Active Surveillance?

[ironmanburg]

Hello everyone, I am 72 and have been on active surveillance for prostate cancer since I was diagnosed in August 2021 but probably had it prior to my first MRI in 2020. I have had 2 biopsies and 5 MRI's and countless PSA tests. First bx showed 3 cores at 3+3 and 2 cores suspicious, confirmatory bx a year later showed 1 core at 3+3 and 1 core suspicious. My PSA has risen from 3.9 in 2018 to 12.7 and back to 11 this year. My previous MRI's showed a bladder outlet obstruction and BPH and one probable subcentimeter utricle cyst rated Pirads 2, the latest MRI report showed the probable subcentimeter utricle cyst as Pirads 3 (grew a bit) and didn't say anything about the bladder outlet obstruction or BPH. All surrounding areas were fine. When I saw my Urologist I brought this up and he had no answer for me other than to say I moved up to an intermediate unfavorable risk since my PSA was up. Said the size of my prostate was borderline enlarged anyway. I suggested that maybe riding my bike 5000 miles a year for over 20 years may have something to do with my rising PSA since the prostate may be in a constate state of proctitis and he had no answer. Of course he suggested a prostatectomy which I am not going to do at this point. I have no other symptoms, I train and compete in Ironman triathlons, eat a Vegan diet and get plenty of rest/sleep. My question is, has anyone else have a similar journey and where did you end up? Thanks for your time.

[Tall_Allen]

I think you are spot on.

[ironmanburg in reply to Tall_Allen]

To stay the course? I’m going to transfer my care to Moffitt Cancer Center here in Tampa but I don’t want to treat it unless I absolutely have to.

[tsim]

You got one of those skinny seats? I'd lose the bike riding and work in maybe more swimming and weight training for sure(always good for old guys like us, great for bone health)

[ironmanburg in reply to tsim]

I have a split seat that takes a lot of pressure off the prostate area.

[tsim in reply to ironmanburg]

That shoudn't be a problem then. You're in good hands at Moffitt, that's where I had my treatments done.

[Courgetter]

I was diagnosed in 2018 and treated with brachtherapy in 2019. My Gleason score of 3+4 was worse than yours. My PSA score of 5.5 in 2018 is now 0.128. So I think the treatment worked and I have peace of mind that I followed the specialist medical advice. But there's no question that the quality of my life took a hit from the brachytherapy. At 68 I'd like to be fitter and have more energy. A ten mile cycle ride a couple of days ago was pretty tiring. I would say maintain the great fitness that you have now and enjoy your life. And perhaps keep talking to a range of specialist medics.

[ironmanburg in reply to Courgetter]

Thanks. I’m transferring my care to an oncologist at the Moffitt Cancer Center here in Tampa but don’t want to treat in unless I have to.

[groundhogy]

if you want to treat it, heres some data..

Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.

prostatecancerfree.org/comp...

It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.

[ironmanburg in reply to groundhogy]

thanks