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About to get MRI results tomorrow

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Posted 9/9/2014 12:02 PM (GMT -5)
Greetings all. It's been 3 weeks since the MRI and I'm going to get the results tomorrow. I'm still up in the air on the best treatment for me so I guess I should wait and talk to the Dr. I have been reading alot of contradicting articles about Bracy vs. prostatectomy. I have a active athletic lifestyle that seems likely will to be serverely curtained. I have 1 60% core out of 12 on my biosopy and got a 2nd opinion from John Hopkins- same result. On a couple of other forums on Bracy vs. surgery everyone seems to side with surgery. either way I'm not in a big hurry for proceed yet since my last PSA was 1.68. I am thankful i am on testosterone replacement for previous level of 136. If it wasn't for the PSAs every 6 months by my Urogist it wouldn't have been found. No way would my GP have see it with once a year PSA.  Any thoughts?

PSA 5/12/13-1.16, 11/20/14-1.4 5/14/14-1.68

Gleeson 3+3

Age 56

1 60% out of 12 cores 23 Jul 2014

 

Posted 9/9/2014 12:18 PM (GMT -5)
You seem to be a perfect candidate for active surveillance. If you are temperamentally unsuited to that, with only one core, you are also a candidate for focal therapy. If you feel you have to have radical therapy, there is also SBRT, pencil beam proton, and HDR brachy (in addition to LDR brachy and surgery, which you're already considering).
Posted 9/9/2014 1:12 PM (GMT -5)
Ken, Is there a reason you aren't considering Active Surveillance?
Posted 9/9/2014 2:42 PM (GMT -5)
I really do want to wait as long as possible. It's just the self imposed pressure to do something or at least get as much info from  literature and from the experiences of others. it is amazing how many of the studies which are the basis of medical thought on the subject are decades old.

PSA 5/12/13-1.16, 11/20/14-1.4 5/14/14-1.68

Gleeson 3+3

Age 56

1 60% out of 12 cores 23 Jul 2014om literature and from the experiences of others.

Posted 9/9/2014 2:55 PM (GMT -5)
Ken,
Active Surveillance is not the same as waiting as long as possible. It is a systematic approach that involves rigorous monitoring and an intention to treat if certain hurdles are exceeded. The data has been updated very recently and includes follow up up to 20 years on the Klotz study.

Long term follow-up of a large active surveillance cohort

I don't know what ancient studies you are referring to, but really very little useful data is decades old. There is plenty of recent data.

- Allen
Posted 9/9/2014 3:31 PM (GMT -5)
Hi Ken

I took the Active Surveillance route and made it an extra three years before I had to proceed with treatment. Many men make it much longer than that. I had the Da Vinci surgery about 1 1/2 years ago and I'm able to continue with the same activities I took part in before...ski, golf, run, cycle etc.
You may not seem lucky, but you are. You were diagnosed early. You'll end up doing just fine.
Posted 9/9/2014 4:13 PM (GMT -5)

Tall Allen said...

Long term follow-up of a large active surveillance cohort


In this study, "Intervention was offered to those patients with a PSA doubling time of < 3 years, Gleason score progression (to 4+3 or greater), or unequivocal clinical progression."

What exactly is meant by "unequivocal clinical progression" since it's not related to PSA or Gleason score progression? Would this be a measurable increase in tumor volume?
Posted 9/9/2014 4:33 PM (GMT -5)
super max,

Yes, detectable bone, LN or visceral mets usually.
Posted 9/11/2014 3:08 PM (GMT -5)
Got the MRI results yesterday. One .5cm prefectly round tumor in the middle of the prostate with good margins. He says where it is at is good because it's not close toother tissue and organs. I'm am going to stay on AS for a while and he has prescribed Finasteride and will check by MRI since my PSA will drop on it.
Posted 9/11/2014 3:19 PM (GMT -5)
That's a good report.

AS sounds like the way to go to me.

Andrew
Posted 9/11/2014 4:13 PM (GMT -5)
Sounds like you have every thing you need at this point: a good report, a sensible doctor, and a plan.

Put your next appointment in your calendar and don't think about prostate cancer at all until the calendar goes ding!
Posted 9/11/2014 4:27 PM (GMT -5)
ken-
Great news!
And I love that he's giving you finasteride. Half the men on AS taking it had undetectable PC on f/u biopsy.
Consider switching to PHI, which includes PSA as well as a number of other measures.

- Allen
Posted 9/14/2014 12:44 PM (GMT -5)
Thanks TallAllen. What do you  mean by PHI?
Posted 9/14/2014 4:35 PM (GMT -5)
He probably means this:

The Prostate Health Index: a new test for the detection of prostate cancer
Posted 9/15/2014 11:57 AM (GMT -5)
Outstanding. I learn something new everytime I log on. I am really not confortable about taking the Finasteride after I saw so much negative news and articles on it, side effects, side effects after stopping it. law suits etc. I haven't told the Dr. yet about my misgivings and I am definitely getting a second opinion on that one before taking it.
Posted 9/15/2014 1:50 PM (GMT -5)
Sexual SEs may affect up to 20% of men taking it, but usually vanish after you stop. You will have to weigh that risk against its known value in preventing PC, and possibly reducing it.

Half of men taking it while on AS had no detectable PC on repeat biopsy.
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