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Mon, Mar 16 10:55am · PCa Genetic Testing in Prostate Cancer

In order to continue with AS for my organ confined adenocarcinoma, T₂aN₀M₀ Gleason Score 3+3, I was advised an Oncotype DX GPS, Prolaris or a repeat mpMRI guided biopsy as my PSA had settled above 10 following the first TRUS guided biopsy. With a very low risk score in the Oncotype DX GPS and the PSA settling below 10 with a negative doubling time, the AS continues. I can't say whether the same patient would undergo both Oncotype DX GPS and the Prolaris tests to be in a position to advise on relative benefits. The treating doctor would be the best person to advise. I saw this write-up and hope it yields some useful information. Best wishes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674810/

Mon, Mar 9 4:17am · PSA numbers: Questions about new treatments in Prostate Cancer

Hi. The consulting specialist is the best person to render advice. I have found that the picture gets a lot clearer with 2nd and 3rd opinions from reliable specialists, preferably from different disciplines eg Radiotherapy vis a vis Surgery etc.

Given the rapidly expanding arsenal against P Ca some thought may be applied to considering specialists’ opinion if they feel active surveillance is a viable option in specific cases. One never knows what new modalities of treatment, such as immunotherapy or focal treatment, might become mainstream during a reasonably safe period a patient can be put on AS. Again, it has to be a judgement call for the patient and the treating doctor.

This write-up came to my attention and can fill in some gaps on the current situation in respect of the condition 👉 https://www.nytimes.com/2020/03/02/well/live/before-prostate-surgery-consider-active-surveillance.html

Mon, Jan 6 10:30pm · Prostate cancer diagnosis and decisions in Prostate Cancer

With new genomic testing to establish probability of metastasis or progression to higher level disease, it may be even easier to examine, in consultation with treating doctors, the feasibility of continuing active surveillance and avoiding, as far as possible, repeat biopsies and depending instead on biomarker and imaging based confirmation of non-progression.

Apr 1, 2019 · PSA Doubling Time Under Active Surveillance in Prostate Cancer

@colleenyoung Hi. Thank you for the valuable links to guidelines and the discussion.

Post biopsy, DREs, monitoring of PSA and imaging (mpMRI) were used over the past year for active surveillance. Another PSMA Ga68 PET scan is scheduled after two months.

The "Very Low Risk" / "Low Metastasis Risk" result of the Oncotype DX GPS has contributed to continuation of Active Surveillance, my personal hope being that current trials on immunotherapy, such as the one currently in progress on Prostvac for localized P Ca, could yield a viable modality for enhancing probability of keeping the disease confined to the organ. The active surveillance guidelines do not yet specifically mention GPS in their recommendations for active surveillance, risk being low or intermediate based on PSA score, Gleason score and viewability of lesion in a scan.

The PSA hovering at 12 levels after the biopsy, therefore, remains a concern.

Mar 17, 2019 · PSA Doubling Time Under Active Surveillance in Prostate Cancer

Dear Group Members,

I was diagnosed as a case of BPH in 2011. With a rising PSA from 2011 to 2017 (app 5.5 to 8) a PSMA Ga68 PET scan was prescribed in Dec 2017, which revealed an organ confined lesion in the prostate. A TRUS guided biopsy revealed an Adenocarcinoma in the prostate with a Gleason score of 3+3. A mpMRI also revealed a prostate confined neoplasm. Staging was at T2aN0M0 (Intermediate risk) at an age of 67 years.

Following the biopsy, the PSA settled above 12 and after one spike to 14 showed a decline, followed by a slight uptrend in tests now done at 3 monthly intervals. The treating radio therapist agreed to active surveillance after the PSA had touched below 10 levels and an Oncotype DX Prostate GPS revealed a very low risk (1%) of metastasis, though the PSA slowly climbed back to 12 levels. The PSA doubling time, from the first post biopsy PSA score in Feb 2018 to the last one in March 2019, taking all the intervening scores into account, is in negative figures, (-) 6.7yrs with a velocity of (-) 1.3ng/ml/yr.

Are there any formal guidelines that would govern active surveillance under such conditions?

Also does anyone have a view on whether the elevated PSA could be a combination of other factors along with the elevation caused by P Ca by itself?

Thanks,

PeeKaa Fighter