I am wondering, with prostate cancer in the early stage, a man can opt to do active surveillance, right?
So let’s say the prostate is removed, and then the PSA levels are checked… and I understand that we want to see it be undetectable, and then we watch for a rise in the PSA.
But what I don’t understand is, why do we need to re-treat when the PSA is still so low. Example, let’s say pre-surgery PSA is 4.5. Post-op gleason is 9. First PSA is undetectable, and then down the road it is .1 or .2.
To me, that still seems like such a low number, so why do we rush in with the ADT and SRT? Is it because those rogue cancer cells will grow/spread faster than what they did when they were in the prostate? I guess I am wondering why this post-surgery active surveillance focuses on keeping the PSA at an undetectable level when it seems as though pre-surgery AS allows PSA’s to be 4, 5, 6 points. Why wouldn’t post-surgery surveillance allow for higher PSA’s before resorting to ADT and SRT?
My dad is in his early 70s and he had surgery in April and is due for his first PSA in May. I have read that with gleason 9's, some docs will even want to do hormone dep and radiation before the PSA rises. I really don't want to see my dad go through more treatments. I really want the doc to say that we'll just watch the PSA and see when/if it rises. But even then I got to thinking, why do we "have to" treat with such small numbers like .1 or .2?