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Uro Did Not Recommend Surgery

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Posted 9/24/2012 11:43 AM (GMT -5)
Hubby's PSA jumped from 2.5 to 4.7 over six months.  He was taking T-shots during that time.  Had a Biopsy on 9/7/12 and was diagnosed on 9/11 with PC with an appointment with URO for the following week.

Met with URO on 9/18 to get Lab results.  Gleason 6, T1C, prostate 36 Grams.  Left side found PC in multiple cores occupying approx. 20-30% of tissue.  No evidence of prostatic extension or perineural invasion.  High grade PIN in right side.

URO went over various treatments which we had read about all ready by reading Walsh's book and spending a lot of time on this site.  URO recommended AS with intent to cure in the future.  He would do PSA every 3 months, DRE every 6 months and another biopsy in a year. Hubby is 58 and URO felt he would like to have him avoid side effects from PC treatment as long as possible.  He felt he could go at least a year or two before any treatment would be needed.

If he would have too much anxiety with AS, then he would recommend Brachytherapy.  We have an appointment with Radiation Oncologist for next week and an appointment in 6 weeks with URO to give him his decision.

I believe hubby is leaning towards doing AS at this point.  Thanks to all of you who post on this forum.  It has been such a wealth of information.

Posted 9/24/2012 12:55 PM (GMT -5)
Mickey58, welcome but sorry you have to be hear. Sounds like your husband caught this early and should have any treatment option open to him. With his stats he should live a long life. Be sure to start a journal and keep all your notes in it. Ask for copies of any tests you get. If possible go with him on any appointments and help take notes. There is a lot of information thrown at you that you think you will remember, but it is difficult to. Ask any questions you have on this forum. There a many good folks here with tons of experience that you can draw from. Take you time deciding what and when to do something.

You can read what I went through by clicking on the link in my signature. Good luck to you. I know it's a kick inthe gut when you find out.
Posted 9/24/2012 1:06 PM (GMT -5)
Mickey58,

Welcome to our forum. Sounds like your URO has given you a good road to follow. I sure hope his doctor has discontinued the Testosterone shots at this point as they will be adding fuel to the cancer fire and that is not something he should be doing while on AS. Did his URO even mention this? It is possible IMO the increased T might have been why his PSA went up so much in 6 months. Good luck to you both and please stay in touch with all of us here.

Terry The Water Guy

Posted 9/24/2012 1:38 PM (GMT -5)
He had stopped the T-shots prior to the last PSA test. That is why URO ran another one. 

 

Posted 9/24/2012 1:48 PM (GMT -5)
Mickey58, sounds like you guys have a very competent URO, incredibly key at this point. Sounds like you've down a good level of research on this thing, I would urge you to continue on with your education. As others have said and you've seen, lots of good folks out here willing to share our experience so we'll be here for, and with, you.
Posted 9/24/2012 2:45 PM (GMT -5)
I was hoping for AS when I was diagnosed but my Uro and RO thought at G7 that wasn't a good idea but at G6 they would have been all for it. Sounds like you've got a good plan. PC is so slow growing that delaying treatment for a few months or even a year or more shouldn't be a problem. The trick to AS is the "active" part. Keep monitoring the PSA and act when you need to.

On the other side, I did beam radiation and am very happy with my treatment. Doing the seeds now is a good option too.

It's tough to decide and if you're like me you always second guess if you did the right thing.

Let us know what the RO says. A second opinion is a good idea - more info might be good.

All the best,
Andrew
Posted 9/24/2012 3:17 PM (GMT -5)
Interesting, my Uro also recommended the same thing. I am also 58 years old. Looks like AS is no longer for those 65 and older.

Akai
Posted 9/24/2012 4:02 PM (GMT -5)
Sounds like a good plan. You should ask about diet and even Adovart to extend the time before you need treatment. USCF's program on AS has had some very good results with diet modification as compared to a control group with no one on the diet program showing any signs of progression.

You can google UCSF Active Survelience program or get in touch with Dr Carrol who runs the program to see what they recommend.

JohnT

Posted 9/24/2012 5:04 PM (GMT -5)
AS, done properly, sounds like a very reasonable plan at this point. Wish more men with the right critera would strongly consider the same option and choice. They could avoid a lot of needless side effects and even complications, while still properly monitoring their low grade cancers.

david in sc

Post Edited (Purgatory) : 9/24/2012 4:59:45 PM (GMT-6)

Posted 9/24/2012 5:31 PM (GMT -5)
AS is gradually becoming a little more accepted, for younger men, as an option. One has to weigh many personal factors. I just think that you have to accept careful monitoring (which unfortunately includes biopsies) and be willing to go for treatment if things get worse. I think the "personal" aspect is what is often missed - every one of us has a different life experience which may make one or the other decision appropriate.

I've personally tried to use the situation as a positive experience, where I take better care of my health and try to improve my outlook on life. That all being said, I don't believe there are any right or wrong decisions in this regard provided men have properly informed themselves of both the potential risks from either course of action.
Posted 9/24/2012 5:50 PM (GMT -5)
Mickey, I've been on AS for several years now. I used to think about PC a lot but that only wore me down mentally. Now the only time I really worry is just before my semiannual PSA test. If AS is what you decide on, don't allow yourself to sit around & worry about the what if's. Get on with life. Sounds like you got a great Uro that's not pushing into a treatment right away. If I can help in any way, please ask.
Posted 9/24/2012 6:01 PM (GMT -5)
great advice uncle harley. more men need to think like you are thinking, even if they are not on AS. Life is more than having cancer, life still goes on and needs to be lived to the fullest of one's abilities.

david
Posted 9/25/2012 7:44 AM (GMT -5)
Uncle Harley. We hope he is able to have the great results that you have on AS. He is viewing this as a huge wake-up call and has changed his diet and is exercising every day. Hopefully, this will slow down the progress of the PC as well as help his high Tryglicerides (sp). He seems so relieved since meeting with his URO.

Thanks to all of you for the support, great comments and suggestions.

Mikey's wife.
Posted 9/25/2012 9:13 AM (GMT -5)
I say Mr. Mickey has a superb urologist. This doctor has read and responded to the patterns and research in his field and incorporated them into his clinical practice. Sadly, he is not joined by all of his colleagues.
A consultation with a radiation oncologist may be helpful as far as consideration for what may be useful at some future time. All the recommendations sounded solid and worthwhile. The opportunity for a life change will also assist in improving quality of life.
We hear of medical malfeasance too often. This doctor is what should be happening to more men. I salute Mr. Mickey for his fine choice and his education at this site and elsewhere. I salute his doctor as well. May their successful relationship continue.
Posted 9/25/2012 9:17 AM (GMT -5)
AS is one thing we don't hear much about here on this site, well that's not exactly true, we hear about it but don't get any feedback for AS in a longer term as you are hopefully anticipating. There is lots of statistics available for cure rates side effects ect for seeds, RT, and RP but what about AS? Surely, there must be some statics? Did the uro have any statistics to offer you? It might just be delaying the inevitable or can statistics show good success in delaying the "cures" that have serious side effect to the extent where some real quality of life is achieved. I continue to be amazed at how little we (they) actually know about this mysterious disease.

Well, all that is a question that comes to my mind, at least, but you and your husband got some great news, and whatever you end up doing, the G6 is about as good as you could hope for. I hope you continue to report your progress with the AS.

Posted 9/25/2012 7:18 PM (GMT 0)
Knotreel,

The URO did not give us statistics on AS.  He said that PC is a very slow growing cancer and that he did not feel based on Mike's current diagnosis that it warranted aggressive treatment at this point.  He feels we could delay treatment and side effects as long as cancer is under control.

Mike will be having PSA tests every 3 months, DRE, every 6 months and another biopsy in a year.

 

Posted 9/25/2012 3:31 PM (GMT -5)
Hi Mickey58, perhaps he can ask to add free PSA to the PSA test, also, perhaps PCA3 test to go with the DRE every 6 months. In my case, there is also Color Doppler Elastrography Ultrasound every six months. My ORO wants Bx every two years. I am not sure if I want to wait two years for my follow up Bx, perhaps if my PSA, free PSA, and PCA3 stay stable and my Ultrasound shows no sign of progression I may agree with Bx every two years.

I am not sure if I will stay with the AS program or not, part of my issue is that the company that I work for will probably be sold next year and I may lose my insurance if the new owner does not provide health insurance (no Cobra). I would hate to have to go with agressive treatment(s) without health insurance.

Akai
Posted 9/25/2012 7:05 PM (GMT -5)
My understanding of this disease is that Gleason, if not the whole game, comes pretty close. With a 6 your husband has a great shot at a long, long life regardless of treatment plan. Hopefully he will always be a 6. Best wishes to both of you!

NewspaperLover
Posted 9/29/2012 1:45 AM (GMT -5)
Hello Mickey and welcome to our forum.  Many of us wives have been down that road you are on now. It is scary and overwhelming, but the support we received here helped so much. Please feel free to ask any questions you may have.

My husband was diagnosed with Gleason 6.  After his DaVinci surgery, it was Gleason 7.  We were never told about AS, but Ron did meet with three other doctors and given various treatment options.  Maybe because he was 5 years older?  The best advice I can give is to research and learn all you can about this disease.  Knowledge is power.  We actually took 4 months to debate and learn.  For him, the robotic surgery was the best step to take.   Yes, frequent testing would be important.  If you read my signature, it provides information which may be helpful.

Prayers for you and your husband. Take care!

Much blessings,

Aimzee

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