Does anyone feel that age is THE determining factor for watchful waiting?

Kongo said:

Watchful Waiting
Mokincaid,

Age is one of several factors that would come into play when making a decision about whether or not active surveillance is the right decision for you. There are many opinions on this and you may wish to read a recently published book entitled "Invasion of the Prostate Snatchers" by Mark Scholtz and Ralf Blum (co-written by a PCa patient that chose AS and his urologist) that describes his journey on AS. You can find it on Amazon.

Studies that have analyzed autopsies on men who have died by other means has shown that as much as 50% of men in their 50s may have some form of prostate cancer and not realize it. The percentage increases almost 10% with each decade in age. So although I hate to see you here, you're in a rapidly growing club of men with prostate cancer.

Most recommendations for AS that I have read are for men who have a Gleason <7, a PSA density <0.15 ng/ml/cc, cores positive, and no core showing >50% involvement. Another factor is PSA doubling time. Many urologists beleive that a PSADT years should be cause for intervention. PSA density can be calculated by dividing your PSA score by the size of your prostate in cubic centimeters (they should have calculated the size of prostate using ultrasound when they did the biopsy). You can use one of the many nomograms on the web to calculate your PSA doubling time. Sloan-Kettering hospital has one and is easy to use.

Notice that age is not a factor and neither is absolute PSA as urologists have found that the PSA density (the ratio of PSA to the total prostate size) is a more indicative factor than just the PSA reading. The PSADT (which should have three or more past readings) in an indicator as to how fast the cancer might be growing. AS is often recommended for older men with a shorter life expectancy in order to avoid potential adverse side effects when quality of life is otherwise excellent. It doesn't mean that younger men shouldn't pursue AS, it just means that most of the men that do are older than you.

When I was considering options I was strongly leaning toward AS as I fit all of the criteria described above and I didn't want to deal with the potential side effects of ANY treatment option. Two different doctors (one a surgeon and one a radiologist) told me that given my age (I was 59) and otherwise good health and long life expectancy that I would have to deal with it sooner or later and I think that was pretty good advice. I chose to deal with it while I had several options and my cancer was at an early stage. Fortunately, I have had no side effects.

Given your age and a Gleason score of 7, I think that if I were in your shoes I would lean toward treatment over AS. A Gleason 7 is leaning farther forward on the aggressiveness meter than a 6 and the fact that you had two cores positive means that something is definitely growing in your prostate. Whether you had sex or not the night before, you're lucky to have been diagnosed with PCa early enough to have many options to deal with it, and all of them will likely offer a high degree of curative effect and long life. There have been many stories about potential overtreatment of low risk cancer patients but your pathology doesn't suggest that.

I would calculate your PSA density and PSADT and see how that stacks up against the low risk criteria. If you haven't done it already, I would get a second opinion on the biopsy slides to make sure you have what you think you have. If you are still interested in AS, I would recommend you seek out a urologist who specializes in that treatment and not settle for a doctor who wants you to do something else. I think a successful outcome requires a close partnership between the patient and the medical team. I know there are some AS specialists at UCLA and other teaching hospitals.

I would seek opinions on what to do from as notable a surgeon, radiologist, and oncologist in your area as you can find. Most surgeons recommend surgery. Radiologists recommend radiation. You will want to get as balanced an opinion base as possible and many of the consults will probably offer conflicting advice. I know you're looking at Loma Linda and proton therapy. There are other radiation techniques that use photons rather than protons such as tomography, SBRT, bracytherapy, HDR brachy, IMRT, and so forth. All radioligists are not familiar with all systems and will likely recommend the system they have been trained on. All of the newer systems have pros and cons so it pays to do independent research on the different protocols. Same with open RP or robotic. Both have pros and cons depending on who is doing it.

In two different posts you've said something like "I don't know what to do." We were all there at one time. Only you can figure out what is best for you but it takes a lot of research and homework and schlepping around to different doctors offices and bending over all over again for a whole new set of strangers and asking lots and lots of questions. Pretty soon it will start to sort itself out and you will begin to get a feeling what is the right solution for you.

Hang in there.</p>

mokincaid said:

Thank you
Kongo, I want to than you and ALL of the people who have responded to my questions. This is a really big help in a really scary time. I am glad I found this site. Thanks again.

Kongo said:

Sorry
Sorry if I seemed touchy, prostateman. I am not a doctor or a medical professional and have no official capacity here in any way. I'm just another survivor. I am sure we would all appreciate your background and welcome to the forum.