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Canceling Radical Prostectomy In favor of AS
Prostate Cancer | Last Active: May 24 6:48am | Replies (20)Comment receiving replies
65 year old male. 11 3+3 and 1 3+4(only 5% 4). No cribiform. No perinureal invasion. 22 ml prostate. Density = 0.18
Was going down the road to SBRT. Side effects of either SBRT or surgery sounded very troubling. Avoiding ED and incontenance very important to me. Then watched the AS video and Jeff on this forum mentioned why rushing to treatment and why not consider AS. Researched some more and joined the Ancan AS group that meets virtually every Wednesday.
Had second meeting with urologist and requested the Decipher test. Received results today (0.36) = low risk. What a blessing for sure.
Also sent out biopsy samples for second opinion with Dr Epstein.
If no changes from pathology second opinion…. going with AS. PSA every 6 mo. Biopsy again 1 year (Feb 2026) after initial one in Feb 2025. Repeat MRI Feb 2026
So glad I joined this forum and learned about AS, Decipher, Dr Epstein.
Not sure why my urologist didn’t suggest the decipher and active surveillance? I had multiple
opinions. I believe the 3+4=7 protocol that many physicians follow automatically goes to treatment?
Replies to "65 year old male. 11 3+3 and 1 3+4(only 5% 4). No cribiform. No perinureal invasion...."
My urologist and oncology radiologist, at a university center of excellence, told me with 3+4=7 that AS was an option but other factors should be considered. According to Dr. Epstein on his video posted here, and Dr. Scholz on his PCRI YouTube videos, 3+4=7 doesn't automatically mean AS, has some gray areas in the research literature, and other factors should be considered like volume of cancer in cores, genetics, PSMA PET scan, family history, cell types (cribiform), nerve invasion, number of positive cores, etc.
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Correct. 3+4 (even with small amount of 4) some docs recommend treatment, but Penn also gave me AS as an option, though not as straight forward as Sloan Kettering. Sloan said they go by their pathologist evaluation of the biopsy slides and all of their evaluations came as 3+3. At Penn two cores came as 3+4 (with 4 less than 5%).