Active Surveillance - a sound option for truly low risk men

[able5]

Originally Posted by BooMan

It's not russian roulette. I am not old and have no co-morbidities that would prevent aggressive treatment. One of the practioners who recommended active surveillance to me has an international reputation as a surgeon and research scientist dealing with prostate cancer. I support the expression of different opinions and would not have responded except that there may be newly diagnosed men doing their initial research on these pages. They have probably already discovered the vast array of treatment options. There's more to one side to these treatment options and we are best served by investigating all of them and then deciding on a course of action with a doctor we trust. That's exactly what I did.

I agree Boo,

Coming from the "only" guy on this thread to actually experience Active Surveillance, I certainly appreciate and value your opinions...

Let's face it, most of us can use a search engine and come back here with cut & paste articles that make us look like scholars in the field. Fact is, they aren't fooling me. From a practicable point of view, a prostate cancer newbie is usually looking for pointers (tips & tricks) from veterans who have already endured a "specific" treatment. I do not try to pretend to be an expert about other treatments. To be perfectly honest, I'm not even close to having much knowledge about about my own. As they say, I didn't create the horse, I only rode it. Sure, I could read tons of research material about another treatment and post that research here on the forum but unless it was a part of my prostate cancer journey (robotic LRP), I'm merely conducting a charade. I had a specific treatment and that specific treatment is all that I can talk about as it relates to my personal prostate cancer journey.

[IADT3since2000]

Originally Posted by BooMan

It's not russian roulette. I am not old and have no co-morbidities that would prevent aggressive treatment. One of the practioners who recommended active surveillance to me has an international reputation as a surgeon and research scientist dealing with prostate cancer...

Hi BooMan,

Thank you for sharing your experience, and I'm hoping you might share more of it if you are comfortable with doing so.

I'm interested in whether the doctor or health team managing your care discussed tactics that might help stabilize your PSA (and the cancer!) or even reduce it. Was the subject of supporting tactics brought up? Specifically, was there any discussion of diet, nutrition, supplements, exercise and stress reduction? Was there any discussion of drugs like finasteride, Avodart, or statins to help improve your odds? Were any information resources provided?

Some of these tactics are still controversial, so it would not be surprising if there had been no mention of them, but I'm wondering how patients are now being advised about active surveillance.

Take care,

Jim

[ashphi]

I'm new here and just to get things off to a good start, I've reworded the name of this thread- at least for my posting.

I was diagnosed in Nov. My urologist started out by stressing the fact that this is a slow growing cancer and there was no need to rush into action. He referred me for some imaging studies, saying again that I needn't do them immediately and that I should return to see him when they were done so we could discuss treatment options.

He was very surprised to see me less than 2 weeks later with the results. He concluded from this that I wasn't a good candidate for active surveillance as I probably couldn't stand the "suspense." We spoke about the other options and I went home to read and talk to anyone who had experienced prostate cancer.

I went for consultations with another urologist, with a radiation therapist, with a surgeon- all head of departments or institutes. Each one of them made a strong recommendation to me for active surveillance. I was feeling stronger and stronger that this is the right path for me.

Some of my data- first off, i'm diabetic, seriously overweight and have high blood pressure. Even before the diabetes, I've been very slow to heal from surgery. I'm 65. My gleason is 6, psa 3.47 (down a full point in the last 6 weeks). There were 2 cores with 20-40% cancer cells in my biopsy.

Each of the doctors I've consulted has stressed a low-calorie diet and regular exercise. No one's been terribly excited about vitamins and other supplements altho there was some inclination to Vit E.

It seems to me that as long as I'm on guard with regular psa's and dre's as well as the occasional biopsy, I have a good "early warning system" in place. Seems better than the assorted down-sides to any of the treatments and their side- and after-effects.

I hope other men who have chosen or are considering this option will speak up here. We can learn from each other, as the body of evidence grows.

[BooMan]

I really try to stay out of this, only because I understand that the concept of watchful waiting or active surveillance seems crazy to so many people. Since Ashphi and IADTsince2000 brought some things up, I'll comment. Jim - no to any mention of Avodart, finasteride, or statins to work on PCa. Yes to a heart healthy or low-fat diet and a stern recommendation to drop some weight. Exercise is also at the top of the list. I'm working on all of those. Ashphi - I am a little more fortunate than you in that my PSA was 2.6 when diagnosed and there were 2 cores out of 24 positive at less than 5% total. Gleason was 3+3+6. What is the recommendation for the interval on your PSA, DRE, and biopsies? Mine was 6 months on the PSA and DRE and yearly biopsy for the time being. I took part in a clinical trial that tried to target biopsy sites based on color doppler ultrasound coupled with a contrast agent and I plan an appointment in March to try to enter the expectant management program at JHU.

[IADT3since2000]

Originally Posted by BooMan

... I took part in a clinical trial that tried to target biopsy sites based on color doppler ultrasound coupled with a contrast agent and I plan an appointment in March to try to enter the expectant management program at JHU.

Thanks for your interesting comments.

CDU seems to me like a highly promising approach for men considering active surveillance, in part because it gives a good indicator whether the cancer is near any locations where it could easily exit the prostate, in addition to the other extra information it provides. I know that I would be more confident as an active surveillance patient if I had had a favorable CDU. Did your report give a clear idea of size and location? I'm glad there is a clinical trial going on to test the targeting aspect, which should also be much improved based on CDU demonstration videos that I have seen. Of course, the supposed advantages need to be proved; if they are, I'll bet that technology will really take off.

My impression is that none of the major active surveillance programs uses CDU routinely. I suspect that is due to the fact that CDU expertise and equipment is so scarce, but it may be because they judge the added benefit would be marginal, though that idea seems strange to me.

I'm curious what the JHU staff will think of your CDU results (and what they think of CDU as a technology for active surveillance).

Take care and I hope you will keep posting,

Jim