PSA numbers: Questions about new treatments

Your description @ronan2011 is so accurate. I was diagnosed 6 weeks ago, Gleason 4+3=7. Age 75. Pretty healthy. Scan shows no cancer outside the prostate. I want to make an evidence-based decision. I am doing research, watched the videos, and have consulted with an esteemed radiation oncologist and an equally esteemed prostate surgeon. They are impressive physicians (and exceptionally patient with my indecision) but even with their input, it isn’t clear to me what to decide. This is clearly one of the most important decisions of my life and it feels like it is harder to decide than it should be. I am normally not indecisive, but one minute I feel like one way is best, only to reverse myself ten minutes later when I read something else about side effects. I keep looking for something that will tip the scale to a choice I can be confident is the best decision in my situation.

@vernonkent, @ronan2011, Once again I am visiting your section of the community. I monitor this group for my life partner who has lived with this process of deciding and learning for several years. So the question is epistemological. How do you know that you know?

Let me see if this helps. I used to teach a brief course in decision making at the college where I worked. The takeaway is this...there is no way to control the outcome of your decision. As long as you have done all of the necessary research, talked with the right clinicians, and either by yourself or with a therapist explored your lifestyle and quality of life expectations, you are good to go.

You will be making the best decision that you can. Then if you hold up your end of the deal, usually with health and lifestyle changes, you will have done everything in your power to have a good outcome. Believe in yourself, have faith in your knowledge and understanding of the choices.

One cautionary note from reading your post. Not deciding is also a decision.

Be safe and protected. Chris

I’m almost 73. My PSA had always been 2.1 and a year ago went to 3.1. This year it went to 4.2. I’ve always had an enlarged prostate and always had PSA and digital every year since my 50s. My Dr. is in a wait mode and monitor. Is that a good idea? Any suggestions or possible first steps to give me peace of mind? I’m headed to Florida and will be close to Cleveland clinic after holidays.

@carlsonte wait and monitor is often referred to as active surveillance. I prefer that term because it indicate action rather than the feeling it can give of doing nothing. Your question is answered in this Q&A on the Mayo Clinic NewsNetwork
- Q & A: Active surveillance reasonable approach for low-risk prostate cancer https://newsnetwork.mayoclinic.org/discussion/tuesday-q-a-active-surveillance-a-reasonable-approach-for-men-with-low-risk-prostate-cancer/

@crozi01 also considered active surveillance and @peekaafighter talks about it in this discussion:
– PSA Doubling Time Under Active Surveillance https://connect.mayoclinic.org/discussion/psa-doubling-time-under-active-surveillance/

Carl, was active surveillance the preferred option for you or were other treatment options also discussed?

I received my latest PSA and it was 3.1. It went down from a 4.5. My GP gave me an antibiotic for thirty days and he believes I had inflammation. I saw him this week and his opinion is we test again in June. He did a digital and he said prostate was soft, nothing abnormal on lobes, and asymmetrical. My prostate has always been enlarged. He said no urologist worth their salt would do a biopsy at this point. He offered that I could have a second opinion of a urologist if I wanted. I’m headed to Florida end of month for three months and Cleveland clinic is within five minutes. I may consider seeing a urologist there??? We’ll see. Any suggestions?

Hello and you stony I have written at the site a while back when I started looking for answers about my newly developed prostate cancer diagnosis I had a MRI of my prostate done last week the results showed that I had to 1 1/2 cm lesion on both sides of my prostate gland
My first question when I joined this site was are there any new treatments any new ways of going in and not killing the prostate completely it seems to me that with all our medical technology why don’t they just go in and take out those lesions ?
they know the size of them And where they are exactly are because of the MRI.
Are there any new doctors that do that is there somebody out there that can help me with this question because I don’t want to lose my prostate next step the telling me is another biopsy or I should go to radiation I don’t want to radiation

As far as leaving the prostate in, there is freezing Cryotherapy which I'm not familiar with. ALso there is a relatively newer one called Focal Laser Ablation where they heat treat the tumors but it is in trials so technically not totally medically accepted yet. I've had a biopsy which gave me a gleason 7 but am going to the Mayo Clinic in January to have a high resolution MRI and they will tell me what procedures they think are medically relevant for me, including whether I qualify for the trial or not. Once I know that I will be choosing between the trial or surgery. They are doing the trials all over the country, at hospitals and clinics and university facilities. THere is a list of who is doing it. There is a Sperling Institute in Florida that does the heat treatment, and they have testimonials of guys having the procedure done and going out to dinner that night. There is not a ton of info out there on it, so I'm waiting to talk with the Dr who runs the program at Mayo to find out the details...............

Do a google search on HIFU and TULSA-PRO, both can be used as focal therapy for prostate cancer. I had the HIFU done in Nashville, TN 1 year ago and am very happy with results. No side effects at all. HIFU was FDA approved in 2015 and TULSA-PRO just recently approved in the USA.

Thank you very much for the information I will look into it I have an appointment with surgeon next week about what he has to offer at Maine Medical Center best to all of you

I have 1.5 on my PSA. My urologist said "The best test is still a digital (finger probe) I can't imagine 15. What did your family Doctor say about your digital test,? or did he do one.Please call your family Doctor and have his office call a specialist within two weeks. My two brothers waited. They died within 2 months on everything but surgery. My heart doctor found he had cancer of the prostate and had immediate surgery. He is so happy with his decision and retired in Australia. Good luck to you.