When I decided to have my surgery was when the wife and I went to my doctor to get the results of my fourth biopsy. My third biopsy had come back with one core Gleason 6 and only 3-5 percent of that one core affected. I had had recuts made from the samples from biopsy number three and the second pathologist scored it Gleason 7 (3+4) -- based on the new slide that was made from that same positive core. Both pathologists commented that there was so little cancer seen that they had almost missed it. After the second opinion on biopsy number three I was a low-intermediate risk with the smallest possible cancer volume reported. I was a good candidate for AS despite being a GS7.
I had talked to a second surgeon and he had said that he would be glad to operate on my but he strongly recommended AS. I wasn't particularly happy to hear this. After three of them I had never learned to like biopsies very much, I had occasional symptoms of prostatitis which was uncomfortable, and the medicine I took for my BPH had annoying side effects. Mr prostate was starting to seem like a high-maintenance organ and I was less thrilled than you might think to hear that I could keep him. I went for a second opinion and d*n*ed if I didn't get
a second opinion. Oh well.
So, to get a bit more data to help me decide my uro did a fourth biopsy and here I was to get the results. Bad news. They were negative. No help what-so-ever with my decision, especially considering that the blood they drew before the biopsy showed my PSA had risen from six point something to eight point something. I was exactly stuck on the fence. Perfectly balanced. A negative biopsy but a rising PSA. On the other hand my prostatitis had always made my PSA a bit wobbly. It was agonizing. My uro told me I would have to decide. It would be unethical for him to help me.
After agonizing for quite a while, sitting there in my urologists office, I decided that going ahead with the surgery would make my wife less fearful. Her dad had died of prostate cancer and the AS regimen (which didn't sound like that much fun to me either) would constantly remind her of her dad's continued progression and decline.
As it turned out my pathology report came back rather dire. I jumped from a low-volume, low-intermediate risk category to a high-volume, high-risk category. My treatment plan was adjusted. Adjuvant IMRT and ADT were added to it to improve my odds for a durable remission. From this point forward I didn't have a lot of agonizing decisions to make. All of my doctors knew what came next and they simply told me what I would be doing and why. In retrospect they made good decisions and I am very hopeful about
my prognosis but I was simply out of my depth at the time, too freaked out to figure it all out. I simply trusted them. I still do.
So, when I advise men with low risk PC to consider AS, as you might imagine, complicated things are going on in my otherwise-generally-inert head. I am in effect telling them that their chances of being me are small and statistically they are better off, on average, to make decisions that would have been bad, bad, bad for me. I have this hysterical voice in the back of my head shouting in tones that remind me of Charlton Heston in Soylent Green but I put on my Mr. Science hat and sit on him.
Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012:
1)neg (some inflammation),
3)positive 1 of 14 GS6(3+3) 3-4%, 2nd opinion GS7(3+4)
Mild Pre-op ED
DaVinci RRP 6/14/12. left nerve spared
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
Start 24 mo ADT3 7/26/12
Adjuvant IMRT 66.6 Gy 10/17/12 - 12/13/12
Leaky but better, Trimix, VEDForum Moderator - Not a Medical Professional
Post Edited (PeterDisAbelard) : 2/5/2013 2:29:10 PM (GMT-7)