hopeful and optimistic said:

"Active Surveillance with delayed treatment if necessary"

Based on the information that you posted, you are a very good candidate to pursue an Active Surveillance protocol. 

I suggest the following: 

Have a second opinion on the results of your pathology by a world class pathologist so that you are not under or over treated. Determining Gleason scores are subjective, and you want an expert to review your pathology.

Have a multiparametric  MRI with a T3 magnet. This test may show if there is extracapsular extension.

Find a doctor, preferably at a major center of excellence who specializes in treating men diagnosed with prostate cancer with, "Active Surveillance with delayed treatment if necessary" protocol

Click my name on the left side. If you read the "about me" page you will see informaton that I posted that is germaine to the Active Surveillance protocol, and how I have been treated.

I have been following this protocol, six years now.

Please feel free to ask any questions that you may have.

Your right, there  is a lot to learn about this beast, and the "best" treatment choice.

Try to educate yourself. There are support groups that are local. One source is USTOO.com that has local chapters in various parts of the world that can be determined at their site....they also put out a "HOT SHEET" each month where up to date information is available...you can also look at previous issues at their site.

Read books, Internet, etc.

With reference to biopsies, I guess that it is a necessary evil. In my case, the doc wants to do one two years from my last one.  Different centers have different protocols...ie Johns Hopkins does one every year since they are researching this. Since I am in Southern CA., I only know the details of some of the major centers.......to be honest, I don't know anything about the technology that the major center that you are considering for AS treatment has available or the protocol that they follow. Hopefully you can share this information with us at the site, and we can provideour  LAYMAN opinions of what is available to you at this center.

The reason that I follow an active surveillance protocol is that I am doing my best to avoid the possible major side effects of treatment to include ED and Incontinence. You mentioned that you had considered surgery. The possible side effects of surgery are very severe; for the most part greater than other active treatment choices, and the biopsies that one must undergo for active surveillance.

By the way there are MRI guided biopsies, in real time,  where maybe 3 or 4 cores are taken. If the biopsy is a major concern to you, you may wish to consider having this type biopsy.

You will do fine 

With that big of a jump in PSA, I would be suspicious of an infection. You might want to ask your Uro about the possibility of an infection and maybe taking some antibiotics .... give the antibiotics a chance to work and then redo the PSA test.

With a previous biopsy of a G6, I feel you have plenty of time for testing and should stay on AS for now. You can make decisions about going off of AS and doing active treatment in the future.

barrytips52 said:

AS

Thanks for the input, very valuable and reassuring.  Waiting to get my PSA result today, will be the first test since the original diagnosis.  Sort of ambivalent about the PSA tests based on my research, but hoping it is stable or decreasing.  Been doing a lot of reading on anti-cancer strategies, looking for ways to give me the best chance to harness the growth of the disease.  I live a pretty clean lifestyle now so it might be tough. 

Commited to AS unless the next biopsy shows something unusual, scheduled for July.  Duke protocol apparently will allow three years till the next one if I get a similar result (one core 5%, 3+3).

The biopsy and protocol at Duke

At Duke what type biopsy will you have? Will it be random as the last one you had, or will it be directed, that is will there be an multiparametric MRI with a T3 magnet, that will determine suspicious lesions, rank them by aggressiveness, then samples taken of those suspicious lesions with a 3 dimension biopsy machine or again with the MRI machine? 

How often will then want to monitor you? Are they recommending other diagnostic tests? ie . genomic gene test.

PSA doubling within six months. I agree with SSW and Beau that this is of concern. You may wish to speak with with doc about determining if this an infection, there are various drugs that you can take over a month or so, one drug is Cipro. Note: doing this makes the drug less effective in preventing infections during biopsies.

MRI ...when I was first diagnosed, the MRI guided biopsy did not exist, so at that time, I had a MRI with a Tesla 1.5 magnet. The 3.0 Magnet was first being made available for clinical use. To improve the accuracy of the test, I had a spectroscopy along with the MRI. The doctor wanted to see what was going on, if there was extracapsular extension, how much cancer and where in the prostate.

Here is a source for a the spectroscopy (Magnetic Resonance Sprectroscopy)

http://www.ncbi.nlm.nih.gov/pubmed/16148633

When I entered the program where an MRI was done first to determine suspicious lesions that need to be targeted, I only have had a Multi-parametric MRI with a more powerful Tesla 3.0....then a three dimensional biopsy..Since the biopsy machine locks into the MRI results, the spectrocopy is not required for this procedure. I have not had an MRS in the last five years.....( Since the MRI's use more powerful magnets now-a-days I think that in general the spectroscopy is done less often.) 

barrytips52 said:

Well, got my PSA back and it went from 3.9 to 7.9 in six months.  Will be waiting for a call from the doc today.  I know there are a lot of factors that can impact a PSA, so will not go into panic mode until we learn more...anyone have insight on this rapid acceleration.

Could be a lot of reasons for your PSA to rise from 3.9 to 7.9 (a doubling) in the last 6 months BUT it's a huge RED FLAG! 

Don't think I'd wait another 6 months to take the next PSA test; 3 months at most.  If it rises significantly again, I also don't think AS would make sense as a long term treatment plan and I'd start considering other treatment options, particuarly Cyberknife which you are still eligible for.  In the meantime, I'd also looking into getting an MRI/MRSI spectroscopic scan w/Tesla magnet (which I believe is the same thing Hopeful is talkng about -- we just use different names) to determine the exact location of the cancer w/in and/or beyond the prostate.

Good luck!!

simonh said:

active surveillance

I have just been diagnosed with Prostate cancer last week and was considering active surveillance --my psa is 3.2 --gleason grade 3  in 10% right side --my age is 47 with urinary problems and the following medical conditions --Severe Asthma --Hypothyridism--Costochondritis--stomach ulcer and possible Seronegative Inflammatory Arthritis --I am 5ft 6ins and 17st so very overweight ---trying to decide what is my best option going forward --any advice would be appreciated--thanks

Simonh,

The three classic choices for non-metastatic PCa are of course A/S, radiation, and surgical removal.

You are pretty young for a positive diagnosis. The cancer will do nothng but get worse over time, and you will at some point have to look toward eradication.  Very likely you could do well for some time on A/S, but it is not a lifetime option for a guy 47 years old.   IMRT or better-technology radiation would probably get you into complete remission, but radiation can be counter-indicated when there is urinary flow restriction. 

I would be thinking surgical removal, based on the small amount of information provided. You have a number of medical issuses, but most, or all, of them would not prohibit surgery, where the doctors are most worried about heart problems and diabetes. Asthma can be controlled and worked around in the operating room, and arthritis is irrelevant in terms of whether to get surgery or not. The older one gets, the harder surgery is to tolerate, and it has side-effects.

So, the issue is primarily: "How long do you want to wait before working toward curative effect ?" Only you can decide that. Since you have had a biopsy, you obviously have a urologist already. Make him explain what he would do, and why.  Then, go see a radiation oncologist and let him make his case. Then, consider everything and choose.

I had exactly these same issues to sort out after getting a positive biopsy several months ago (I am 58).  I came home from the hospital TODAY, following surgical removal, which was a decision that took a long time to make.

max

simonh said:

active surveillance

I have just been diagnosed with Prostate cancer last week and was considering active surveillance --my psa is 3.2 --gleason grade 3  in 10% right side --my age is 47 with urinary problems and the following medical conditions --Severe Asthma --Hypothyridism--Costochondritis--stomach ulcer and possible Seronegative Inflammatory Arthritis --I am 5ft 6ins and 17st so very overweight ---trying to decide what is my best option going forward --any advice would be appreciated--thanks

It is important to know where you stand before making a treatment decision.

What led to you getting a biopsy?

What is the history of your PSA's?

Did the Digital Rectal Exam (finger wave) indicate any abnormality?

Any family history of Prostate Cancer?

In your biopsy, how many cores were taken?

In the core that was positive, you mentioned a gleason grade 3....the Gleason comprises two numbers, so it can be a 3+3=6 or a 3+4=7. or a 3+5=8...what is yours?.....Are there any other cores that were positive?

Enrollment in an Active Surveillance program is generally not dependent on age...where I am treated there is man who was enrolled at age 35.....About 75 percent of us who are in an Active Surveillance program, do not experience progression of disease.

There are additional more sophisticated tests and protocols that you can do to determine what is going on that are advisable to do....please read some of the comments to the person whose thread this is, for more information. Please start another thread with your answers, so  posts can be customized to you, and your concerns.

Best,

barrytips52 said:

Progression

About 75 percent of us who are in an Active Surveillance program, do not experience progression of disease.

Happy to see that comment from hopeful and optimistic.  Diagnosed last July and in first year of surveillance.  I am also very hopeful, thinking I can stop the progression of low grade, low volume cancer.  Have made some dietary changes (already lived pretty clean, so not much to do) that include fully eliminating dairy (went to soy and almond based products), fully eliminating white starches and refined sugar (one dessert a week, sure look forward to that Saturday night!), and continuing to focus on whole foods.  Easy adjustments for me.  Exercise regimen has always been in place, its 6 days a week with Sunday rest.

Noted above that my PSA went from 3.9 to 7.9 on last test...and yes, I am being treated for an infection as some commenters suspected could have caused the elevation.  Will get another PSA next month just to see what normalizes, and will make sure to refrain from sex AND exercise a couple days befor the test.  Curious to see if the exercise was a factor as noted in one study.  At the very least,  docs should be directing patients to refrain from sexual activity before a PSA test, seems consistent in the literature that activity can cause elevation...therefore leading to concern, therefore leading to possible unnecessary biopsy.

A lot of work needs to be done in diagnostic research for this disease.  The more I read, the more I am convinced that a lot of guys are being overtreated.  And I also believe we have a chance to control this with some lifestyle adjustments...hoping to prove that myself.

 

Hi Barry,

I can vouch for the proposition that PSAs are affected by your activities.  I had some fluctuating PSAs prior to my diagnosis in 2010 that eventually led to getting a biopsy.  But, my urologist back then assured me that no activities before the test affected the result, including exercise or sex.  He was wrong, but in retrospect, in my case it was probably a good thing to get that biopsy and the early diagnosis.  So, it worked out.

Anyway, I would certainly recommend curtailing all exercise or strenuous activities, and all sexual activities, for at least 48 hours before the blood is drawn.  No need to add variables to the process that may cause changes in the PSA results that are totally unrelated to cancer. 

I will say that the fluctuations I experienced were not of the magnitude you have - 3.9 to 7.9.  That does sound like infection would be the more likely culprit.

My decision to begin AS in 2010 was not unlike yours.  Here is a link to the post describing my thinking... 

http://csn.cancer.org/node/203437

Best wishes,

Mac

MCinNC said:

PSAs

Hi Barry,

I can vouch for the proposition that PSAs are affected by your activities.  I had some fluctuating PSAs prior to my diagnosis in 2010 that eventually led to getting a biopsy.  But, my urologist back then assured me that no activities before the test affected the result, including exercise or sex.  He was wrong, but in retrospect, in my case it was probably a good thing to get that biopsy and the early diagnosis.  So, it worked out.

Anyway, I would certainly recommend curtailing all exercise or strenuous activities, and all sexual activities, for at least 48 hours before the blood is drawn.  No need to add variables to the process that may cause changes in the PSA results that are totally unrelated to cancer. 

I will say that the fluctuations I experienced were not of the magnitude you have - 3.9 to 7.9.  That does sound like infection would be the more likely culprit.

My decision to begin AS in 2010 was not unlike yours.  Here is a link to the post describing my thinking... 

http://csn.cancer.org/node/203437

Best wishes,

Mac

"Curious about your note regarding "75% of those in AS are not seeing any disease progression."  Are you seeing anyone who is experiencing improvement, ie reduction in disease volume from biopsies or reductions in PSA results?  Going to get another PSA next month to attempt to "normalize" my number.  Will make sure I do not exercise a day or two prior and obviously no sexual activity. 

Just finished a round of antibiotics for a urinary tract infection that may have also caused my big bump from 3.9 to 7.9 in six months.  Different labs as well.  So paying for one myself just to see what happens.  I found one article online of a guy who had nearly the same diagnosis as mine who was able to get to undetectable levels on a biopsy using supplements and other diet changes.  My diet was pretty clean already but have made even more of a concerted effort to eliminate all dairy, white starches, and refined sugar.  Have added pomegrante juice with breakfast, green tea mid morning, eating more kale and other cruciferouse veggies, and keeping my exericse routine intact.  My goal is to keep it where it is...3+3, 1/12, 5% in that one positive core."

 a twelve core random biopsy is not extremely effective......a cancer may or may not be found.....so for example if one finds a 3+3=6, 5 percent involvement as in your case....the next series of random biopsies may or may not detect a cancer....in approximately 25 percent of cases a more aggressive cancer may be found that is already in the prostate or might develop, so active treatment will be required.

A targeted multiparametric MRI biopsy is able to better determine cancers, so that the need for  treatment  is determined sooner than later, thus increasing the effectiveness  of active treatment if needed, and if cancers are not determined, you will have more confidence in the AS protocol.

PSA Since each lab calibrates their machine slightly differently , it is best to stay with one lab so you can better evaluate the trend.....remember the psa is a trend only, the biopsy is the critical information.

"I found one article online of a guy who had nearly the same diagnosis as mine who was able to get to undetectable levels on a biopsy using supplements and other diet changes"

Sorry but the cancer does not go away....the biopsy simply did not determine a cancer(which is astill a good thing).

As far as diet and life style , many of us have made changes to have a heart healthy life style which is prostate healthy

Suggest you read the book, The China Study by T. Colin Campbell   or see the dvd ForksoverKnives  avalaible at the library or net flicks...there is a doc Mark Moyad who is a prostate cancer nutritionist, an expert....I suggest that you read his books.  Also Dean ornish did a small study , measuring the effects of veggie diet, lower stress and exercise on PSA, and noted a reduction in PSA.

Some docs recommend a veggie diet,while others a medterainian diet....I personally do not eat meat or dairy, but some fish. Idrink green tea, spice include tumeric, allspice , cinnimum. I eat tomato sauces and other sources of lypopene.....I eat lots of veggies. I take a D3

..............

Basically these diets are heart healthy, and we who have prostate cancers are more likely to die from heart disease than PCa,,,,,,,so its a great idea to eat healthy.