Continuing active surveillance??

[Phil]

I have an appointment with my urologist next week, to review my status. I've been on AS for just one year. The latest PSA went from 4.0 (Apr 08) to 5.11 (Dec 08). I had a biopsy in Dec - Gleason went from 6 to 7 (3+4). There were 5 positive cores (of 10 samples), highest reading was 40% in one core (all on the same side of the prostate).

What should I be looking at to decide whether to continue AS or if it's time to do something more agressive?

Thanks for your imput.

[Ralph Valle]

Hello Phil,
A treatment/no treatment decision is always difficult. One protocol of active survellance (Johns Hopkins) would not accept you based on your recent Gleason Score and positive biopsy cores. Their guideline Is: "Combined Gleason score is 6 or less and no more than 2 biopsy cores contain cancer."

Prostate cancer is generaly a slow growing malignancy. I suspect that your original biopsy missed the more aggressive (GS 7) cancer. Your PSADT is over 25 months based on just the two levels provided. You have time to make a decision although GG 4 in your recent biopsy (if verified) becomes a factor in your decision process. The fact that you would not qualify at JHU is probably something to consider.

Wish you the best possible outcome,

RalphV

[Lenny Hirsch]

Phil
I have forgotten which doctor you are seeing. A visit to Dr.Eli Rosenbaum might be worth your while. He is one of the top oncologists in the country and a great champanion of AM. Give me a ring. Like Ralph I would think again about continuing your present protocol.
My phone number is;0544570595

[E. Michael D. ("Mike") Scott]

Phil: Another issue that is very important here is the combination of your age, your life expectancy, and any other comorbidities.

In a man of 60 with no comorbidities and a family history of men commonly living into their 80s, the combination of the number of positive cores and the occurrence of Gleason 4 cancer in at least one core would be a strong indicator for treatment.

Conversely, in a man of 70 with 2 comorbidities and a family history of men only occasionally living into their 80s, a continued non-treatment regimen would appear much more justifiable.

You appear to be somewhere between these two categories, so there are serious issues you may want to discuss with your doctor about your comorbidity status (assessible using the Charlson score) and your family history or life expectancy.