Active Surveillance or Radical Prostatectomy?

Max Former Hodgkins Stage 3

bob4894 said:

Still weighing on me

So much information on treatment options.  I struggle daily on what to do.  Because of the randomness of the biopsy process, I keep thinking that there may be some GS 4 somewhere as 20% change on re-biopsy or RP. 

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PSA

Jan 2013 - 2.76

Mar 2014 - 3.12

May 2014 - 3.4

Jul 2014 - 3.5

1/30/2015- 3.46

Color Doppler Biopsy 2/12/15 - 12 cores.  1 core Gleason 3+3 <10

I understand

Bob,

I understand the agony of deciding on this. As we have discussed, my case was very similiar to yours, except that my Doubling Rate was significantly faster than yours, but at around 1.0/year, even mine was not cause for imediate action.  You are actually experiencing virtually no increase presently.

If you retrace my decision-making at my threads, you will see that I actually had resolved for radiation, and changed to RP only later, for a few technical reasons (urinary obstruction mostly).   At five weeks since surgery, I have few regrets. My urinary control is doing well (I wear only "liners").  I was fortunate and the doctor said he spared the erectile nerves, but recovery in that arena reportedly takes a good bit longer than urinary control.  Even radiation can cause some symptoms of ED, however.

Go slow, read a lot,  and realize that all of the best doctors say that there is in fact no such thing in most cases as a "best" decision regarding which treatment to go with.    The most recent IGRT and CK results are virtually identical to surgical removal today for long term cure rates. In general, radiation is becoming better and better, while surgery, obviously, is essentially static in its results.

max

 

hopeful and optimistic

bob4894 said:

Still weighing on me

So much information on treatment options.  I struggle daily on what to do.  Because of the randomness of the biopsy process, I keep thinking that there may be some GS 4 somewhere as 20% change on re-biopsy or RP. 

----------------------------------------------

PSA

Jan 2013 - 2.76

Mar 2014 - 3.12

May 2014 - 3.4

Jul 2014 - 3.5

1/30/2015- 3.46

Color Doppler Biopsy 2/12/15 - 12 cores.  1 core Gleason 3+3 <10

Bob,
At you initial visit

Bob,

At you initial visit with Dr. M , he will decide when it will be appropriate to have an multiparametri MRI and biopsy.( I don't know what the wait time will be)..this will give you a pretty good idea of where you stand

At any rate there is no rush. The initial diagnosis that you have had is a low volume, low aggressive disease.....so far you appear to be a perfect candidate for AS.

Even if there is a 4 somewhere in there, you still do not have to rush.....just keep on doing research.

 

 

bob4894

Max Former Hodgkins Stage 3 said:

I understand

Bob,

I understand the agony of deciding on this. As we have discussed, my case was very similiar to yours, except that my Doubling Rate was significantly faster than yours, but at around 1.0/year, even mine was not cause for imediate action.  You are actually experiencing virtually no increase presently.

If you retrace my decision-making at my threads, you will see that I actually had resolved for radiation, and changed to RP only later, for a few technical reasons (urinary obstruction mostly).   At five weeks since surgery, I have few regrets. My urinary control is doing well (I wear only "liners").  I was fortunate and the doctor said he spared the erectile nerves, but recovery in that arena reportedly takes a good bit longer than urinary control.  Even radiation can cause some symptoms of ED, however.

Go slow, read a lot,  and realize that all of the best doctors say that there is in fact no such thing in most cases as a "best" decision regarding which treatment to go with.    The most recent IGRT and CK results are virtually identical to surgical removal today for long term cure rates. In general, radiation is becoming better and better, while surgery, obviously, is essentially static in its results.

max

 

How to Follow Threads

Max,

I just clicked your name to the left.  Is that your thread?

Thanks for advice.  I'm know everyone here knows that I scared but I'm trying hard to not let fear cloud my judgement.  Gonna check out IGRT and CK results now.

bob4894

hopeful and optimistic said:

Bob,
At you initial visit

Bob,

At you initial visit with Dr. M , he will decide when it will be appropriate to have an multiparametri MRI and biopsy.( I don't know what the wait time will be)..this will give you a pretty good idea of where you stand

At any rate there is no rush. The initial diagnosis that you have had is a low volume, low aggressive disease.....so far you appear to be a perfect candidate for AS.

Even if there is a 4 somewhere in there, you still do not have to rush.....just keep on doing research.

 

 

UsToo

Hopeful and Optimistic,

Thank you for providing web address for USTOO.  There is a lot of information on this site!  And I was able to find a support group close to my home.  The site also has a list of questions I should be asking my doctor and will be bringing that with me to Dr. M.

Thanks again!

 

hopeful and optimistic

Max Former Hodgkins Stage 3 said:

Thanks

Thank you for the link, Hopeful.  I Guess G-6 is possibly similiar to PIN-cells; pre-cancerous or proto-cancerous.

Shock and fear

Bob,

When we are diagnosed virtually all of us go through all of those negative feelings. This lasts about two or three months. During this time,  we , the patients are faced with making a decision from a choice of treatments, all of them negative, that can severely impact our lives. To complicate this, there are sharks out there who are touting their treatment type, sometimes at your expense, so you need to develop knowledge so you will not be a victim.

There are strategies to help with your emotions; surround yourself witrh positve people. If you attend religious services have an upbeat clergyman, if not switch, even if it's to a different religion..."upbeat" is the key. Attend support group(s). Keep on posting here.

Generally when a person is diagnosed , the first inclination is to get the "cancer" out. This can have serious side effects. This was my first thought, but instead, I did a lot of research, and am in an Active Surveillance program for the last six years, where I have had no side effects, and believe that I can seek active treatment if necessary, using my initial treatment choice with equal amount of success as I would have done. In fact since i have been successfully on Active Surveillance(with no side effects) for the last 6 years, I have investigated "newer and better" treatments which I will probably pursue if necessary (which may never be)

 

Please feel free to click my name to the left to follow what I have done, and information that I listed about Active Surveillance.

 

Old Salt

bob4894 said:

Still weighing on me

So much information on treatment options.  I struggle daily on what to do.  Because of the randomness of the biopsy process, I keep thinking that there may be some GS 4 somewhere as 20% change on re-biopsy or RP. 

----------------------------------------------

PSA

Jan 2013 - 2.76

Mar 2014 - 3.12

May 2014 - 3.4

Jul 2014 - 3.5

1/30/2015- 3.46

Color Doppler Biopsy 2/12/15 - 12 cores.  1 core Gleason 3+3 <10

I guess the glass is half empty for you

but really, if your prostate deteriorates in the future, there will still be many options for treatment.

I am  rather of the philosophy to not overly worry about issues that I don't know about or can't control.

CC52

Options

Bob,

First off, my regrets for your diagnosis. Secondly...PROCEED SLOWLY!!

One of the great aspects of this forum is the wide variety of opinions and experiences of everyone here. I don't know that I can add much to the conversation that hasn't already been said, but if you care to follow my story, here is the link: http://csn.cancer.org/node/264905.

Ultimately, the decision is a very personal one, and there is no "one size fits all" answer. Take your time...do your study...make the decision that works best for you.

Best wishes - CC

Max Former Hodgkins Stage 3

bob4894 said:

How to Follow Threads

Max,

I just clicked your name to the left.  Is that your thread?

Thanks for advice.  I'm know everyone here knows that I scared but I'm trying hard to not let fear cloud my judgement.  Gonna check out IGRT and CK results now.

see the following

Bob,

My thread that traced my own treatment decision is entitled, "Please Send Membership Card." My journey is similiar perhaps to many; if nothing else it will show that other guys have the same  confusion and ambivalence that you are going through. Our  clinical presentation and ages are similiar, but no two cases are ever the same. Urinary restriction, for instance, had a significant role in guiding me toward surgery. Even rapport with one doctor verses some other doctor effects some guys, rightly or wrongly.

My more recent thread is titled "Post RP", but it just discusses my questions and issues since surgery, which has only been about five weeks ago.  

I will volunteer that I wore a cath six days, and then an Attends (diaper) one (1) day, before deciding it was unnecessary. I then changed to "guards" (similiar to women's panty liners), which I still use. From what I have read this is great, better than normal recovery, for which I am thankful. Urinary control post-op can take months or more.  Sexual recovery takes a lot longer (commonly a year or more). Just laying out what RP did for/to me, and as I noted, my post op has been easier-faster than most. Other guys stories are different.

max

 

 

bob4894

Max Former Hodgkins Stage 3 said:

see the following

Bob,

My thread that traced my own treatment decision is entitled, "Please Send Membership Card." My journey is similiar perhaps to many; if nothing else it will show that other guys have the same  confusion and ambivalence that you are going through. Our  clinical presentation and ages are similiar, but no two cases are ever the same. Urinary restriction, for instance, had a significant role in guiding me toward surgery. Even rapport with one doctor verses some other doctor effects some guys, rightly or wrongly.

My more recent thread is titled "Post RP", but it just discusses my questions and issues since surgery, which has only been about five weeks ago.  

I will volunteer that I wore a cath six days, and then an Attends (diaper) one (1) day, before deciding it was unnecessary. I then changed to "guards" (similiar to women's panty liners), which I still use. From what I have read this is great, better than normal recovery, for which I am thankful. Urinary control post-op can take months or more.  Sexual recovery takes a lot longer (commonly a year or more). Just laying out what RP did for/to me, and as I noted, my post op has been easier-faster than most. Other guys stories are different.

max

 

 

After prostatectomy

Max,

Haven't really been doing too much research regarding after care for RP.  I know there will be incontinence and ED as every story I read pretty much says the same thing. I just thought that ED would be mitigated with Viagra.  2 days out from my consult with Dr Marks to get his opinion on my results and see what he has to say about active surveillance.  Anxious.

Thanks