinions, how do you become comfortable that the cancer is low risk? This would be my issuer.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/2/2010 10:23 PM (GMT -6)   
John, I was really surprised this week, when my long term GP spoke so strongly against any use of AS, with PC. I didn't bring it up, he did, as he was getting an update on my PC situation. Of course he's not a cancer expert or a radiation doc or even a surgeon, but he thought it was odd that I told him that there were low grade indolent acting cases where AS might be the best thing in the short term. It is amazing how much fear the word Cancer can bring to a person's mind and heart, even my own GP, who aside from that remark, has been a really good doctor to me over the years.

Not sure a name change would help. The only thing that would help, and not sure many would agree with me, is if insurance companies didn't automatically pay for surgeries or radiation for early PC cases that met the strictest criteria for responsible AS. Even if it delayed a primary treatment for a year, it could still help avoid a lot of expensive treatments and terrible side effects that might not be needed. Just an idea.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 375
   Posted 9/2/2010 10:25 PM (GMT -6)   
Yep John T, once you say the word cancer a lot of us freak out, even though our stats say sit back and relax. I think you provide a good service here to the newbies who want some options after being diganosed with slow growing, Gleason 6 cancer instead of surgery with multiple complicatons. I still say to the day that I die that I want my cancer out, regardless of what the stats say due to family history of other, terminal cancers. Keep giving us the newest updates....

mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 375
   Posted 9/2/2010 10:26 PM (GMT -6)   
signature

mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 375
   Posted 9/2/2010 10:27 PM (GMT -6)   
signature hope it works now
my age=52 when all this happened,
DRE=negative
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/14/08, 2/12 cores positive on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 6 both cores,
Clinical Stage T1C
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery
No signs of spread, organ contained,
5 0's in a row now, 18 months out
Incontinence gone in early December '08,
ED still a problem, normal erections with manual effort but wife is now ill, not interested in sex anymore

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 9/3/2010 8:37 AM (GMT -6)   
BB_Fan said...
Short of a pathology report with second optinions, how do you become comfortable that the cancer is low risk? This would be my issuer.


You have to accept the fact not all cancer is the same for one thing. The old get it out of me now!!!! panic, years from now will be largely blamed for this massive over treatment since the dawn of the PSA era. The fact that I have felt like this since 2007 has been validated increasingly as time and studies come out. It's like I tell friends about PCa is that it's a disease unlike other cancers where chemotherapy is rarely used. Why they ask? Because chemo targets fast growing cells which are for the most not PCa cancer cells. That's a major difference alone. Then their eyes glaze over for who wants to hear about cancer if they themselves don't have it..

Also for many years many of our a male ancestors died with PCa never knowing they had it and having little effect from it. Did my father have it? Maybe who knows for they really never could test for it and if it wasn't the cause of death I doubt many autopsies from past times would look for it. One urologist I talked to guessed you could biopsy any group of 50+ males and about half may have a positive result. Since the PSA era began that's been almost happening, and the resulting over treatment that lets face it is the biggest cash cow to ever happen to urology.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A

2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study

4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal

7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy

2/16/10 12 of 12 Negative Biopsy

Post Edited (Ziggy9) : 9/3/2010 8:48:36 AM (GMT-6)


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 9/3/2010 9:12 AM (GMT -6)   
Less than 15% of men diagnosed would qualify for active surveillance using the standards that are out there today. We just don't know as much as we think we do because the studies used today are level II-2 or lower like this one and the longest studies are using a span of 8-10 years after diagnosis with a 35% drop out rate. Many will do well with AS, most will drop out for some form of treatment given enough time. 8-10 years is not enough time to determine mortality rates in prostate cancer for a Gleason 6 man. In this study, most patients were not on AS for even a year before treatment. The longest was on AS for 6 years and the median was 18 months.

I'm not certain this study tells us much. Certainly the amount of evidence will improve as we mature the clinical trials.

Tony

el perro
Regular Member


Date Joined Mar 2010
Total Posts : 46
   Posted 9/3/2010 10:15 AM (GMT -6)   
Isn't it generally agreed that there is no significant survival benefit to treating Gleason 6 cancer until at least out 10-12+ years in time? My (rhetorical) question would then be what treatment options will come available in the next ~10 years? Maybe I'm polly-anna here, but with improved understanding of cancer biology, vaccines already coming online, refinement of focal therapies, molecular targeted therapies in testing, etc., it's just hard for me to believe there won't be better options available in time for a low-risk patient diagnosed today.
Dx 11/2008, Gleason 3+3
Active surveillance for now

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 9/3/2010 10:27 AM (GMT -6)   
I think in time there will be PCa differences established. I believe those who have it like Tony at a young age is one thing while most of those who find it lets say at 55+ will be quite another. I can see the latter group just having it as a fact of aging like baldness, increasing loss of libido, cataracts etc. It will be monitored routinely and treatment call upon when warranted. What will be different is that threshold will not be the knee jerk reaction as it is today with too many. In addition less invasive less loss of quality of life treatments like my TFT will become more common than todays over used radical treatments. There's a track record there already comparing the present use of lumpectomies to past mastectomies in breast cancer. There are many similarities in the treatments of breast cancer and PCa with the former receiving more funding and being years ahead in research at this time. As time goes by better diagnostics will be established. I personally think one of the best things I had done was my 3D 45 needle saturation biopsy, but I digress.


Bottom line is that there are huge differences between low risk PCA and those with high risk numbers. One size does not fit all for treatments. Only through panicked eyes do they and that's natural for most when first hearing they have cancer. What should be mandatory for all is a period of education and never a rush to treatment. Quality of life issues and risks need to be brought up and faced before any decision is made. For there are no do overs afterward.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A

2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study

4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal

7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy

2/16/10 12 of 12 Negative Biopsy

Post Edited (Ziggy9) : 9/3/2010 12:43:41 PM (GMT-6)


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 9/3/2010 10:38 AM (GMT -6)   
el perro said...
Isn't it generally agreed that there is no significant survival benefit to treating Gleason 6 cancer until at least out 10-12+ years in time? My (rhetorical) question would then be what treatment options will come available in the next ~10 years? Maybe I'm polly-anna here, but with improved understanding of cancer biology, vaccines already coming online, refinement of focal therapies, molecular targeted therapies in testing, etc., it's just hard for me to believe there won't be better options available in time for a low-risk patient diagnosed today.


I generally agree with you but we're in the minority here. Although I'm not sure about 10 -12 year wait in all cases. It should be monitored semi annually to annually in my opinion. But nowhere as small a minority as it was only a couple of years ago. I don't know what biopsy you had but if it was the standard 12 needle I would opt for a better one such as color dopler or what I had . Of course there you may have a battle with your insurance to cover it but it's worth it IMHO.

Post Edited (Ziggy9) : 9/3/2010 10:43:06 AM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/3/2010 11:33 AM (GMT -6)   
The longest AS guys are in the 10 to 12 year range. The typical Gleason 6 case is about 6-7 years before the majority have decided on intervention. The best place I know to look for some comparative cases is at yananow.net. There are 950 members that are at the site and about 60 AS cases. Terry Herbert, the Sitemaster there is a Gleason 7 case that made it 7 years before he had signs of progression. He is on intermittent ADT. I had dinner with him in June and his PSA was pushing 20. He wanted to wait until he returned to Australia to restart Zoladex.

Should he have been an AS case? He was 54 when Dx. Some men would take 14 years as success as Terry does. But Ziggy is correct, a younger man would want better long term results.

Here's the YANA cases on AS:

www.yananow.net/Experiences.html

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/3/2010 11:56 AM (GMT -6)   
I guess I could clarify Terry Herbert's story. He started out as a Gleason 6. It later was updated to Gleason 7.

Here is his case:
www.yananow.net/Mentors/TerryH.htm

I use Terry's case often because he has done AS for a long period, has documented it well, and is still going strong although his case did in fact become advanced. I think his case is very typical and is a very good reference.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

el perro
Regular Member


Date Joined Mar 2010
Total Posts : 46
   Posted 9/3/2010 1:19 PM (GMT -6)   
Thanks for the link, Tony, it's an interesting case study. It would be interesting to know if Terry maintains the same perspective on AS today that he had 10 years back. I was surprised to read that he had TURP with known PCa, unless I'm misunderstanding something? I don't think that would be done in the U.S.?

I guess I'm still of the opinion that folks embarking on an AS program today are likely to fare better than those of 10-15 years ago. Of course I have no crystal ball, but I have to believe the advances of the past decade in diagnostics, imaging, pharma etc., are going to have a positive impact going forward.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/3/2010 1:34 PM (GMT -6)   
He was quite clear, if he had it to do over again he still would have chosen the same rout. He had difficulty getting his doctors to bite on DES, but he had a heart condition that made DES less appealing to his doctors. So eventually when it came time to intervene, he was on Zoladex...He looked terrific when he came to the states a couple months ago...Here is a picture of the Herbert's and the Crispino's:

www.facebook.com/photo.php?pid=1298978&id=1061563409

He had quite a healthy appetite, but maybe I just noticed because we bought the dinner...lol

Tony

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/3/2010 1:58 PM (GMT -6)   
Tony, you know the drill, a free lunch or dinner always tastes better, lol
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 9/3/2010 3:47 PM (GMT -6)   
Thanks for the post. A co-worker of mine was recently diagnosed with PC and seeked my advice. He has PSA over 7 and the biopsy came in with 1 out of 12 cores as cancer. Based on advice from his doctor, he is going the AS route. What surprised me was the high PSA. I wished him well and told him to make sure he keep going in for PSA tests. He said he was going in every 4 months. I told him he may want to go in after 3.
 
Age 48 at diagnosis
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
22 month  PSA <.04
continent at 10 weeks (no pads!)
ED is still an issue

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 9/3/2010 5:47 PM (GMT -6)   
The above study and the Sweedish National Health Study, just released, (New Prostate Cancer Infolink Sept 2) show the same thing as all the other studies: patients on AS for low risk PC have the same result if treated in a couple of years as if treated immediately. The point everyone is missing is that not everyone that is on AS is on forever. If the PC shows signs of progression in a few years you get treatment and have the same result. The fear that I must do something now or it may escape is completely unfounded. Most progression is identified in the 1st three years.
To clearify Tony's statement: guys that are in STUDIES have been on AS for 10-12 years, but many men have been on it for much longer, and most don't know it. The majority (70%) show no signs of progression in 7 years, but about 30% decide on treatment anyway without signs of progression.
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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/3/2010 7:21 PM (GMT -6)   
I agree the studies show the same thing. And both are immature. This from the much longer Swedish study:

"The authors conclude that there was no significant difference in the presence of adverse pathology features or in prostate cancer-specific mortality after primary as compared to deferred radical prostatectomy. However, the authors do acknowledge that longer follow-up is needed to conclusively evaluate whether deferred radical prostatectomy can be considered to have equivalent clinical impact to immediate radical prostatectomy in this set of patients."

Both studies have the same problem. The median age at follow up of the Swedish study is 8.2 years. The example I show a man who had just about at that point started seeing the signs that his cancer was changing. Could he have avoided this if he was treated in 1998? How about 2002? The treatment in 2006 was hormonal therapy. Terry would argue this on your side John. He thought he would only live to 70 when he set out. He is 68 now and looking like he's fit enough that he's gonna give 80 a nice run... It possible. Did you look at the other AS guys at YANA? More than half of that 60 man cohort dropped out at a much sooner pace...

I will always be the devils advocate against long term AS. I think it's right for the median aged 64 yo G6, low PSA man. That stated I have a few friends on it, and I recommend it for my own father (Age 76).

Tony

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/3/2010 7:26 PM (GMT -6)   
Tony, I have always felt the criteria you state for the safe use of AS is good advice. If we are lucky enough to live long enough to see better pre-treatment testing, i.e. the indolent vs. agressive strands, then I think the case for safe AS would be easier to make, and some treatments could indeed be eliminated. Until they can get the big gamble out of the formula, I can't see a dramatic change in thinking on AS as an alternative.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/3/2010 8:27 PM (GMT -6)   
If we could come up with the ultimately safe, side effect free, extremely effective way to treat prostate cancer, those who would argue for active surveillance would not have a case at all.

Call me the dreamer...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4157
   Posted 9/3/2010 9:28 PM (GMT -6)   
John, your statement, "The point everyone is missing is that not everyone that is on AS is on forever. If the PC shows signs of progression in a few years you get treatment and have the same result. The fear that I must do something now or it may escape is completely unfounded. Most progression is identified in the 1st three years." is clear as a bell and backed by experts and studies.
I don't know why this is such a hard concept for some to grasp and why some keep throwing in red herrings that attempt to get away from this basic point.
 
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"!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/3/2010 10:14 PM (GMT -6)   
Tudpock,
You must have misunderstood my responses. I apologize if I said anything that offends you.

Did I get something wrong?

Tony

BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 234
   Posted 9/3/2010 10:39 PM (GMT -6)   
AS - When diagnosed with a T1C Gleeson 6, I was initially told that AS was one approach for inital consideration.  It was noted that "Most men can't stand waiting more than 2 years and get cut anyway".. confused
 
When a Second-Opinion suggested Immediate-Action, I deferred to this opinion.
When the Post-Mortem was undertaken on the removed gland, (less than 5 months after diag') , it was shown that the  PC was about to escape the capsule.
The bottom line is that had I chosen AS, then the next time I checked, I could have been in a far more serious position.
 
The argument used on me was most valid - If they could offer 95% guarantee of cancer cure by having the operation TODAY, why risk anything by postponing things.  The percentages MUST reduce with time..
There will always be valid reasons why different paths might be chosen , but surely Putting-off the inevitable, just because you can, has to carry a significant risk.
 
I know of friends on AS, who have heart conditions, and in the end are forced into an operation, because "we can't wait any longer".. 
Surely - Their heart condition won't be any better, when older, or is it a case "Well we got a few more years -- if the heart goes now, it does not matter as much  "
.
.
Full Bloods -- Nov 09 = PSA 5.0 @ 60yo - Absolutely NO symptoms
DRE-Non-Palpable
Jan-2010 - TRUS Bx DX - AdenoCarcinoma T1c - Geeson(3+3)=6 , 5 & 45% max., Left MidZone
Jun-2010- open-Cut RP- Nerve Sparing
Post Op. Gleeson(3+4)=7, 1.1cm3, Pos Margins, EPE (focal) Lateral Left
Margin-Involvement (extensive) Posterior , Grade3 x 8mm
+8week PSA <0.01 , Full-ED, Mild Incont.

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 9/4/2010 2:39 AM (GMT -6)   
Out of the 4 people in the August surgery thread with 3+3 cancer 3 were found to have 3+4 cancer post surgery.

I know that this may not be representative of the overall stats for prostate cancer but my point is that biopsies and screening options at the moment are very far from adequate. Pre-surgery they may have been candidates as low risk PC patients for AS. But the fact is they were not low risk but intermediate risk and were not ideal candidates for AS and short of being lucky on the biopsy there was no way to tell. Maybe 18 months on AS would not have made a difference even then but I am not sure what they would have gained in 18 months. Their cancer would not have gone away. And given the component of Gleason 4 there would be some risk that it would have escaped the prostate. They would be that much less likely to regain their urinary function and more likely to have ED as they would be that much older.

If the point here is that there is no rush to treatment - yes that is true because PC is a slow growing disease.

An

Post Edited (An38) : 9/4/2010 7:32:39 AM (GMT-6)

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