It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Cancer: Prostate Message Board

  • Active surveillance

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 10-09-2007, 08:03 PM   #1
    Harry57
    Newbie
    (male)
     
    Harry57's Avatar
     
    Join Date: Oct 2007
    Location: Austin, TX, USA
    Posts: 7
    Harry57 HB User
    Active surveillance

    I just ran across this info:
    "Active Surveillance with High Resolution Color-Doppler
    Transrectal Ultrasound Monitoring: "

    This ultrasond probe can give a color view of the cancer in a Prostate so one can determine if the cancer is organ confined. This could help make a dicision to choose "active surveillance" if you could see that the cancer was for sure organ confined. Its the only no-invasive technique that I've heard of to be able to tell if the cancer is Organ confined.

    Has anyone got any other info. on HR-CDU (i.e. High Resolution Color-Doppler
    Transrectal Ultrasound )??
    -Harry57

     
    Sponsors Lightbulb
       
    Old 10-10-2007, 04:47 AM   #2
    Kemahsabe
    Member
    (male)
     
    Join Date: Jul 2007
    Location: Houston, TX, USA
    Posts: 78
    Kemahsabe HB User
    Re: Active surveillance

    Interesting thought. My post-op pathology found two small tumors - one in each side of the prostate. (Biopsy found one.) The doppler ultrasound showed the larger one. The ultrasound tech pointed to a colored spot and said it was "probably" a tumor. Tumors are detected by sensing the increased blood flow. My urologist said there's no guarantee ultrasound will see a tumor. You could try it - it might work. Personally, I wanted the tumor gone.

     
    Old 10-10-2007, 01:40 PM   #3
    shs50
    Veteran
    (male)
     
    shs50's Avatar
     
    Join Date: Aug 2006
    Location: NJ,USA
    Posts: 362
    shs50 HB User
    Re: Active surveillance

    Quote:
    Originally Posted by Kemahsabe View Post
    Interesting thought. My post-op pathology found two small tumors - one in each side of the prostate. (Biopsy found one.) The doppler ultrasound showed the larger one. The ultrasound tech pointed to a colored spot and said it was "probably" a tumor. Tumors are detected by sensing the increased blood flow. My urologist said there's no guarantee ultrasound will see a tumor. You could try it - it might work. Personally, I wanted the tumor gone.

     
    Old 10-10-2007, 02:04 PM   #4
    able5
    Veteran
    (male)
     
    able5's Avatar
     
    Join Date: Jun 2007
    Location: Philadelphia, PA USA
    Posts: 358
    able5 HB User
    Re: Active surveillance

    Regretfully, I never gave "Active Surveillance" a second thought when I was considering my treatment options. I was from the old school of thinking that says, "If it's cancer, I want it out!".

    I sort of wish I had given "Active Surveillance" more consideration. Then again, my only surveillance at this point in time is that I have just one more PSA test with my urologist at the one year anniversary of my surgery and then I return to the regular routine of yearly PSA tests at my family doctor's office. Just like old times! I'm not so sure I would really want the infamous "probe" up my rectum on a regular basis and having blood drawn every 3 months for a PSA test to maintain a watch for a tumor that may or may not be growing inside me. Just the thought of having it still inside would give me concern. But that's just me! That's just my humble opinion. Besides, my post-op pathology came back worse than expected showing both lobes involved (T2c). Unfortunately for me, the TRUS biopsy did not pick that up. My pre-op TRUS biopsy indicated that I was only a T1c. After that false positive experience, in my opinion, there's only one sure way to know your true staging numbers. That's with your prostate gland out of your body and on a pathology lab table with the entire gland sliced up and examined under a microscope.

    That being said, in my opinion, "Active Surveillance" is just as valid a treatment for PCa as all of the other treatments. It's a personal choice and nobody has a right to say their treatment is better than your treatment. If you decide to choose "Active Surveillance", I applaud you for making this choice and hope you'll continue to actively post your progress for those who are having trouble with a treatment decision in the future.

    Best of luck with "Active Surveillance"!

    __________________
    robotic LRP; Jan2007

    Last edited by able5; 10-10-2007 at 05:30 PM.

     
    Old 10-10-2007, 02:12 PM   #5
    shs50
    Veteran
    (male)
     
    shs50's Avatar
     
    Join Date: Aug 2006
    Location: NJ,USA
    Posts: 362
    shs50 HB User
    Re: Active surveillance

    Good advice from kemahsabe. The endo-rectal spectroscopic MRI has been around for a number of years. Memorial Sloan-Kettering has been using it around 10 years for pre-operative imaging of extra-capsular extension or organ confinement. They always followed the maxim of "measure twice--cut once" with as much advance information as possible to minimize surprises in the OR..
    HOWEVER, as they're quick to point out " Absence of evidence is never evidence of absence"' The MRI is far from foolproof in picking up the size and location of the tumor(s) Its complicated because prostate cancer is a multi-focal tumor which means it occurs in clusters of cancer cells in the prostate rather than a singe spot. Thats why the entire prostate must be removed rather than simply excising the tumor as can often be done with breast cancer and other solid single tumor cancers.
    Active surveillance can be risky since a small, early stage ,localised PC can turn aggressive without warning reducing the chances for curative treatment and available treatment options. Its usually more appropriate for the elderly with less than 10 years life expectancy who are more likely to die of other causes.
    Active surveillance requires scrupulous monitoring with periodic PSA's usually every 3 months and annual or semi-annual biopsies plus whatever other imaging the Dr uses. As long as there's an untreated cancer no matter how indolent at initial diagnosis it can turn aggresive and begin to progress in under a year.

    Last edited by shs50; 10-10-2007 at 02:15 PM.

     
    Old 11-13-2007, 03:35 PM   #6
    IADT3since2000
    Senior Veteran
    (male)
     
    Join Date: Nov 2007
    Location: Annandale, VA, USA
    Posts: 2,521
    IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
    Re: Active surveillance

    Quote:
    Originally Posted by BooMan View Post
    Harry, ...those like me with a Gleason sum of 6 or less, no more than 2 cores involved, no more than 50% involvement in any one core (mine are both less than 5%), and a low PSA (2.5). The diagnosis and tissue analysis of this disease are the questionable areas for those of us on this end of the scale. I believe studies have been done indicating that most of us by age 57 (like me) would have cancerous cells found in our prostate if examined during an autopsy if no cancer was previously suspected. Determining the aggressiveness and extent of disease before treatment is an area that needs a lot of study. ... A urologist I saw at Johns Hopkins told me that with my numbers I would not miss the window of opportunity for curative treatment by taking this path. Of course, no one can guarantee that. I'm comfortable with it for now. I'll let you know how the biopsy goes next month.
    BooMan
    You seem very well informed for a new patient, or have you been on active surveillance for years?

    Active surveillance sure would not have fit my challenging case, but I have been learning about it for friends. I've been amazed at the number of major, very well known cancer centers in the US, in Canada, and in the Netherlands that have vigorous active surveillance programs in progress, at least two of them involving some of the leading prostate cancer surgeons in the world.

    I have been very impressed with the effectiveness of these programs in selecting appropriate patients, maintaining diligent surveillance, and moving them to hopefully curative therapy if their cancers show unacceptable signs of aggressiveness. By the way, I think using color Doppler ultrasound for a biopsy is a great tactic for someone on active surveillance, especially to ensure that an otherwise mild cancer does not chance to be located in a strategic location that makes it dangerous. I hope the active surveillance programs will start emphasizing CDU; at the moment, I don't think any of them emphasize or even use it. You mentioned Johns Hopkins, and I recall that a leading doctor in that program recently said or published that about half or more than half of patients in their active surveillance program were still on active surveillance, and he also said that for those whose cancer proved too aggressive and who had elected surgery, none had cancers that penetrated the prostate capsule.

    We are under tight restrictions here on what we can cite on the web, so I will just mention general locations for leading programs that I have learned about: Toronto, Baltimore, New York City, the Netherlands, Houston, and San Francisco.

    It is also worth mentioning that active surveillance has been a major emphasis in some of the key medical association conferences this year. The conference for the medical oncologists association had three presentations/papers on active surveillance of just twelve total papers in the section of their Education Book on genitourinary cancers this year for their annual meeting. The Education Book is the key information that medical associations want to communicate to their members. Vu-graphs and audio recordings of the talks are on the web.

    The IMPaCT conference, involving about 600 researchers sponsored by the Prostate Cancer Research Program arm of the Congressionally Directed Medical Research Program over the past ten years, as well as other leading researchers and about 100 survivors who had served for two years or more on proposal evaluation panels, was held in Atlanta in September. Many renowned researchers were there; it was a premier event. It too devoted a plenary session to leaders of active surveillance programs, including a panel member who had also given a presentation I found highly informative and encouraging at the medical oncologists conference. (I did not attend the latter, but I studied the material on the many pages of material from his talk and heard the talk on the web.) I don't believe material from the IMPaCT conference has made it to the web yet, but that is in the works. (IMPaCT: Innovative Minds in Prostate Cancer Today)

    Active surveillance also came up at this year's National Conference on Prostate Cancer 2007, held in September in Los Angeles. (A couple of years ago, a leader of the Johns Hopkins active surveillance program had given a presentation to the 2005 national conference in Washington, DC. He might have been the doctor you mentioned.)

    It's encouraging that the major centers are homing in on the best way to select, monitor and support patients on active surveilliance. Some are emphasizing diet/nutrition/supplements, exercise, stress reduction, and mild medication in support. For instance, at least one or two of the programs are now or are about to use one of the mild 5-alpha reductase drugs (finasteride or Avodart) to help prevent progression of the cancer and to improve monitoring results.

    My hat is off to you for having the guts to follow this course and be comfortable (more or less) with it. It's certainly not for everyone or even most of us, but it looks very promising for a large group of patients with a priority for preserving quality of life and avoiding side effects of major treatment, as well as gaining time for additional treatment breakthroughs to occur or a cure to be found, while still maintaining high confidence that the cancer does not escape the potential for cure should it prove aggressive.

    Take care and good luck,

    Jim

    Last edited by IADT3since2000; 11-13-2007 at 03:39 PM.

     
    Old 11-14-2007, 01:25 PM   #7
    shs50
    Veteran
    (male)
     
    shs50's Avatar
     
    Join Date: Aug 2006
    Location: NJ,USA
    Posts: 362
    shs50 HB User
    Re: Active surveillance

    For whatever its worth, Sloan-Kettering's prostate cancer specialists have a rule of thumb for "Active Surveillance". Their experience indicates that when the PSA exceeds 10 after a cancer diagnosis there is a 50/50 chance it has begun to spread.

     
    Closed Thread

    Related Topics
    Thread Thread Starter Board Replies Last Post
    Active Surveillance for Prostate Cancer: Age of the Patient IADT3since2000 Cancer: Prostate 22 09-23-2010 06:01 PM
    Effectively preserving curative options - Active Surveillance for Prostate Cancer IADT3since2000 Cancer: Prostate 14 12-15-2009 06:24 AM
    Active surveillance Eventod Cancer: Prostate 9 06-26-2009 12:00 PM
    Considering Active Surveillance for low risk cases - overcoming abhorrence IADT3since2000 Cancer: Prostate 7 05-26-2009 01:56 PM
    Active Surveillance - a sound option for truly low risk men IADT3since2000 Cancer: Prostate 30 03-02-2008 04:39 AM




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 11:35 PM.





    © 2020 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!