My only worry and the only reason I am not 100% sold on AS is my 2 PSA tests. My first in May was 6.7. Second one in August was 6.49. From all the stats I have seen or heard of, this is a really high PSA for such low volume non aggressive disease that my biopsy showed. Just afraid there is more there that was not found and that is what continues to lead me to wanting surgery.
While the biopsy indicates you are a very low risk patient, biopsies are known to frequently under-sample (and often completely miss) tumors of significant size. The PSA is a red flag. If it cannot be brought down by antibiotics, I would strongly consider a second biopsy (perhaps MRI or color doppler ultrasound guided) focused on the area of the positive core before going into AS. And, as others have stated, you should also absolutely have a expert second opinion on the pathology.
I was diagnosed in March at age 40 with a wife and two kids ages 8 and 11. I was also G6 but was a bit higher risk than you as I had a palpable tumor on DRE (my first and only PSA in Jan was only 1.23 -- a bit high for my age but would not have triggered biopsy) and was positive for perineural invasion on biopsy.
I didn't really give too much serious consideration to AS because I was not comfortable with the ~30% chance of higher grade disease that was missed on biopsy or with my stage T2a and PNI+ stats and figured the sooner I have the surgery the better likelihood of a good outcome. I focused my energy on finding the absolute best surgeon (you can read the details here
) and I had surgery at the end of May with good results both oncologically and in terms of side effects. I had very little pain (despite
open surgery complicated by mesh hernia repair) and was back to work in three weeks. Continence has been a bit slower than some report but at three months I am now nearly dry. Potency still has a way to go but I have been having sex with the help of Cialis since 9 weeks, which is ahead of the curve (but I think fairly typical for a patient my age). Thankfully, I never had to tell my kids I had cancer.
But even though I've had a pretty good experience with surgery I'd strongly advise you not to rush into that (or any other risky and irreversible treatment) with your apparently very low risk stats. In your case AS does seem like a great initial option. Just be sure to at least get the expert opinion on the biopsy and get to the bottom of your elevated PSA...
Jan '13: PSA 1.23, small nodule on DRE (1st screening @ age 40)
Mar '13: Biopsy 2 of 12 cores GS 3+3: rt mid 10% and rt apex 20% w/ PNI+ Stage cT2a
Apr '13: Biopsy confirmed by Dr. Epstein @ Hopkins
open RRP by Dr. Burnett @ Hopkins. Both nerves spared.
Final Path: GS 3+3, organ confined (tumor extent moderate), SV and 11 nodes all negative (pT2a), negative margins!
PSA: 0.01 @ 6 wks
Post Edited (njs) : 8/30/2013 9:05:37 PM (GMT-6)