Active Surveillance Update - 18 months post diagnosis

MCinNC

Hello all. Felt an update was due. I was diagnosed in August 2010 after a biopsy showed 1 of 12 cores positive, Gleason 6, 5% of tissue involved. June '10 PSA was 2.3. Father had PC. General health good, age 56. Highest PSA was 6 months earlier at 2.9.

In October '10, after several months of fairly strenuous investigation and education, I formally decided to AS, or "expectant management with curative intent," with a goal of monitoring a slowly developing condition closely, delaying the side effects of treatment, and doing it without losing effective treatment options.

So, time has passed, and since then I have had regular PSAs, exams, and an annual biopsy. Most recent PSAs have been

March '11 2.2
June '11 2.3
Nov '11 2.4
March '12 2.5

A 2nd biopsy was performed June '11 with the same results as in June '10: Gleason 6, 1 of 12 cores and 5% of tissue. Another will be done this summer.

Had decided in '10 that in the event treatment was needed, that I would likely consider RRP or Cyberknife. I was interested in CK because of the research I had done on it and experiences like that of Kongo, and its availability at a medical center here near me in North Carolina. And, I also would consider RRP due primarily to finding an experienced surgeon that I really hit it off with and in whom I have great confidence and trust. I was really surprised how much of a difference in my decision making it made to run across a great doctor that you really like personally, and unfortunately, how rare that was among the many doctors that I met. Anyway, I've been followed since diagnosis both by my local urologist and at a university medical center where the RRP surgeon works and where CK is also available.

So far, I am pleased with things. The '11 biopsy showing no change was obviously big. And, while the PSA is slowly rising, it is something I can tolerate so far. One step at a time is the plan. I have much enjoyed the 18 months without the risk of treatment side effects, and should I need treatment in the future I will have extra months or years of data to better evaluate the outcomes of the various treatment options. CK or RRP will still be at the top of my treatment list, but I would certainly update my thinking if that time comes.

As we all know, we are all different individuals and our cases are different. But, the choice I made for AS in 2010 was the best decision available for me at the time, and one after considerable homework that I was most comfortable with. All have risks. There are few guarantees. But unless or until things change, I will be continuing down my current path.

I really appreciate all of you regular posters on CSN. The generosity you show with your time and the considerable knowledge you share so freely is a truly wonderful resource to those faced with such complex and emotional decisions.

Thanks again. Best wishes to all.

Mac

mrspjd

Great News!
Mac,

Welcome back & congrats! I remember your thread & posts very well. Your excellent thoughtful questions and rational conclusions evoked an interesting and educational discussion.

Thank you for sharing this thorough & articulate update on your PCa journey. Best wishes for continued success with Active Surveillance/Monitoring.

M (mrspjd)

Kongo

Great News
Mac,

Great to hear from you again and thanks for the update. I've wondered how you were getting on and am so happy to hear the great news of your positive results on AS.

Here's hoping that everything continues to go well.

All the best.

K

hopeful and optimistic

Mac


Good to read your posts.

I am glad that AS is working .

I'm thinking that there are very minor changes in your PSA which may be due to "any" factor other than PCa. To me your PSA looks steady. Hard stool, a little extra exercise before the test. Lab analysis. By the way, diet change may be a factor in PSA numbers, eating without dairy or meat may reduce PSA (Dr. Ornish)

MCinNC

hopeful and optimistic said:

Mac


Good to read your posts.

I am glad that AS is working .

I'm thinking that there are very minor changes in your PSA which may be due to "any" factor other than PCa. To me your PSA looks steady. Hard stool, a little extra exercise before the test. Lab analysis. By the way, diet change may be a factor in PSA numbers, eating without dairy or meat may reduce PSA (Dr. Ornish)

PSA results
Hopeful, I agree with you about interpreting the psa results. As the patient I'm likely to over analyze any new data that comes along. But, all of my doctors say the psa test is not precise enough for recent results to prove a trend. Also, from personal experience in years past I know that pre test activity can significantly affect test results.

Thanks for your comments.

Mac