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Questions about Active Surveillance as a treatment option
Prostate Cancer | Last Active: Jun 4 4:41pm | Replies (28)Comment receiving replies
I posted something similar in another thread but it seems relevant here. My team said that in most cases, the type of treatment is mainly based on Gleason grade and spread. But for 3+4, there are secondary factor such as genetics, family history, size of lesion, location of lesion, volume of grade 4, cribriform, intraductal, perineural invasion, and number of positive cores that should be considered for deciding on active surveillance or treatment. For me as a 3+4, having several of those factors led me to decide treatment over surveillance. RARP is scheduled for July 18.
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Hi, My husband was 3+3 Gleason initially and AS was the recommended action by our health board (who don't have facilities for surgery or radiotherapy, but have to refer you to a neighbouring health board - and thus pay them). 4 biopsies were taken from the identified 'lesion' area, 1 was positive, 2 other biopsies came back positive from the lower half of the one side of the prostate , the other side was clear.
We decided to consult with a surgeon who immediately said he was not a case for AS as the legion was over 10mm (it was 15mm) and on the outer edge of the prostate (this was indeed our initial worry). We decided on a prostatectomy and my husband recovered fantastically so we were devastated at our post op consult to hear it had been upgraded from 3+3 to 4+3 and it was an aggressive Cribriform prostate cancer . The lesion had grown from 15mm to 34mm by time of the op having grown outwards. the 2 other positive biopsies were indeed still low grade. Numerous PETCT PMSA scans, Nuclear bone scans, MRI's, CT scans etc couldn't identify the location of the metastatis for 8 months before it was found in a rib. SABR radiotherapy followed and we are currently waiting to discover the next locations.
My husband had hormone therapy last August (3 month injection) as his PSA rate was rising exponentially. The hormone therapy has had many side affects and he doesn't want to go back on it again quickly, favouring quality of life over quantity. It took him over 8 months to feel it wearing off, but now needs cardio investigations as a result.
In essence we are very pleased he decided for the operation as if we had listened to the AS advice we wouldn't have known the cancer was spreading rapidly as he had no symptoms of prostate cancer at all. It's the pathology post op that has provided all the correct information.
My husband had just turned 65 at the time of the operation. We feel grateful that we at least have our new oncology team on our side being very proactive as opposed to the health board we initially started out with (in UK).
Ultimately the treatment you opt for is a personal choice that only you can make and everyone has different views. We researched everything, but are so pleased we chose to ask a surgeon for advice, otherwise time would have been so much shorter for us by now.
Good luck on your journey.