"Monitoring prostate cancer (PC) by active surveillance (AS), with the expectation to initiate treatment if the cancer progresses, is a preferred initial option for men with low-risk PC and a life expectancy of at least 10 years. According to the results of a new study conducted at Brigham and Women's Hospital (BWH), there is evidence to also support AS as an initial approach for men with favorable intermediate-risk of PC (men with no evidence of the cancer spreading beyond the prostate, a Gleason score of 3+4 or less and PSA, prostate-specific antigen, under 20). These findings are published online by JAMA Oncology."
So, what this says to me, is that only GLeason equal,to or greater than 7 (4+3) that appears to be contained, should be considered for surgery, since most DRs would NOT recommend surgery to ANY patient with less than 10 years life expectancy.
The big question for me would be, for those men with low intermediate risk, does initially choosing AS ultimately raise their risk of needing treatment at a more advanced stage later, When neither Brachy nor surgery would offer a cure, thereby putting them at risk for lesser quality of life with radiation AND HT.
I maybe be way off base here, as I'm not that well versed in treatment of advanced cases. Just thinking out loud and playing devils advocate.
Both Brachy and surgery offer the same 1% PCSM rate as mentioned for AS in the study. So does AS now increase the chance of requiring more difficult treatment later.
There is no question in my mind that Brachy offers the same chance of cure to these men as RP. I'm still not convinced that AS is a riskless treatment.
Yoop, it's great that you bring this stuff to the forefront for discussion. Thank you.
Rising PSA from 2008 through April 2013
PSA 2008 - 2012 .7 TO 2.2
Dec 2012 - Biopsy, 14 core, nO PCA, one core HGPIN
4/13 PSA 2.8, FPsa 11, PCA3 13, 10/13 PSA2.7 fPSA 15
4/14 PSA 3.1 fPsa 16, 10/14 PSA 4.3 fPSA 12 PCA3 26
11/14 BX 3/12 cores + G610%, G6 20%, 3+5=8, 70%
2nd opinion Johns Hopkins, all G6 10%, 20% 80%
3rd opinion MSKCC all G6 10%, 15%, 70%
RALP scheduled January 6th 2014
Final pathology stage pT2c, upstaged to Gleason 7 (3+4)
ECE, Margins, SV, Lymph nodes (9) all negative, PNI present.
5% involvement of Prostate by tumor.
My story, at tinyurl.com/qgyu3xq