Can a man be too young for active surveillance? Answer=NO!

TA, Thank you for this thread and article.

You have changed my thinking on this subject. The big AS programs have impressive retention rates, probably due to the minimum ages used in their guidelines. My previous thinking was that allowing much younger men into these programs would jeopardize those statistics at a time when AS is really coming into its own as a default protocol for certain men.

Thanks to your example of the man in your support group, and the reality that any time safely spent before intervention allows a normal quality of life, I now agree that age should not be an automatic barrier to choosing AS. Of course, the larger task is to see how soon and widely that medical practitioners agree to suggest it as an option.

Hello Tall Allen,

Thanks for sharing your post ---

I was diagnosed in my 40s and have had some meaningful successes in my sequence of treatments ...

My thoughts go out to the fellow you described from your support group --- thank you for what you are doing to reach out to him. We would ALL certainly welcome him here on this forum, if he ever wishes to join us --- he would find tremendous comraderie and support from the fellows here --- and tremendous insight and compassion.

That being said --- I realize his life and his "world" has been turned upside down from his treatments ---

As a teacher, I think that there IS life still waiting out there for him --- I realize he's got some walls to climb over, some hurdles to jump, some bridges left to cross, and some healing left to do --- emotionally and physically.

That being said --- I want to tell you that I have seen LIVES CHANGED, right in front of my eyes, as a classroom teacher --- people from the community where I teach --- finding a mate --- taking in foster children --- adopting children from near and far.

This past year --- the principal placed several children in my classroom that had been adopted by families that I have known for years --- these children have TRANSFORMED the lives of all of us now --- their new adoptive families, their classmates, the community --- and my life, as well, as their teacher.

Case in point: a female friend of mine adopted a child from a foreign orphanage, as a single parent. A year ago, she married a friend of mine --- he had faced a cancer diagnosis as a boy, and has overcome many obstacles in the decades since then --- he is now the newly adoptive father of this child, along with his new bride. This past spring, as I was driving through town, I noticed him and his son practicing "catching and pitching" with a baseball out in their front yard. Talk about a storybook ending ...

My point is this --- the gentleman, up until a year ago, had lived in the shadow of the cancer diagnosis he faced in his boyhood --- he had been a lifelong bachelor --- in the past year, he married his new bride and now is an adoptive parent to a child he loves with all of his heart --- everyone's life being completely transformed in the past year.

Keep shining a light for that fellow in your support group --- I'm thankful you are there for him ! We'd certainly welcome him as a brother right here ...

Sent with my best,

I.S.U. "Cyclone Fan"

Great post TA and follow-up from Dr Marks. The side effects suck more than the cancer, but as you point out, mentally at the time, the cancer sucks having been diagnosed with it. All of it is a tough journey. Thanks -JR

halbert said...
The key, regardless of the age of the patient, is in the term "properly managed" when talking about AS. Sometimes I wonder just how many men (and doctors) act as if AS means "check things occasionally, if at all". I'd think the "Active" part is probably even more important as the patient gets younger.

Totally agree, Halbert. AS is a structured program, not really a DIY project. The patient needs to join a study group or find a knowledgable urologist who will lay out the requirements. I like to joke that I have a plastic tag in my ear, which has "JH" followed by a number. As such, while I can discuss my case with my specialist, he alone determines what tests I will have, and when.

So far, so good for me, so I can only recommend that other AS patients be under a formal regimen of testing.

It depends a lot on the individual and circumstances. My husband was very young and had surgery within months of being diagnosed. All data indicated AS could be appropriate - low gleason and only the smallest of cancer noted. But after surgery PSA crept up despite good pathology and after SRT is still creeping up. I wonder "what if" he had the surgery even one month sooner - would that have made a difference? He does have some side effects from surgery but not major. His QOL is excellent and we already had our children. I wish he had been even more aggressive earlier - ADT with the SRT - but all the doctors were so confident that he had nothing to worry about. I guess my point is there can be "what ifs" both ways and it's not always clear what the facts are until it's too late.

Great article TA,

As I have posted in other threads, you must have complete faith in your uro and the AS program to keep your sanity and maintain a low risk of progression detection failure.

As others have noted, the key to AS is the "Active" element. For your own benefit, the PC victim must be knowledgeable and proactive on the monitoring at ALL times. You cannot depend on others to address what should be done.
__________________________________________________
JULY 2016: Bone Scan (NEGATIVE)
JUNE 2016: PSA 2.7
APRIL 2016: PSA 3.7

OCTOBER 2015
Age: 59
PSA: 3.0 elevated to 3.5 in (6) months
3T-MRI: (1) lesion identified
Fusion Biopsy Results: Lesion cores benign, additional (12) cores = (1)5%
Pathology Summary: Grade Group 1 (G6:3+3), 2nd pathology verification
Clinical Stage: T1c

Genetic DNA Profile: Above average risk for Aggressive PC (Genetics Test)
Existing Cancer DNA Profile: DNA risk unknown (Oncotype DX test cannot be performed, <1mm)
High Grade Biological Score: 27% aggressive risk (Mi-Prostate Score)
Other Health Conditions: Diabetes Type II (DX 2000), on meds & insulin

PCa Treatment: "Active Surveillance"
Risk: Undetected Cancer Progression
Risk Likelihood: LOW

My Story: https://www.healingwell.com/community/default.aspx?f=35&m=3528051

you can never be too young
or too sexy...