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Active Surveillance (watchful waiting)

hopeful and opt...
Posts: 1293
Joined: Apr 2009

The doctor that I seen for the last year is a surgeon at UCLA. I visited with him yesterday, and he referred me to an other physician at UCLA who specializes in Active Surveillance.

There is a new type biopsy which is " three dimensional ultrasound" for a prostate biopsy which this doc is able to do....I understand it to be superior to the standard biopsy that we all have had, since you can really tell where the biopsy is takenfrom and repeat, if I understand correctly.

At UCLA I'm pretty sure that they basically monitor the disease and do not do anything to retart the disease. There are other docs in the area who do this,however I wonder if I want to do any of this........there is a drup called avodart that some docs prescibe, but I really don't know if I want this or something else that they might do.......ie , other monitoring techiques or drugs , etc.

Anyway I'm looking for input.

Thanks
Ira

Active Surveillance
Diagnosed 3/09 for 66 birthday
By chance doc found a bump in the cavity , not on the prostate(which turned out to be non cancerous)
PSA's had been at 2.26/2.27 for a few years
Biopsy 3/09 Gleason 3+3=6 2 of 12 cores positive- 5 percent involvement in each
second opinion john hopkins
4/09 MRI with spectroscopy, no nodule involvement, staged t1
Aureon molecular test on biopsy, 97 percent chance will not progressin next 8 years
PSA Jan 2.2, JUly 2.5, November 2.6, February 2010 2.0

erisian's picture
erisian
Posts: 109
Joined: Dec 2008

Those numbers make it look like it. I'd say that it's a very good sign that your surgeon steered you toward AS. There's something to be hopeful and optimistic about!

Do some research on nutrients and supplements for your stage disease. The ACS and Sloan-Kettering have good, conservatively written info on their websites. There are some botanicals and nutrients that have shown real promise in studies, and these things are generally more effective against early-stage disease, so you might get some real benefits.

http://www.cancer.org/docroot/ETO/ETO_5.asp?sitearea=ETO
http://www.mskcc.org/mskcc/html/1979.cfm

Swingshiftworker
Posts: 626
Joined: Mar 2010

Active Surveillance is a viable approach for men w/early and low grade PCa (T1c, Gleason 6 and PSA less than 10) and you qualify. Men at Stage 2 and above w/Gleason 7 or above and higher PSA levels need some kind of treatment and do not quality for Active Surveillance.

UCSF has an Active Surveillance program that has involved over 600 men to date. Only 20% of those men have received treatment in the past 3 years and they haven't "lost" anyone yet. They monitor the men w/quarterly PSA tests, semiannual ultrasounds and biannual biopsies.

One of the risks of Active Surveillance is that, even if you are regularly monitoring the cancer and see no signs of advanced cancer growth, you may actually have a larger cancer in your prostate than you realize (as has been reported by some men here) that has the potential to metastasize before you get treatment.

So, whether you're comfortable taking an Active Surveillance approach or not depends on how you "feel" about the cancer and how you deal (cope) with risk.

Some men just can bear the idea of the cancer in their body (and/or the risk of it spreading) and take action to immediately remove it by surgery or radiation. Other men, like me, would rather postpone the negative quality of life issues associated with treatment(many of which are simply awful) and are happy to engage in Active Surveillance until treatment is absolutely necessary.

Only you can decide which choice is best (emotionally and physically) for you.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Very good and thoughtful post. Ira, I worry about you constantly and pray you are watching yours like a hawk! I admitt, I am too chicken to ever consider active surveillance from the pure thought of allowing the cancer to exist in my body...My decision was easy in that regard...I HAD TO GET IT OUT...or at least attempt to get it out...the hard part is deciding what method to extract/erradicate it. It's easy for me now to say I made the exact right choice for myself with the results I had...but will I feel that way in 5, 10, or 15 years from now...I hope so..and think I probably will.

Randy in Indy

hopeful and opt...
Posts: 1293
Joined: Apr 2009

the literature that I read, tells me that active surveillance is a "best" treatment for older men with low grade prosate cancer, and I have been doing this for the last year, and intend to continue..i am comfortable with this decision....in fact when I saw the surgeon last week, he reemphasized that he thinks that I have indolent cancer, and it is very unlikely to spread.......since he is in charge of the entire prostate cancer program at UCLA, who am I to disagree.

Anyway I will be getting another biopsy as soon as I can schedule.

Well I think that my question was not that clear, since I will be continuing with active surveillance until and if there is a change and I need to follow another treatment option.

So, my question actually is directed toward the Active Surveillance protocol........at various institution, the disease is closely monitored,different institutions have slightly different protocols, without any intervention to retart the disease; while others prescribe meds such as Avodart and others, as well as use other techniques to monitor other than biopsies and psa's..........what I am wondering , will this different monitoring and treatment , enhance the effectiveness of Active Surveillance. Also, what are some of these additional things to monitor and treatments , other than avodart?

Thanks again

Ira

erisian's picture
erisian
Posts: 109
Joined: Dec 2008

I read in a post here recently about a 3-D ultrasound imaging system. That sounded really good to me for AS use, for a few reasons. It's noninvasive (relatively). It's not hit-or-miss like a biopsy. And subsequent images can be digitally compared to previous ones to look for any changes.

erisian's picture
erisian
Posts: 109
Joined: Dec 2008

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bdhilton
Posts: 756
Joined: Jan 2010

Hey you are 11 years older than me and from a clinical stand point you appear to have a low grade of cancer…Just keep an eye on it and get tested often…I have read studies on Active Surveillance and if my clinical was less I would had opted for Active Surveillance by a major institutions like UCLA …. Most of us after surgery found that our cancer was more aggressive in our pathology report than our clinical biopsy… Just keep an eye on it and get tested often

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