On Active Surveillance since August 2017

[Hope4Happiness]

Hi folks -- I've been on active surveillance since August 2017. My fifth biopsy (!) revealed Gleason 6 in two cores. Here is my current info:

Age 52 at Dx - 8/17 (5th biop); MSKCC-NYC

2 of 14 cores: Right base medial, G6, 1%, 0.1mm; Right apex medial, G6, 3%, 0.5mm

6/17, Pre-biopsy: MRI - PI-RADS 3 - hypointensity in peripheral zone; no dominant lesion or adenopathy

Prost. vol. 43cc

PCA3: 29

PSA at Dx: 6.19, fPSA: 23%

PSA, 2/18: 6.06

Confirm. biop. (4/18): 1 of 14 cores: Left apex medial, G6, 2%, 0.3mm

PSA, 8/18: 6.41, fPSA: 22%

My journey has been pretty long so far. I've had a high PSA (above 4) for about 10 years since I was in my 40s. I had biopsies in 2009, 2010, 2011, and 2012 -- they were all negative. I was not diagnosed until August 2017 biopsy. I then had a confirmation biopsy in April 2018, and that revealed Gleason 6 in one core of 14.

The docs at Sloan Kettering in NYC think my case is best for active surveillance at this point, and I agree.

I welcome all comments and questions. Thanks, and good luck to you all!

[Hidden]

I like your numbers.

[den44]

Hi. Out of curiosity, why did you have 4 biopsies between 2009 and 2012? Based on a PSA doubling time of about 2 years, in 2016, I had 2 biopsies and in each one, there was 1 core with less than 5% Gleason 6. Here is my history:

PSA - May 2014 - 2.1, Oct. 2015 - 3.4, April 2016 - 4.0, Oct. 2016 - 2.5, April 2017 - 2.9, Oct. 2017 - 3.4, May 2018 - 3.5

Age 69 - Active Surveillance

Prostate: 54 grams

TRUS Biopsies: May 27, 2016 & July 29, 2016:

May 27, 2016: Gleason 7 (3+4) in 1 core, less than 5%. Dr. Epstein (John Hopkins) pathology review - inconclusive. MSK pathology review - Gleason 6.

Yes, three different pathology opinions.

I had scheduled surgery based on the Gleason 7 (3+4) report from the first pathologist. I cancelled it when I received Dr. Epstein's report. The first pathologist then decided to send the slides to Sloan Kettering for a third review.

July 29, 2016: Gleason 6 in 1 core, less than 5%. 3 Pathologists agree.

I can't have an MRI because of my defibrillator. Two years ago, I had a consult with Dr. Edhaie of Sloan Kettering and he agreed with AS and said that I should have another biopsy in 2-3 years. Since that consult, I've had several PSA tests and my PSA has stabilized. I'm hoping that it stays level. I will see my urologist in early November after my next PSA test. I also have an appointment scheduled with Dr. Ehdaie for another consult. Based on my next PSA, I'm hoping that I can delay the next biopsy.

Based on everything I've read, statistically, I will die of something other than prostate cancer. Because of this, I'm thinking of not having any more PSA and biopsies. I will discuss this with my doctors.

Mitch

[Hope4Happiness in reply to den44]

Hi den44:

Thanks for your response.

When I first had my PSA read in my early 40s in 2008 it was 2.0. A year later, it came back at 4.75, which prompted my first biopsy. After that biopsy came back negative, the doc at that time had me on a very strict schedule for PSA readings and it was up and down every few months. I guess given my age, the doc didn't want to take any chances, and called for a biopsy each year... In 2018, with the advent of more precise MRIs, that probably wouldn't be the plan of action anymore.

[den44 in reply to Hope4Happiness]

What doctor(s) have you seen at MSK?

[Hope4Happiness in reply to den44]

From 2010 until 2017 diagnosis - Dr. Sogani.

From 2017 diagnosis / AS program - Dr. Ehdaie

My first two biopsies were not performed at MSKCC.

[den44 in reply to Hope4Happiness]

I saw Dr. Ehdaie 2 years ago when I first learned I had prostate cancer. I have an appointment to see him in November after my next PSA test. I have a local urologist in NJ, however, I go to Dr. Ehdaie for consultation(s). If MSKCC was closer, I would consider using Dr. Ehdaie as my urologist.

[Umpire20]

I have been on Active Surveillance for Gleason 6 since diagnosis at age 59 in November 2006. Doctors work for YOU!

[Darryl Partner]

There will be SIX doctors from MSKCC presenting at the NYC Prostate Cancer Patient Conference, including Sigrid Olsen on AS, on Oct 5. Please get your tickets to this now...it will sell out! Click here: eventbrite.com/e/prostate-c...