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Prostate Cancer Active Serveillance vs. Surgery
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tim2008 posted:
My doctor is really advocating active serveillance . I was diagnosed with prostate cancer one year ago. PSA still under 5. I am 64. I think the reason my doctor doesn't suggest treatment is I am likely to die in 20 years of something else. If I don't, I am at risk of dying of prostate cancer. Like to hear an opinion. My biopsy results are from 1 year ago. My doctor wants to wait 18 months between biopsies. Tim


A: PROSTATE, RIGHT APEX, NEEDLE BIOPSY:
- BENIGN PROSTATIC TISSUE.

B: PROSTATE, RIGHT MID, NEEDLE BIOPSY:
- PROSTATIC ADENOCARCINOMA.

B. PROSTATE NEEDLE BX - RIGHT MID:
Histologic Type:
Adenocarcinoma (acinar, not otherwise specified)
Histologic Grade:
Primary Pattern: Grade 3
Secondary Pattern: Grade 3
Total Gleason Score: 6
Tumor Quantitation:
Number cores positive: 1
Total number of cores: 2
Total linear millimeters of carcinoma: 1 mm
Perprostatic Fat Invasion:
Not identified
Seminal Vesicle Invasion:
Not identified
--------------------------------------------------------

C: PROSTATE, RIGHT BASE, NEEDLE BIOPSY:
- BENIGN PROSTATIC TISSUE.

D: PROSTATE, LEFT APEX, NEEDLE BIOPSY:
- BENIGN PROSTATIC TISSUE.

E: PROSTATE, LEFT MID, NEEDLE BIOPSY:
- BENIGN PROSTATIC TISSUE.

F: PROSTATE, LEFT BASE, NEEDLE BIOPSY:
- BENIGN PROSTATIC TISSUE.
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tim2008 responded:
Oh well, I used to get replies on this board. I am a kidney cancer survivor. Tim
 
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bigred53 replied to tim2008's response:
Be patient it is the weekend and this site is kind of slow. Even though I'm a woman I check here for information for my male family members and friends. I wish I had an answer for you. If you are not happy with your doctor about all you can do is find another one. Good luck to you.

Michelle
 
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meidoorn responded:
Its really a chronic disease, treat it like it is.
 
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az4peaks2 replied to tim2008's response:
Hi Tim, - I don't know whether you are still monitoring this Board or not, It has had numerous, belatedly addressed problems lately which discourages its activity.

But if you are still here, I encourage you to contact me at the e-mail address in my signature and I will be happy to respond to your questions. John@newPCa.org (aka) az4peaks
 
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az4peaks2 replied to az4peaks2's response:
Hi Tim, - From what you Post above, it appears that Active Surveillance (AS) is certainly an appropriate consideration as one of choices for going forward. However, there are other options as well and you should be aware of their pro's and con's, so that you can make an INFORMED decision.

Are you comfortable with your present Urologist and confident in his/her knowledge and technical skills and, also, confident in the Pathologist/Laboratory that examined and provided the Pathology Report on the Biopsy tissue samples?

Are you comfortable in monitoring this Gleason 3 3=6 Cancer which, since changes adopted in 2006 in REPORTING clinical Gleason Scores, is now the lowest G-Score commonly seen on Biopsy results. It appears that it is also limited in size and found only in one Core of the total samples taken, which would normally amount to 12. (2 each in 6 patterned locations), although you do not specify. Some men have psychological difficulty in monitoring knowing a Cancer is present in their body.

It appears that your clinical STAGE is either T1c or T2a, depending on whether any abnormality was found on your Digital Rectal Exam (DRE), although again, you do not specify. I'm GUESSING that it was probably T1c, which indicates that the Biopsy was performed solely because of an elevated PSA, although again you do not supply that information.

IF AS is your continuing preference, then have formal plan of action and stick to it. Like the planned follow-up Biopsy at 18 months after the first one and regular PSA results not more than 6 months apart. The question always is, "do the Biopsy tissue SAMPLES accurately reflect the PSA present in the entire Prostate". This is something that has statistically improved since the changes in reporting made in 2006, but can not be guaranteed.

I will directly E-mail you a chart that I made of the common considerations for acceptance into the Johns Hopkins AS Program, based upon T1c Biopsy Results for your information. (helping to define clinically significant vs. clinically insignificant disease).

Only you can make the appropriate choice for YOU, but guidance from a trusted Physician and being informed of options helps the comfort level with your decisions. Hopefully, some of the above has helped clarify a few of the considerations. Good luck! - John@newPCa.org (aka) az4peaks


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