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Update on Active Surveillance - 8 Years
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Newsguy
May 18, 2013, 4:06:43 PM5/18/13
to
Steve,
My latest quarterly "active surveillance" testing continues a relatively
positive trend. My PSA was 1.80, the lowest it's been for a couple of years.
Thus far I have been on this path for eight years. I was diagnosed in 2005
with a Gleason of 6 (3+3) in small portions of two cores, confirmed by Johns
Hopkins. In other words, yes, I had prostate cancer, but it was not widely
present in the gland, and the cells were not especially undifferentiated or
malignant.
My PSA has bounced around a bit, but has stayed under 3.0 for almost seven
years - since I started on finesteride (Proscar), which is thought to halve
the PSA reading. The drug shrinks the prostate gland and may, my oncologist
believes, slow the growth of cancer - a view disputed by other researchers.
I have experienced no side effects from the finesteride. The drug, a
generic, is quite inexpensive.
A number of research reports published recently suggest that many guys
diagnosed with PCa probably do not need to immediately undergo surgery or
radiation.
Active surveillance is not risk-free. Cancer cells could migrate from my
prostate to other parts of my body and set up shop there. A decision in the
future to undergo surgery or radiation might be too late to produce a
"cure."
But surgery and radiation are not risk-free. They can have significant,
life-altering side effects, and may not eradicate all of the disease. No
matter what path we choose, there are no guarantees with prostate cancer.
Clearly, for those with aggressive disease, treatment is necessary and delay
is not an option.
But with the more common slow-growing form of prostate cancer, a "wait and
watch" approach -- difficult as that may be when our natural impulse is to
"get it out now" -- may be a reasonable choice.
Alex
2013
05/14 - 1.80
02/07 - 2.31
2012
11/08 - 2.05
09/15 - MRI of the prostate. No evidence of disease.
07/18 - 2.06
04/25 - 2.03
01/14 - 2.20
2011
10/12 - 2.64
07/14 - 2.34 - Ultrasound unremarkable.
04/01 - 2.90
01/13 - 2.40
2010 (age 66, 5 years after diagnosis)
10/13 - Doppler ultrasound: "No evidence of disease progression. Remain on
close PSA watch."
09/15 - 2.19
06/08 - 1.59
03/25 - 2.85
2009
12/12 - 2.24
09/17 - 2.37
06/12 - 1.28
03/10 - 1.52
2008
11/19 - 1.49 - Ultrasound-guided biopsy, 8 cores, none with cancer.
Confirmed by Bostwick Labs.
06/27 - 2.60
03/26 - 1.52
2007
12/27 - 2.50
08/27 - 2.44
05/17 - 3.56
02/09 - 3.44
2006
11/20 - 6.25 (scared me, but my Doc said wait)
09/15 - 3.3
08/07 - 6.12 Started on Proscar (finesteride), which halves the PSA reading
05/04 - 4.50
02/02 - 5.81
2005 (age 61)
11/10 - 5.25, T/F 20%
08/19 - 5.81
07/14 - Biopsy, 12 cores, 2 w/ cancer, < 10% of each sample.
Confirmed by Johns Hopkins Labs, with Gleason 3+3
07/05 - 6.2 T/F 14%
02/14 - Biopsy, 12 cores, no cancer found
02/08 - 4.8 T/F 16%
2001
11/30 - 1.1
No further tests til 2005 (dumb!)
2000
06/06/ - 0.96
1999
03/22 - PSA 1
My latest quarterly "active surveillance" testing continues a relatively
positive trend. My PSA was 1.80, the lowest it's been for a couple of years.
Thus far I have been on this path for eight years. I was diagnosed in 2005
with a Gleason of 6 (3+3) in small portions of two cores, confirmed by Johns
Hopkins. In other words, yes, I had prostate cancer, but it was not widely
present in the gland, and the cells were not especially undifferentiated or
malignant.
My PSA has bounced around a bit, but has stayed under 3.0 for almost seven
years - since I started on finesteride (Proscar), which is thought to halve
the PSA reading. The drug shrinks the prostate gland and may, my oncologist
believes, slow the growth of cancer - a view disputed by other researchers.
I have experienced no side effects from the finesteride. The drug, a
generic, is quite inexpensive.
A number of research reports published recently suggest that many guys
diagnosed with PCa probably do not need to immediately undergo surgery or
radiation.
Active surveillance is not risk-free. Cancer cells could migrate from my
prostate to other parts of my body and set up shop there. A decision in the
future to undergo surgery or radiation might be too late to produce a
"cure."
But surgery and radiation are not risk-free. They can have significant,
life-altering side effects, and may not eradicate all of the disease. No
matter what path we choose, there are no guarantees with prostate cancer.
Clearly, for those with aggressive disease, treatment is necessary and delay
is not an option.
But with the more common slow-growing form of prostate cancer, a "wait and
watch" approach -- difficult as that may be when our natural impulse is to
"get it out now" -- may be a reasonable choice.
Alex
2013
05/14 - 1.80
02/07 - 2.31
2012
11/08 - 2.05
09/15 - MRI of the prostate. No evidence of disease.
07/18 - 2.06
04/25 - 2.03
01/14 - 2.20
2011
10/12 - 2.64
07/14 - 2.34 - Ultrasound unremarkable.
04/01 - 2.90
01/13 - 2.40
2010 (age 66, 5 years after diagnosis)
10/13 - Doppler ultrasound: "No evidence of disease progression. Remain on
close PSA watch."
09/15 - 2.19
06/08 - 1.59
03/25 - 2.85
2009
12/12 - 2.24
09/17 - 2.37
06/12 - 1.28
03/10 - 1.52
2008
11/19 - 1.49 - Ultrasound-guided biopsy, 8 cores, none with cancer.
Confirmed by Bostwick Labs.
06/27 - 2.60
03/26 - 1.52
2007
12/27 - 2.50
08/27 - 2.44
05/17 - 3.56
02/09 - 3.44
2006
11/20 - 6.25 (scared me, but my Doc said wait)
09/15 - 3.3
08/07 - 6.12 Started on Proscar (finesteride), which halves the PSA reading
05/04 - 4.50
02/02 - 5.81
2005 (age 61)
11/10 - 5.25, T/F 20%
08/19 - 5.81
07/14 - Biopsy, 12 cores, 2 w/ cancer, < 10% of each sample.
Confirmed by Johns Hopkins Labs, with Gleason 3+3
07/05 - 6.2 T/F 14%
02/14 - Biopsy, 12 cores, no cancer found
02/08 - 4.8 T/F 16%
2001
11/30 - 1.1
No further tests til 2005 (dumb!)
2000
06/06/ - 0.96
1999
03/22 - PSA 1
Alex
May 18, 2013, 6:44:36 PM5/18/13
to
This should have been posted as from "Alex." I had a setting wrong in my
newsreader software.
Alex
---------------------------------------
<tuchasoffentisch@_NO_SPAM_gmail.com> wrote in message
news:kn8n1...@news1.newsguy.com...
newsreader software.
Alex
---------------------------------------
<tuchasoffentisch@_NO_SPAM_gmail.com> wrote in message
news:kn8n1...@news1.newsguy.com...
Steve Kramer
May 19, 2013, 6:20:35 PM5/19/13
to
That was a gutsy decision at 61 Alex. I've always said that. I am sure
glad it's turned out the way you had hoped.
PSA OCT 2000 @ 46
Biopsy NOV 2000 3+4=7, T2c
RRP DEC 2000 3+4=7), T3cN0M0, SVI, Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT MAY - JULY 2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron started JULY 2003 @ 48
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added JUL 2006 @ 51
Last PSA <0.05 Next draw AUG 2013 @ 58
Illegitimati non carborundum
"Newsguy" wrote in message news:kn8n1...@news1.newsguy.com...
glad it's turned out the way you had hoped.
PSA OCT 2000 @ 46
Biopsy NOV 2000 3+4=7, T2c
RRP DEC 2000 3+4=7), T3cN0M0, SVI, Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT MAY - JULY 2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron started JULY 2003 @ 48
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added JUL 2006 @ 51
Last PSA <0.05 Next draw AUG 2013 @ 58
Illegitimati non carborundum
"Newsguy" wrote in message news:kn8n1...@news1.newsguy.com...
Alex
May 21, 2013, 7:44:59 PM5/21/13
to
Thanks, Steve.
It wasn't really gutsy, because I never thought about it as an absolute
decision, but simply as a short-term choice that I could always change if
circumstances required. Not exactly taking it "one day at a time," but more
like "one three-month period at a time."
Fortunately, thus far I have not had to face the need to opt for active
treatment.
In my view, the gutsy folks in this group are guys like who have had to
really wrestle the bastard, and try to not let it grind them down.
Alex
"Steve Kramer" <skr...@cinci.rr.com> wrote in message
news:knbj07$28s$1...@dont-email.me...
It wasn't really gutsy, because I never thought about it as an absolute
decision, but simply as a short-term choice that I could always change if
circumstances required. Not exactly taking it "one day at a time," but more
like "one three-month period at a time."
Fortunately, thus far I have not had to face the need to opt for active
treatment.
In my view, the gutsy folks in this group are guys like who have had to
really wrestle the bastard, and try to not let it grind them down.
Alex
"Steve Kramer" <skr...@cinci.rr.com> wrote in message
news:knbj07$28s$1...@dont-email.me...
Alan Meyer
May 22, 2013, 10:30:05 AM5/22/13
to
I meant to post this to the list but accidentally just sent it to Alex.
One of the peculiarities of the Thunderbird email and news client is
that there are separate buttons for Reply and Followup. It's easy to
click the Reply instead of the intended Followup.
------------------------------------------------------------------
I think the decision to choose active surveillance is very hard for some
people and very easy for others.
I have a cousin who is a medical oncologist. He sees cancer patients
all day long. When I called him about my PCa diagnosis he said that, if
it were him, he'd want surgery right away. He said that he knows
intellectually that radiation works about as well as surgery but he
wouldn't want to have any cancer in him, even if it was quiet or dying.
He'd want it cut out. He didn't even suggest active surveillance.
In his case, I wonder if his knowing a lot about cancer actually scared
him more than the average guy who doesn't know much.
Then I've met other guys who who don't even get follow-on PSA tests,
much less treatment, after their diagnosis. Some of them think, "It
ain't gonna happen to me." Some think "Odds are I'm going to be fine."
Some think, "The treatment is worse than the disease." And more than
a few think - "Ah ... I don't want to think about it."
And of course many men just do whatever the doctor tells them to do -
get treatment, get active surveillance - the doc knows best - I'll just
follow his advice.
It takes an independent and strong minded person to figure out for
himself what is best and then put aside all fears and emotions to do
what reason tells him is right.
Alan
One of the peculiarities of the Thunderbird email and news client is
that there are separate buttons for Reply and Followup. It's easy to
click the Reply instead of the intended Followup.
------------------------------------------------------------------
I think the decision to choose active surveillance is very hard for some
people and very easy for others.
I have a cousin who is a medical oncologist. He sees cancer patients
all day long. When I called him about my PCa diagnosis he said that, if
it were him, he'd want surgery right away. He said that he knows
intellectually that radiation works about as well as surgery but he
wouldn't want to have any cancer in him, even if it was quiet or dying.
He'd want it cut out. He didn't even suggest active surveillance.
In his case, I wonder if his knowing a lot about cancer actually scared
him more than the average guy who doesn't know much.
Then I've met other guys who who don't even get follow-on PSA tests,
much less treatment, after their diagnosis. Some of them think, "It
ain't gonna happen to me." Some think "Odds are I'm going to be fine."
Some think, "The treatment is worse than the disease." And more than
a few think - "Ah ... I don't want to think about it."
And of course many men just do whatever the doctor tells them to do -
get treatment, get active surveillance - the doc knows best - I'll just
follow his advice.
It takes an independent and strong minded person to figure out for
himself what is best and then put aside all fears and emotions to do
what reason tells him is right.
Alan
I.P. Freely
May 23, 2013, 1:32:27 PM5/23/13
to
Alan Meyer wrote:
>
> Then I've met other guys who who don't even get follow-on PSA tests
Or, lately, even preemptive screening. Several very intelligent middle
>
> Then I've met other guys who who don't even get follow-on PSA tests
aged friends have said variations of the following to me lately:
"Haven't "they" decided that PSA isn't meaningful any more and that
testing is a waste of time, especially after middle age?".
I need to print my answer on a T shirt. It would ave me a lot of time
... at least for the fast readers.
Danged media!
I.P.
Steve Kramer
May 23, 2013, 9:06:42 PM5/23/13
to
My mother asked me that very question three days ago. Her husband died from
PCa at 50!!!
PSA OCT 2000 @ 46
Biopsy NOV 2000 3+4=7, T2c
RRP DEC 2000 3+4=7), T3cN0M0, SVI, Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT MAY - JULY 2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron started JULY 2003 @ 48
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added JUL 2006 @ 51
Last PSA <0.05 Next draw AUG 2013 @ 58
Illegitimati non carborundum
"I.P. Freely" wrote in message news:knljjl$ftm$1...@dont-email.me...
PCa at 50!!!
PSA OCT 2000 @ 46
Biopsy NOV 2000 3+4=7, T2c
RRP DEC 2000 3+4=7), T3cN0M0, SVI, Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT MAY - JULY 2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron started JULY 2003 @ 48
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added JUL 2006 @ 51
Last PSA <0.05 Next draw AUG 2013 @ 58
Illegitimati non carborundum
Alex
May 24, 2013, 2:23:51 PM5/24/13
to
Alan,
Thanks for a thoughtful response, as always.
The reaction of your cousin the oncologist is understandable because in
addition to being a medical scientist, he's also just a guy. Emotionally, it
feels better to do something.
The problem, of course, is that "cutting it out" isn't necessarily a
guarantee that all the cancer will be successfully removed. And surgery is
almost certain to come with some side effects -- temporary and manageable in
most cases, but persistent and quite challenging in some others.
Also, I don't think guys get enough advice about the emotional reaction they
may experience after surgery or radiation. The side effects, undergoing the
treatment, and the knowledge that the bastard might still rear its ugly head
in the future -- all are pretty powerful reminders of our own mortality.
No path through this minefield -- surgery, radiation or active
surveillance -- is an easy one.
I would differ with you on one point, at least in my case. I certainly have
not been able to "put aside all fears and emotions." At best I've worked my
way through those fears and emotions, in part by remembering that, if my
cancer acts up or I simply change my mind, I always have the option of
electing to undergo surgery or radiation. No guarantees that it won't be too
late by then, of course, but I learned long ago that there are no guarantees
in life.
Alex
"Alan Meyer" <ame...@yahoo.com> wrote in message
news:knikhq$dss$1...@dont-email.me...
Thanks for a thoughtful response, as always.
The reaction of your cousin the oncologist is understandable because in
addition to being a medical scientist, he's also just a guy. Emotionally, it
feels better to do something.
The problem, of course, is that "cutting it out" isn't necessarily a
guarantee that all the cancer will be successfully removed. And surgery is
almost certain to come with some side effects -- temporary and manageable in
most cases, but persistent and quite challenging in some others.
Also, I don't think guys get enough advice about the emotional reaction they
may experience after surgery or radiation. The side effects, undergoing the
treatment, and the knowledge that the bastard might still rear its ugly head
in the future -- all are pretty powerful reminders of our own mortality.
No path through this minefield -- surgery, radiation or active
surveillance -- is an easy one.
I would differ with you on one point, at least in my case. I certainly have
not been able to "put aside all fears and emotions." At best I've worked my
way through those fears and emotions, in part by remembering that, if my
cancer acts up or I simply change my mind, I always have the option of
electing to undergo surgery or radiation. No guarantees that it won't be too
late by then, of course, but I learned long ago that there are no guarantees
in life.
Alex
"Alan Meyer" <ame...@yahoo.com> wrote in message
news:knikhq$dss$1...@dont-email.me...
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