Another Prostate Cancer Anniversary

Another anniversary today —> 13 years ago today (4/27/2012), I was diagnosed with prostate cancer.

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 (in 2000), 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 on 27 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.

But, since it was only a 3+3, there was no need to panic or rush to a hasty treatment decision; I had time on my side. (Note that this was well before the availability of PSMA PET scans; and regular PET CT scans were generally not approved for initial diagnosis. So, we were reliant on MRI, CT, and bone scan results for any indications of metastasis.)

With no medically-necessary reason to treat (and after a thorough evaluation of available data and literature), I chose active surveillance (AS). I was on AS for about 9 years, not only tracking PSA (every 4-7 months) and biopsy (about every 2-1/4 years), we also regularly calculated often lesser-tracked numbers (% Free PSA, PSA Doubling Time, and PSA Density), as well as obtained OncotypeDx and Prolaris biomarker (genomic) test results.

Those 9 years on AS bought me time to get referrals, evaluate all available treatment modalities, and take advantage of medical and technological advances, so that when the time came to make a treatment decision, I’d be ready to pull the trigger. (PSA eventually hit 8.0, Gleason reached 7; so on 19 April 2021, I started 28 sessions of proton radiation.)

Now, we simply track PSA every 4 months. Most recent PSA was 0.47 ng/mL. If/when any other monitoring tests come out that are FDA-approved and covered by insurance, we’ll look into trying those as well.