Tall Allen said...
You may be interested in the discussion at the thread:
For those of you who didn't follow this link when Tall posted it above, here's another chance.
I am convinced of the problem of over-treatment and, at the same time, my personal experience with the disease makes me very leery of recommending AS for anyone except the most perfect, textbook candidates. Of my four biopsies (about
60 cores, total) I had one that was positive. (On my third
biopsy -- my fourth was negative.) That one positive core was very low volume. Initially scored Gleason 6(3+3) and 3-4%. I got a second set of slides made from that biopsy and had another pathologist look at them. That second opinion found cancer only in the same core. It edged it up to Gleason 7(3+4) but concurred with the 3-4% part. Both pathologists commented that there was so little cancer present they almost missed it. At 59 years old with a very-low volume GS7 diagnosis many AS programs would have considered me a good candidate.
But I chose surgery and my post-op pathology report showed a large, growing Gleason 9(4+5) tumor that had escaped the prostate and, in a few places, the surgical margin. Currently, with ART and ADT I have a good chance for a durable remission (doctors don't like to use the word 'cure' with GS9s.) If I had waited much longer that chance of a remission would be much reduced.
So I want to recommend AS since it would allow many, many men to avoid the side effects of treatment, but on the other hand, I am easily spooked by any deviation from 'pure' GS6(3+3).
What is discussed in the link above is preliminary research that might lead to a test that can be applied to Gleason Pattern 3 tumor samples. The test might be able to distinguish between cancers likely to progress and cancers that will probably be indolent.
This is exciting for two reasons. It would provide a means by which some Gleason 7 men could be taken off AS because their risk was higher than average for Gleason 7. This excites Tall and Casey but me not so much. The other thing -- and the thing that does excite me -- is that it would allow you to identify a population of Gleason 6(3+3) men for whom AS would be even safer -- so safe, in fact, that even I could steer them towards AS without being nervous about
giving out advice that I would be glad I hadn't taken myself.
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) : 5/29/2013 8:54:27 AM (GMT-6)