Active Surveillance: 34 months post diagnosis

This supplements the summary below from April, 2012.  I'm continuing on AS since a 2010 diagnosis.  I've had a third biopsy in Sept '12 which was virtually identical to biopsies in 2010 and 2011:  1 of 12 cores positive, 5% of tissue involved, Gleason 6.  Additional PSAs have been:  July '12 2.7; Feb '13 2.3.  DRE normal.  Will be 59 in 2 weeks.

I'm being followed by my local urologist and also by a RRP specialist several hours away.  Since my biopsies show no progression, the DREs are normal, and the PSAs are not remarkable, I haven't had to work very hard to stay on the AS path.  I really don't have any known counter-indications to struggle with.  Obviously, this could change, and our knowledge could be incomplete. But due to this consistency, my biopsies are now being scheduled every 24 months rather than 12 months, with DREs and PSAs at 6 month intervals.

As indicated in prior posts, my early treatment choices, if it became necessary, leaned toward Cyberknife or RRP.  I have enjoyed the opportunity to follow ongoing studies and data re these techniques and others in the interim.  I am also interested in any progress being made generally in identifying characteristics of one's particular cancer on a molecular or genetic basis so as to help more precisely make a treatment decision.  While we are not there yet with prostate cancer, we hope and think that one day we probably will be.  

So, I am continuing to enjoy my day to day life without any PCa treatment side effects, while being reasonably "certain" that if and when treatment is necessary it can be successful.   If treatment related scientific progress is made in the meantime that benefits me, obviously I'll be happy to benefit from it.    For now, I"m comfortable with this strategy, but will be prepared if a change is warranted.

I hope you all are doing well.  It is always remarkable to see the work of the regular posters whose diligence and loyalty in their posting provides such a wonderful resource to those in need.  Cudos again to them.

Mac 

AS Update at 18 months post diagnosis:

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