You're welcome. Glad to help.
Dr. Zelefsky is definitely one of the world's leading radiation doctors for prostate cancer. One thing I like very much about him is that he is a prolific author and researcher. I hope you get the appointment.
Dr. Tewari has been the featured presenter on robotic prostatectomy for at least two of the nearly annual National Conferences on Prostate Cancer. In my book that's a strong mark in his favor. His results and research are also well published.
Dr. Scardino, in addition to being a top flight surgeon, is also, I think, a senior leader of MSKCC's active surveillance program. He is listed as the senior author on some of the MSKCC's AS research. He has authored a fairly recent book on prostate cancer directed toward patients.
What you have stated so far is consistent with active surveillance: only one core positive (less than 34% of cores); 4% cancer in one core clearly not exceeding 50% cancer in any core; PSA of 5.3 not exceeding 10; and Gleason not exceeding 6 (or 7 if older and other health concerns, a judgement call). With just 4% cancer in only one core, the DRE probably did not result in a palpable cancer; is that right? Up to stage 2a, based mainly on the DRE, is within AS concurrence limits. Do you know the PSA density (PSA divided by the volume in cc)? AS experts want the PSAD to be <.15; with a PSA of 5.3, the prostate could be as small as 36 cc and still satisfy this criterion. A larger prostate would decrease the PSAD, which would be even more favorable. Do you know the rate of change in the PSA over the past year or so? Ideally, it would be a PSA velocity (PSAV) of less than 1. However, PSAV is sometimes influenced by infection or by benign growth, giving some leeway if those factors are involved. These criteria are from the consensus statement emerging from the expert conference on active surveillance held in 2007.
One very important point is that age was not included as one of their criteria!
In other words, patients of any age
are deemed eligible for active surveillance if the risk features are appropriately low. Some doctors are still trying to shepherd patients toward active therapy by suggesting they are too young for AS, but that is changing as evidence of AS success continues to accumulate. However, the experts do look for especially low-risk features for very young men, and 56, though not very young, is on the youngish side. (I was diagnosed at age 56 too.)
With case characteristics that appear to be quite low-risk, an outstanding book to gain strategic perspective is the new book "Invasion of the Prostate Snatchers -- No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency," by Ralph H. Blum and Mark Scholz, MD, 2010. (Emphasis is on the word "unnecessary"; radical treatment is , of course, highly desirable in the right circumstances, as the authors make clear.)