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Thread: What I Need to Know About Active Surveillance

  1. #11
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    Here's an update...

    Will hopefully get Epstein's third opinion on my slides next week. But I met with one of my urology surgeons here in Charlotte, NC, today, who says that I can continue AS if Epstein doesn't see any 3+4, but should treat if he does. As luck would have it, the other urology surgeon with whom I've been consulting called me about something else, and I asked him about all of this, and he said that he wasn't overly concerned about the 3+4 finding because my cancer is "predominantly" 3s, and that he's still comfortable with AS if I am. I asked him how confident he was that we could detect that the cancer was growing and needed treatment with quarterly PSAs, and he said PSAs were good, but not 100%. I'll see what Epstein says before figuring out next move.

    When he offers second opinions, does Epstein recommend treatment is warranted, or does he just evaluate the cores?

  2. #12
    Moderator Top User HighlanderCFH's Avatar
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    True, you can't just go with the PSA number all by itself. Actually it is the current PSA number, compared to the previous PSA number, that can be suggestive of a problem if it has dramatically risen. One number, by itself, does not necessarily mean that PC is present.

    As for continuing with AS, I would personally not feel comfortable with it if there is a Gleason grade 4 found -- or if there is even a chance of a grade 4 being in there. Think about it -- Gleason Grade 4, if found in a biopsy core all by itself, would grade out to a Gleason 8. And there is no way for a standard 12-core biopsy to give a definite answer on whether the biopsy needle could have missed another tumor (possibly of G4) in the prostate.

    Perhaps a saturation biopsy (with about 40 cores) could give a better idea, though.
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Eight annual post-op exams 2012 through 2019: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  3. #13
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    Active Surveillance

    I have been on AS since March 2012. My original diagnosis was 1 core out of 12, G6. I had a second biopsy hoping they would find more PCa so I can get treated and put this behind me. The second biopsy came back all 12 cores negative. I am not comfortable with getting a biopsy very year which my Oncologist recommends (along with a psa test every 3 months). Being in my early 50's I will be very conservative and at the slightest rise in psa or if they find more PCa on biopsy I will be treated. I have an appointment with my Oncologist on 8/15/13 to get results of another PSA test. I will discuss with him if I should consider taking one of the new genetic tests to determine the aggessiveness. When I need to be treated I am leaning towards Brachytherapy.
    Age 51 when, diagnosed,2/12 Psa 5.3 and 3.5,
    3/12 PSA 3.9 Biopsy 1 core of 12, 23% gleason 6
    6/12 Psa 4.0, Free PSA 10%
    9/12 2nd biopsy, all 12 cores negative.
    2/13 PSA 4.2
    5/13 PSA 4.2
    8/13 PSA 4.3
    11/13 PSA 4.6
    2/14 PSA 5.3
    2/14 MRI Guided biopsy at MSKCC, 12 cores negative
    8/14 PSA 5.7
    2/15 PSA 6.3
    8/15 MRI, PSA 7.04, 2/16 PSA 8.05
    MRI and biopsy scheduled for August 2016

  4. #14
    Jerseyguy - Is this next biopsy a 12 core or something more comprehensive?
    BD: 1959 PSA 4.9 11/2012 (no symptoms)
    Biopsy 12/2012 Negative
    PSA 5.9 05/2013 (still no symptoms)
    Biopsy 6/2013 3+4 (thank goodness for PSA tests)
    1 core positive (upper left), 1 suspicious (lower left) out of 12
    DRE: bump right side T1c; PCA-III = 20 (normal)

    Da Vinci 7/18/2013: Invasive carcinoma involves left lobe of prostate only, extends from left apex to posterior mid region of left lobe Gleason 7/10 (4+3); G4 tumor comprises 75% of invasive carcinoma present
    Estimated total volume of carcinoma in entire prostate gland: 10%
    TNM: T2b NX MX (Stage IIA)

    8/13 11/13 2/14 8/14 2/15 8/15 3/16, 8/16, 3/17,9/17,4/18, 9/18 PSA undetectable
    3/19: .1 (damn), 4/19,6/29 retests: .1 (damn)


    My Story:
    T-Minus-36-Hours-until-da-Vinci...
    Catheter is Out!

  5. #15
    Quote Originally Posted by Jerseyguy View Post
    Being in my early 50's I will be very conservative and at the slightest rise in psa or if they find more PCa on biopsy I will be treated. I have an appointment with my Oncologist on 8/15/13 to get results of another PSA test. I will discuss with him if I should consider taking one of the new genetic tests to determine the aggessiveness.
    I'm OK with some of your ideas, but relying "the slightest rise in PSA" as your lynchpin is just crazy.

    PSA tests can jump up and down for reasons completely unrelated to prostate cancer.
    I've had two jumps in my PSA tests followed by returns to the norm only 6 months later.
    One was up to 7.4 followed by a 3.8.

    You've had 24 cores with 1 positive. Your normal PSA seems to be in the 3.9 to 4.2 range.
    BTW, if you keep taking your PSA every 3 months you are bound to see some jumps up and down.

    Example. I once had two lab orders. One for a range of blood tests, including a PSA. Plus I had a order for a PSA and free-PSA.
    So I go to the same lab at Kaiser. The technician draws the first blood to complete the first order including the PSA.
    Then she takes the next order and draws blood for the psa and free psa.

    Same lab, two draws, only a minute or two apart. Sent to the same lab. But I get two PSA scores. At that time they were 2.5 and 2.7.
    So imagine by your criteria, you got the slightest rise in PSA. Do you really want to rely on such a test.

    I'd certainly wait for at least 3 months to see if the rise is confirmed before switching to surgery or seeds.

  6. #16
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    Quote Originally Posted by Jerseyguy View Post
    I have been on AS since March 2012. My original diagnosis was 1 core out of 12, G6. I had a second biopsy hoping they would find more PCa so I can get treated and put this behind me. The second biopsy came back all 12 cores negative. I am not comfortable with getting a biopsy very year which my Oncologist recommends (along with a psa test every 3 months). Being in my early 50's I will be very conservative and at the slightest rise in psa or if they find more PCa on biopsy I will be treated. I have an appointment with my Oncologist on 8/15/13 to get results of another PSA test. I will discuss with him if I should consider taking one of the new genetic tests to determine the aggessiveness. When I need to be treated I am leaning towards Brachytherapy.
    For your reference-I had one of those tests (Fish Test) on my cancerous biopsy cells in January, 2012. You can see my more detailed trail below. The results indicated I had 'aggressive' cancer cells and my Urologist said the tests were of dubious reliability. At the time I was showing G6 and he said he had guys full of cancer that showed only mildly aggressive cells with the same test. As it turned out, after post-op pathology, I had more aggressive cells than the two biopsies had shown me. All this test did was add to my confusion, and make my decision more difficult. Best of luck, hope this gives you some sort of perspective.
    Bill
    T1c N0 M0
    Did 24 months Active Surveillance
    Age 63 July 2011 PSA 7.9 DRE negative with normal size
    August 2011 Biopsy 1% of 1 of 12 cores Gleason 6
    April 2012 PSA 8.1
    Age 64 August 2012 Biopsy 1,5,5% of 3 of 12 cores Gleason 6
    December 2012 PSA 8.4
    April 2013 PSA 12.4
    MAY 2013 PSA 13.1
    Age 65 July 16, 2013--DaVinci Robotic Assisted Radical Prostatectomy
    July 2013 Pathology post-op 15% glandular involvement Gleason 4+3=7
    Negative margins & 0 0f 9 Lymph Nodes involved
    November 2013 PSA <0.01
    February 2014 PSA <0.01
    May 2014 PSA <0.01

  7. #17
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    Active Surveillance

    To answer a few of your questions my next biopsy will probably another 12 samples. I did have a second reading of my slides and they came back the same with one core positive G6. I have always been a healthy eater and exercised but now I am more self conscious eating less meat but not cutting it out totally, eating more fruits and vegetables.
    Bill, it seems that the genetic test confirmed you had a more aggressive cancer then what the biopsies turned up. So why did this test add to your confusion, and make your decision more difficult? I would have thought it would have made it easier.
    Bob
    Age 51 when, diagnosed,2/12 Psa 5.3 and 3.5,
    3/12 PSA 3.9 Biopsy 1 core of 12, 23% gleason 6
    6/12 Psa 4.0, Free PSA 10%
    9/12 2nd biopsy, all 12 cores negative.
    2/13 PSA 4.2
    5/13 PSA 4.2
    8/13 PSA 4.3
    11/13 PSA 4.6
    2/14 PSA 5.3
    2/14 MRI Guided biopsy at MSKCC, 12 cores negative
    8/14 PSA 5.7
    2/15 PSA 6.3
    8/15 MRI, PSA 7.04, 2/16 PSA 8.05
    MRI and biopsy scheduled for August 2016

  8. #18
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    Quote Originally Posted by Jerseyguy View Post
    To answer a few of your questions my next biopsy will probably another 12 samples. I did have a second reading of my slides and they came back the same with one core positive G6. I have always been a healthy eater and exercised but now I am more self conscious eating less meat but not cutting it out totally, eating more fruits and vegetables.
    Bill, it seems that the genetic test confirmed you had a more aggressive cancer then what the biopsies turned up. So why did this test add to your confusion, and make your decision more difficult? I would have thought it would have made it easier.
    Bob
    Bob,
    My Urologist downplayed the Fish Test. His experience was that the test was less than reliable and their office was considering not using it any longer. He steered me back down the AS path when he probably should have lead me to a more aggressive approach. It all worked out, I hope, and I caught it early enough, I hope. Had I put more faith in that test I probably would have acted quicker given my escalating PSA scores.
    Bill
    T1c N0 M0
    Did 24 months Active Surveillance
    Age 63 July 2011 PSA 7.9 DRE negative with normal size
    August 2011 Biopsy 1% of 1 of 12 cores Gleason 6
    April 2012 PSA 8.1
    Age 64 August 2012 Biopsy 1,5,5% of 3 of 12 cores Gleason 6
    December 2012 PSA 8.4
    April 2013 PSA 12.4
    MAY 2013 PSA 13.1
    Age 65 July 16, 2013--DaVinci Robotic Assisted Radical Prostatectomy
    July 2013 Pathology post-op 15% glandular involvement Gleason 4+3=7
    Negative margins & 0 0f 9 Lymph Nodes involved
    November 2013 PSA <0.01
    February 2014 PSA <0.01
    May 2014 PSA <0.01

  9. #19
    Senior User
    Join Date
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    Posts
    100
    Quote Originally Posted by Jerseyguy View Post
    I have been on AS since March 2012. My original diagnosis was 1 core out of 12, G6. I had a second biopsy hoping they would find more PCa so I can get treated and put this behind me. The second biopsy came back all 12 cores negative. I am not comfortable with getting a biopsy very year which my Oncologist recommends (along with a psa test every 3 months). Being in my early 50's I will be very conservative and at the slightest rise in psa or if they find more PCa on biopsy I will be treated. I have an appointment with my Oncologist on 8/15/13 to get results of another PSA test. I will discuss with him if I should consider taking one of the new genetic tests to determine the aggessiveness. When I need to be treated I am leaning towards Brachytherapy.
    I considered Brachytherapy as my option, but once my PSA jumped over 10 I no longer had that as an option.
    T1c N0 M0
    Did 24 months Active Surveillance
    Age 63 July 2011 PSA 7.9 DRE negative with normal size
    August 2011 Biopsy 1% of 1 of 12 cores Gleason 6
    April 2012 PSA 8.1
    Age 64 August 2012 Biopsy 1,5,5% of 3 of 12 cores Gleason 6
    December 2012 PSA 8.4
    April 2013 PSA 12.4
    MAY 2013 PSA 13.1
    Age 65 July 16, 2013--DaVinci Robotic Assisted Radical Prostatectomy
    July 2013 Pathology post-op 15% glandular involvement Gleason 4+3=7
    Negative margins & 0 0f 9 Lymph Nodes involved
    November 2013 PSA <0.01
    February 2014 PSA <0.01
    May 2014 PSA <0.01

  10. #20
    I may be the poster child for not relying on PSA only. Over 7 years my PSA peaked at 6.9 but two biopsies over that time were negative. A DRE showed left lobe getting enlarged early this year, PSA was 2.9 but biopsy showed 1 out of 14 PC and 1 suspect. Final pathology showed both sides involved. I'm for using all the tests at your disposal to as accurately confirm what is truly going on as possible.
    Fran
    BD 1950
    DRE in 2005 showed right lobe enlarged/hard
    Biopsies in 2006 and 2009 both negative
    Biopsy May 2013 positive 1 of 14 cores
    4+3=7 T2a. PSA 2.9
    daVinci surgery 7/17/13 by Dr. Dennis LaRock
    Final pathology 7/29/13
    Tumor size 1.5 cm
    PC found on both lobes (biopsy indicated one)
    T2b Gleason 4+3=7
    Negative margins
    first post surgery psa 8/30/13 undetectable
    second post surgery psa 11/23/13 undetectable
    18 month post surgery psa 2/17/15 undetectable
    5 year post surgery psa 3/20/18 undetectable

 

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