Tall Allen said...
The National Comprehensive Cancer Network (NCCN) is an organization of many of the top US cancer centers of excellence. Often, what they say is the standard of care. In their patient treatment guide (link below) see page 50 - Primary treatment for low risk. It clearly states: "The criteria for low risk include T1c and T2a tumors."
If a DRE doesn't disqualify from AS, then why do one as the NCCN suggests? (I'm not trying to be cute here. It's genuinely confusing. It's contradictory.....they're saying two things at once....do a DRE...but do not base AS on it's findings. "Do 'em, and if positive, no problem. Continue AS.").
T1C from probably 7 or 8 different uro's, surgeons and RO's. One (Dr. Tewari) found my prostate to be "more firm on one side than the other". When asked if, in his mind, that changed my T1C status, his reply was...."Aye....don't worry about
it". He also did the scans. So....he knew where my cancer was.
I had those same scans sent to another radiologist for his interpretation. (One I could speak with). He showed me on the slides where my cancer was. It was close to the edge on one side.
After this, if a doc did a DRE on me, I'd ask them...."Does it feel to you firmer on one side than the other?" They all replied yes.
My surgery was done locally (a mistake). My positive margin was on the same side as the firmness and where the scans showed the cancer to be.
So...now my opinion (based on my case). DRE's are important. Your uro (coincidentally enough) seems to believe they're to be considered as well. (Why the NCCN suggests them for AS but don't use their findings for decision making is .... well....weird).
Gumby.....It sounds to me as if your doc has a handle on your case. You need to speak with RO's about
your case. You need to ask, from now on, if they feel a nodule. You need to ask if that nodule is significant in your decision making process. Also ask any AS doc you consult the same 2 questions.
PSA 2010 thru 2014...4.0 +/- .7
Dx 12/14 @ 56 yo...2 cores G6 <5%, 1 core G6 20%, 1 core HGPIN.
RALP 11/25/15...3+4. 3-5 mm lateral margin (depending on who you ask). 15% involvement pT2+ PSA's 01/16 .01 04/16 .00 07/16 .00 10/16 .01 01/17 .01
Post Edited (island time) : 3/21/2017 3:46:54 PM (GMT-6)