Active surveillance plan

[Mufj]

Hi All-currently on Active surveillance

summary

DX 4/18 1/12 G6(5%) initial PSA at DX-4.3,DRE-nodule, MRI-piRADS 2 nofocal lesions BPH identified, 2nd DRE(penn med) slight induration.

PSA basically flat running between 3.0 and 3.5-see signiture

2nd BX 6-19 15 cores all negative, 2nd MRI 1-20 no change, DRE(1/20) slight induration

path forward biopsy 6-20,PSA every 3 months

note original biopsy done by NJ urology but switched to Penn Medicine(any comments about Penn appreciated)

Writing the cause just had urology appt with the RN(she was way better at explaining thing in a manner that made sense than anyone I dealt with) of a urologist(one who did 2nd biopsy) who practice specializes in oncology.

Previous appt were with a general urologist who had a different opinion he wanted MRI 6-20 not biopsy and PSA every 6 Mo

So my preference would be to do just the MRI given the fact that there are no markers indicating a problem and eliminate or defer another intrusive biopsy(had no problems with previous biopsies). The RN told me there practice is to do at least 3 biopsies after which they will decide to just stick with MRI and PSA, spread out biopsies in some way or stick with annual biopsies with MRI. This assumes that there are no negative developements. I dont wnat to be sloppy and miss something but biopsies are intrusive and have risk so would like to avoid them

Also is it common to visit with an RN instead of the DR. Do like her cause she listens and explains well so far. Figure the urologist is reviewing all that is goin on. The first urologist at penn did not seem to be totaly on board with active surveillance(old school). Probably ready to retire??. Also he was diagnosed with melanoma(a bias here)

Will have a further question about BPH later but dont know if this is the right forum??

So any comments deeply appreciated

sorry bout being so long winded, I know most here have far more serious issues to deal with and I feel for them but in spite of many problems we do live in miraculous times where we can so easily share our experiences with a broad spectrum of people

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Monitor freePSA as well, if not already doing.

[Tall_Allen]

No biopsy sounds right to me - that follows the MSK protocol. If you take finasteride for your BPH, that seems to increase the probability that no PC will be found.

[Mufj in reply to Tall_Allen]

So youre saying that skipping a biopsy in june and spreading out biopsy with MRI in between sound right to you. would you be doing any blood test cuh as 4k or PHI in addition to PSA

Regarding BPH-my symptoms are mild but do empty the bladder. Had one of their flow test but did not know in advance and probably did not have a full bladder and had just finished drinking coffee which can make me erratic. flow test was a probelm but probably at my worst. they are recomendingTamsulosin. But there is a concern with someone who may need cataract surgury which is definitly in my future(several years out. Would diet change be a good first step before going on meds.

Thanks much for youre comments

[Tall_Allen in reply to Mufj]

Your negative biopsy makes the risk of finding significant PC on a f/u biopsy very small:

ncbi.nlm.nih.gov/pmc/articl...

I like tracking with PHI rather than PSA, and considering your BPH, it might be a good idea. Unlike cutting PSA in half, I'm guessing that finasteride would reduce PHI by the square root of 2 (1.414).

Cataract surgery is still possible - just let the surgeon know. I don't think diet or supplements will do anything useful, but it may give you more of a sense of participating, which is important on AS.

[Mufj in reply to Tall_Allen]

Thanks much for the link

Regarding diet was think about affecting bot

Can deal with symptom at this time so may defer meds but prob0ably will eventually have to do. Increased risk for cataract surgery concerns me

Or am I making too big a deal out of it

Sent a note to my eye doc waiting to hear

Thanks again

[Tall_Allen in reply to Mufj]

Floppy iris syndrome is not an exclusion for cataract surgery - it's just something the surgeon should be aware of when operating.