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Watchful waiting?
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doxiedog1 posted:
My dad has bladder cancer confined to lining but i think grade3... Cancer free for one year. Psa was high at beginning. ( not sure of actual number) maybe 4, after BCG therapy for the bladder cancer it has gone up to 6.1 .... After 3 biopsies, 2 with"suspicious cell" 1 neg, he was referred to dr. Shinohara at ucsf. He did another biopsy which was positive for a slow growing cancer, my dad said he recommended just monitoring it since it was small and sow growing. Of course he didn't ask any questions so I don't know the Gleason score or anything. My dad is only 52, does the doctor just not think he will live long enough for this to cause him an issue? I'm very worried about that, or is this an option for any younger healthy man without bladder cancer? Also are the 2 related or just had luck? My dad never smoked or had risk factors for the darn bladder cancer in the first place. Any help would be greatly appreciated.
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survivingcancer responded:
Dear doxiedog1,

PLEASE, by all means have him get another opinion. My husband had enlarged prostate for 10 or more years, then PSA levels started going from 4 and 5 then down again and up again to 6, the doctor (VA urologist), took the watch and see approach. Then in 2010, May he was diagnoised, via biopsy for prostate cancer. By the time he went to UAB (University of Ala. @ Birmingham), his PSA was 7 pre-op, 8 post-op, the cancer had spread to two lymph nodes out of the 12 they removed. This is not good at all, since they have no record of a man surviving for 10 or more yrs. w/his condition. This has been an awfull outcome for the "wait and watch" attitude...he is 63 now, and the doctors keep telling him he is still a relatively young man. SO BY ALL MEANS; do whatever you have to do to get your dad to go for 2nd or 3rd opinions till he finds someone who will do more than just "wait and watch"!!! It could mean all the difference in the world to get treatment for it now. My husband lost his prostrate, he is incontinent, and has no libido from having to take testosterone blocking shots...his PSA has remained less than, .001 But that won't last because the cancer mutates after awhile and learns to grow w/o the testosterone. We live in fear from one blood test to the next. I don't mean to scare you, but if that is what it takes for your dad, then it might mean a big difference in his outcome. I don't know the relation to the bladder cancer, but I worry about that too. Prostrate cancer is treatable, if caught in time. Good Luck and God bless you, your dad & family
 
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Basir U Tareen, MD responded:
Dear Reader,

It sounds like your father has a very slow growing type of prostate cancer that I'm presuming is low risk. (Gleason 6, PSA < 10) and if you think about it, he's now had 4 biopies (I'm assuming at least 48 cores taken) of which only the most recent showed a few cores (1 or 2?) of low risk prostate cancer. I think by all accounts active surveillance is a reasonable option in these types of cases. In many cases, its not that he may never get treated, but he may be able to safely delay treatment for 5, 10 or more years if the cancer is not progressing. The key to active surveillance is close monitoring by a urologist with regular exams, PSA checks, and repeat biopsies.

Bladder and prostate cancer are typically not related. Statistically speaking, if a patient has a high grade bladder cancer (even Stage I) and a low risk prostate cancer, there is no doubt that the bladder cancer is the more worrisome disease in terms of risk of progression, metastatic disease, etc.

It sounds like you and your father are on top of things. If you are uncomfortable or have doubts, by all means get a second opinion and I always advise patients to bring at least one other family member (extra set of ears) to such visits.

Good luck.


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