AS has to be both Active
and involve Surveillance
It is not a case of the uro saying that your problem is not that serious and that you should come back in a couple of years.
Thus you have to have a plan for regular, perhaps even frequent PSA tests DREs etc to help establish the speed of any changes (PSA velocity or PSA doubling time).
Yes PCa is bound to get worse over time, the question to be answered during AS is "how fast is it happening": a PSA that goes up from say 4.5 to 5.2 over three months will ring alarm bells whereas one that goes from 4.5 to 4.6 over a year may not. (My father-in-law has been on AS for nearly 15 years as his PSA has stayed very stable, this is good news for him as his general health is such that he is not well enough to undergo surgery etc.)
A doc's view about
how and when to react to having Prostate Cancer has to be seen in the context of how they/you have to react to other cancers. Other cancers can get nasty very quickly, so you don't often get much time to think about
what you want to do let alone decide to do nothing besdies monitor it.
With me, after telling me I had PCa my uro told me to go home and have a think about
what I might want to do and then come back and see him in two weeks, and he said it wouldn't matter if I needed twice as long. But for other cancers it just isn't like that - a couple of examples:
A few years ago my Mum's neighbour had a bad back, she went to the doc and was diagnosed with lung cancer and was dead within two weeks.
A young friend of a friend was diagnosed with melanoma and the mets had killed her within 9 weeks of the diagnosis.
Yes PCa is cancer, but it comes with a different time line. And AS is only an option because of this. And remember that opting for AS has to involve the realisation that at some point the monitoring will detect a change that will call for decisions to be made about
treating the cancer.
Edited (I forgot to sign!)
Post Edited (English Alf) : 5/27/2011 8:37:52 AM (GMT-6)