I appreciate everyone's comments here -- thanks so much!
I just got back from MSKCC, and a strange situation has arisen, and I'm in need of some advice.
My PSA came back slightly lower than it's been (6.06, down .13 points from June 2017), and my latest DRE was normal as usual.
I inquired about scheduling my confirmatory biopsy, but the intern who saw me (I never even met with my new doctor -- Dr. Ehdaie -- during the appointment) felt I do not need another biopsy just yet. She and the doctor feels that because my MRI from June showed no distinct lesions and I only currently have a very small amount of cancer, I would only warrant:
-- another PSA in six months (July 2018)
-- another MRI six months from that (January 2019), and if there if nothing suspicious on that,
-- a biopsy in August 2020.
I was floored by all this. I explicitly stated that I have not seen an AS protocol this "loose" -- the AS protocol at Hopkins, MD Anderson, etc. all call for a confirmatory biopsy at max a year after diagnosis.
I ended up speaking to the Dr. Ehdaie's assistant later in the day, and he essentially stuck by the "no biopsy now" plan given my current readings.
I'm in a bit of a quandary at the moment because if this was some "roadside medical stand," I would surely be seeking another doctor/facility, but this is the very respected MSKCC! I know I currently fall into the "very low risk" category, but...
I'm wondering if I should consider an AS program at another facility... Is this warranted or should I just slow my roll and put more trust in these professionals?
Thanks for any perspectives offered.
I am sure that there are good arguments for another Bx now. OTOH, your doctors, who are far more experienced in managing this disease than most any of us here, don't think there is. FWIW, I agree with them. But of course, I am not a physician specializing in PC cancer. You- as so often happens with us- are now faced with opposite opinions from different groups of PC specialists. And as usual, you must make the final decision, although I suppose that would entail finding some physicians who agreed with you if you decide your guys are wrong.
But I think I understand where they are coming from. Every treatment, or most tests, they can offer you has some corresponding level of risk, even if very a very small risk. And of course expense. That certainly includes prostate Bx, which is by no means risk free.
That must be balanced against what is known
the disease that you have and it's risk. And a far as you know, you have a very small amount of a very low risk cancer
that, even if you never do another thing, is quite unlikely to kill you. Actually, probably a large percentage- maybe even a majority- of older males walking around diagnosed have the same thing as you do, only they don't know it, lucky bastids.
Your PSA has not risen even a smidgen, has in fact even gone down a smidgen, your DRE remains normal, and your risk is very low to start with. It is true that there is a small chance that your 1st Bx missed something, but there is certainly no reason to assume that it did. If you have another Bx now, you will take on some additional risk. And guess what: it can once again miss something. It might even miss what it found in the first place, leaving you to wonder if it went away on it's own or the needles just missed it. So even then you will still have no guarantees that there is not something more sinister lurking in there. But if you are unlucky, you will join the I suppose very small % that gets a nasty unwanted SE from the Bx.
And based on the #s and %s, really what is the risk for someone with your #s if their followup Bx is delayed for a year, or at least you wait for some other sign of advance?
So I'm thinking- if it was me- and these doctors feel that another Bx is not yet warranted- good for me! Of course, as always, I might be totally in error to feel that way. It is only my feeling, not guaranteed fact! Good luck to you as you figure it out!
PSA 10.9 ~112013
Bx on 112013 at age ~65yrs, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, G9 down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.01 on 6/14 and all until 9/15 = .01, still .01 9/16, .02 on 3/17,6/17,10/17
Post Edited (BillyBob@388) : 2/27/2018 9:06:45 AM (GMT-7)