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active surveillance

1005tanner
Posts: 29
Joined: Dec 2017

Any body on active surveillance status? Just wondering how often blood work required and biospy is done.

I am considering it once i get my oncotype dx testing back .  I have 3+3=6 gleason score t2a 25% left mid 

psa 2.97. negative for lymphovascular or perineural invasion 61 years old also considering robotic surgery

at Vanderbilt with Mr Joseph Smith who has done thousands. Any input greatly appreciated'

Thamks Frank

hopeful and opt...
Posts: 2224
Joined: Apr 2009

There is some difference between institutions that administer Active Surveillance.......if you click my name to the the left you will come to the about me page that will show exactly what I have done, and active surveillance sites by professional in the field.

If you are eleigible , active suveillance is the perferred treatment since there are NO side effects. It can last a life time. I've been doing it since March 2009.

Please provide specifics about your situation; biopsy results, number of cores taken? You mention only one core that is positive with 25 percent involvement, any others? Any other information revealed in the biopsy.  ...Have you had a second opinion of the pathology results by a world class institution. There is a difference among pathologists and facilities. ...there may be a reclasification based on a second opinion......Johns Hopkins is a great institution for prostate pathology.  

DRE digital rectal exam, I think that you mentioned that there is a bump, please detail the information;

what is your psa history? did you have a FREE PSA or any other diagnostic tests? 

Any image tests?

What led to you receiving a biopsy.

 

 

Clevelandguy
Posts: 456
Joined: Jun 2015

Hi,

With a 3+3 you still have time to do three things, ASA for who knows how long, surgery or various forms of radiation.  Your doctor and you should work out the plan on how many biopsies will be needed based on where the cancer lays inside of your Prostate.  Sounds like it was caught at an early stage & is not very agressive.  If you want to stay on AS you could do that while you contimplate your next move(surgery or radiation).  When you decide what to do there are plenty of people on this board that can advise on any type of treament.  Never done AS myself, I wanted the cancer out of my body before it progressed outside of the Prostate.  Good luck.................

 

Dave 3+4

Tech70
Posts: 53
Joined: Nov 2017

Gleason 1 core, 10% 3+3, PSA 3.5, T1c, MRI showed no lesion of concern, Oncotype DX GPS score 19.   My doctor plans PSA every 3 months, a conirming biopsy at 4 months, annually thereafter which is in line with the NCCA guidelines.  To me the biggest advantage of AS is the fact that the technologies available for treating PCa are advancing qiuckly so if the need to take more aggressive treatment arises in the future, there may be treatments available that are less likely to cause side effects.  To me the temporary irritation of an annual biospy isn't nearly as bothersome as peeing in my shoes when I sneeze or fearing a fart.

Your Oncotype DX results, if favorable should give you peace of mind to persue AS.  In the confirming study of the test, NO participants with a GPS of 20 or less died or developed metastises within 10 years.

JJO
Posts: 10
Joined: Sep 2017

I've been on active surveillance for two years.  I have a PSA every quarter, and once a year we first do an MRI, and then a biopsy.  If the MRI shows anything suspicious, it would be a fusion biopsy, if not, it's the standard 12 core sample biopsy.  So I recently had my second annual MRI/biopsy.   

Tomorrow I'm going to consult with a urologist at a different hospital just to talk things over.  I spoke to him about a year ago.  I think it's good to talk to several doctors even if you fully trust your primary doctor.  

1005tanner
Posts: 29
Joined: Dec 2017

Thanks for the infomation greatly appreciated. Waiting on oncotype  dx test results now. found out October 

2 cores positive 25% left mid with biospy after dre exam felt nodule. Psa 2.57 1year ago then 2.97 .T2a tumor

Having slides checked at Vanderbilt for second opinion. Havent had a free psa test or any MRI at this time 12

samples taken 2 positive. no invasion still localized. Options given AS , robotic , considering age and health

were recomedations by both urologist. Weighing my options Thanks for all input. 

ASAdvocate
Posts: 116
Joined: Apr 2017

The percent of Gleason 6 men choosing AS has skyrockted from near zero to about fifty percent over the past 8-10 years.

This is especially true in large institutions and practices. Not so much in small and solo practices, where the urologists are slower to change their ways (and revene streams).

AS is now the default action for men with very low and low risk PCa. That is according the three medical organizations (NCCCN, AUA, ASCO) that issue guidelines for the treatment of prostate cancer. The regimens for blood work and other tests vary between programs. Mine at Johns Hopkins was the strictest, and you would have six month PHI tests, annual DRE's, and either a biopsy or an MRI every two years. However, the first year they would insist on a second, targeted biopsy, to lessen the chance of a more serious cancer that was missed on the first positive one.

 

IMHO, surgery has life-altering consequences, an you want to avoid such treatment as long as you safely can.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Along with the results of the oncotype test and second opinion of your pathology, please also post the results of your digital rectal exam so we can provide our opinion of your qualification for active surveillance.

Also at some point it's best for you to have a T3 multiparametric MRI which can reveal if there is extracapsular extension. This is important before  AS or any treatment.

 

FREE PSA...this is a blood test, relatively simple to administer...suggest that the next time you receive a PSA, also ask for a FREE psa. With a free psa, the higher the number the better.

 

Entrance to Active Surveillance program is not age related. There is a man of 35 who is in the active surveillance program where I am treated. The side effects from activee treatment for a younger man can infringe on his life for a very long time. It is fairly common for men who are 60 to be in an active surveillance program, remember that men who are monitored can still be treated with the same treatment that they would orginated choosen if the cancer porgresses. They would have a better qualitiy life dduring that time.

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