Tall Allen said...
An, All AS programs include a confirming re-biopsy within a year. There have been great improvements in imaging technologies in the last couple of years. One of my favorites is detection with 3T multiparametric MRI with an endorectal coil fused into a real-time ultrasound-guided biopsy. In the hands of an experienced radiologist it has been getting down to that critical detection length of 5mm, and it does detect anterior tumors. I agree that detecting anterior tumors is an important under-detection issue. When 12-core biopsies are negative and rising PSA can't be ascribed to any other cause, I think one of these MRIs or a saturation biopsy should be tried.
My husband did have a multi parametric MRI with an endorectal coil. With an experienced radiologist. It did not pick up on his anterior tumour which was well over a cm in diameter. As for doing yearly biopsies, the edge of the tumour was awfully close to the anterior wall and I am very happy we did not wait for a year. Two of Paul's close relatives have died painfully and young from prostate cancer, his uncle died at age 59. AS is not for everyone and choosing not do do AS can be a logical thought through option based on a patients age, family history, PSA history and a variety of other factors including the lack of adequate imaging and biopsying techniques.
As for Gleason 6 not being cancer - there are too many people here diagnosed as Gleason 6 on biopsy, reclassified to Gleason 7 and above post RPA. The solution to the over treatment issue is having better systems to image and biopsy as the current systems do not give a patient the ability to make confident decisions. If someone told my husband on biopsy that he had a 95% chance of keeping his Gleason score and that the cancer was contained within the prostate he might have taken the option to go on AS. The 60-70% chance that this is the case when you are diagnosed with a Gleason 6 is just too low.
Post Edited (An38) : 5/20/2013 9:02:01 AM (GMT-6)