All of the advice you have received thus far is sound; you are a great candidate for AS and your ability to cope psychologically only you can answer. As Pratoman said "you can always change tracks off AS if you choose"... you cannot change tracks after surgery, it's a binary event. Many here would consider you lucky because you qualify for AS and sadly many do not or were misinformed by their Uro's.
I have just walked your path myself with a 10% G6 finding. I have chosen AS, I have the mind for it and frankly even a month without side effects is worth it to me, if I can get a year, 5, 10 or 15 it's all upside to me. IF or when the AS needle twitches in the wrong direction I'll be all over it like a cheap suit. Even then surgery will be bottom of my list, IMHO for me at least, it's an outmoded and draconian solution with a horribly under-reported side effect profile. As has been said, there are MANY other options to consider, as and when the time comes, and who knows what NEW treatments may be available or better proven in the future; focal and immuno therapies and possibly even 3D Haptic DaVinci surgery being among them.
If you're 50, just like me, you're not ready for diapers and you probably enjoy sex. I would hold on to what you have for as long as a cadre of wise healthcare professionals say it is prudent to do so.
On that note... 'cadre' I say this because you HAVE to triangulate opinions, you simply cannot trust one voice (including mine), infuriating though that statement is... it's just true. I have a close friend who had a RP at Mass General (he regrets). He made an observation "I had a cross-disciplinary meeting at MGH, they had ALL the experts there; surgery, brachy, IMRT, AS, you name it... it was great! Within about
2 minutes I realized I was sitting in a room with a bunch of salesmen".
Finally, mpMRI is your friend in the hands of a good radiologist/reader thereof. This mode of detection is starting to become the mainstay of good AS programs and is highly sensitive and specific toward higher Gleason grades, e.g. beyond G6. With PCa being slow moving and G6 being considered 'well-behaved' a good AS program with mpMRI will catch things in good time to act in the vast majority, VAST majority, of cases. I have had two very wise Dr's say to me within the last week, "we are starting to trust 3T mpMRI more than Trans Rectal biopsy. We're calling it Magnetic Surveillance."
On the recovery at 50 thing... OK, yes, younger is always going to be better BUT if you are fit and healthy you'll still do very, very well if you have to treat after 5, 10 or even more years of AS. If you're not fit and healthy... well you just got your wake-up call!!! I would WANT those 5, 10 years...
Bottom line is "what is important to you and what balance are you comfortable striking?"
I'm kinda passionate about
this because I just went through these EXACT conversations, panic attacks, sleepless nights, tears, throwing up, tantrums, frustrations and finally... peace that I had heard all the arguments and seen a path that fits ME not the establishment.
I shall end with a new piece of information to the forum that may provide you some comfort... now this IS MY CASE, not yours and not advice... but it helps contextualize. I had my mpMRI read by Johns Hopkins, they said "you have a lesion, we're going to biopsy it". It was benign, they found G6 in another random core. They said nothing
else. I had my MRI read by a pioneering Radiologist in PCa, here's what he said:Your MRI was diffusely abnormal throughout the left peripheral zone on the enhanced images but it looked more inflammatory than cancerous as the other sequences in the MRI study were essentially normal.
It is not surprising to find a 10% Gleason 6 lesion in one core biopsy sample in a man of your age.
This is likely a spurious finding and I would recommend that you simply follow with MRI and PSA tests (every year and every 6 months respectively). The positive core probably represents non significant cancer as nothing of note is visible by MRI.
I had not told him that my prostate is regularly raped by a 1200lb quadruped... that's the inflammation part right there, he got it on MRI.
Everything in life is a bell curve of course...
I would say 'good luck'... but with low volume G6, and having found this place and these remarkable guys... you're already lucky dude!
7/6/14 PSA: 1.07
7/6/15 PSA: 4.3 DRE: Negative
7/17/15 PSA: 2.56
8/10/15 PSA 8.41
8/14/15 PSA: 8.5 PHI 47.5 DRE: Enlarged
9/18/15 3TMRI: 1xPIRADS 3/5 9mm lesion
11/10/15 UroNav Fusion biopsy
11/13/15 10% G6 one core left baseActive Surveillance (Hopkins)
Next: Push my wife around the carpet
Travel assistance - www.healingwell.com/community/default.aspx?f=35&m=3514920
Post Edited (Paul65) : 12/1/2015 7:17:28 AM (GMT-7)