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Where are all the people on Active Surveillance (AS)?
Prostate Cancer | Last Active: Jul 24 11:42am | Replies (61)Comment receiving replies
I mention my active surveillance journey regularly,
Having first heard about PSA testing when I was 40y (in 1995), I started having PSA tests as part of my annual health checkups when I was 45y, and watched my PSA slowly rise each year (1.30, 1.64, 1.79, 1.87, 2.10, 2.60, 2.70, 3.40, 4.00 & 4.20).
So, it wasn’t a big shock to me in April 2012 (at 56y), that my urologist told me that my “blind” biopsy showed low-grade, localized prostate cancer: Gleason 6(3+3); an independent second opinion confirmed this.
I chose active surveillance (AS). I was on AS for about 9 years, which bought me time to learn about prostate cancer, get referrals, evaluate all available treatment modalities, and take advantage of medical and technological advances, so that if/when the time came to make a treatment decision, I’d be ready to pull the trigger.
The decision to go on AS was fairly easy because it was based on the data. By keeping AS truly “active” - and that involved monitoring much more than just PSA - I kept continuous track of my cancer status (just as I would do with any other disease, illness, or injury).
Eventually, my PSA reached 7.976; Gleason reached 7(3+4); a second opinion upgraded it to a 7(4+3).
By then I had already decided on proton radiation for my treatments. So, in April 2021, I started 28 sessions of proton radiation + 6 months of Eligard.
PSA dropped to < 0.008 while on Eligard; nadir was 0.13. These days PSA varies between 0.35-0.55; Most recent PSA was 0.473 ng/mL.
Today (more than 4-1/2 years post-treatment), life is pretty much back to normal (besides getting PSA tests every 6 months). My active surveillance decision was the right one.
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@brianjarvis
Your experience mirrors mine except for the timeline. I was 62 when diagnosed - no health issues - very active (still). I was gleason 6 for 16 months with 4.1, 3.74, and 3.5. Three months later my annual physical blood work showed an increase in my psa to 4.04. I advised my urologists office and they sort of dismissed it and I asked to order a psa (I was 9 months out from a scheduled MRI). The PSA came back at 4.1, I asked for an MRI in January (6 months early) that came back pi-rads 4 (which the urologists office also thought was less urgent). I asked to move up my appointment and biopsy. When the actual urologist saw the results, he immediately scheduled a perineal biopsy (vs rectal) for better accuracy. The result showed cribriform in one tumor (new) and cribriform developed in an existing tumor (3+4). The progression occurred in about 16 months. I start radiation in the next 3 weeks (SBRT - 5 sessions at center of excellence).
Prostatectomy vs. SBRT offered no advantage per my urologist surgeon (Joseph Wagner - a star robotic surgeon with over 4k successful case and one of the pioneers in the application). He was very straight forward - your choice advised that if he were me he would be unable to determine a best option (he is known internationally as a Highly Regarded surgeon). Under his care I opted for SBRT with a MSK trained radiologist and 6 months ADT.
Prostatectomy is right for many patients. For me with localized cribriform and a curative option with radiation I was not willing to take the chance on lifelong/regular incontinence and ED. I expect a full recovery within 6 months and regular psa until I am toes up.