I am 62 with type 2 Diabetes managed with diet and exercise but otherwise pretty healthy. My journey was similar to others. My PSA had risen over the past couple years during annual physicals. My family Doc referred me to a urologist after my PSA reached 5.5. The Urologist recommended a 4K test first to see if a biopsy was warranted or if I could wait. It came back with a score of 17 which means a 17% probability of cancer. Therefore, I decided to have a biopsy in late October to find out for sure.
My biopsy showed Gleason 6 in five of 12 cores and low involvement. Like everyone else I was rocked when I got the news. My local urologist recommended surgery and a friend who is a Radiation Oncologist recommended radiation (Brachy or EBRT). I also had an MRI which showed one lesion with PIRADs 3 and no evidence of involvement in the neurovascular bundles, seminal vesicles, lymph nodes or bones. My urologist recommended a Prolaris test to see how aggressive the cancer is and it came back a little outside the range (3.6% DSM) recommended for Active Surveillance.
I had a consult with my RO after the MRI and Prolaris report and the first thing he said when he walked in the room was, "Well it looks like Active Surveillance is out." His comment seemed odd considering the Gleason 6 and MRI so we did more homework. We also had a consult with another local urologist who recommended surgery (of course). When explaining the options other than surgery he described radiation as "cooking the prostate." That really pissed me off because it was such an obvious ploy to scare us away from radiation.
I did a lot of reading to learn more about my options. The more I learned, the more I became concerned about the side effects of surgery and radiation which can diminish the quality of life I enjoy now. I ultimately found my way to Memorial Sloan Kettering for a consult with Dr. Ehdaie. I read some of his articles and he is a proponent of Active Surveillance. We had a telehealth consult and he said I am a candidate for Active Surveillance and we decided to pursue that path. My next milestone is a follow-up biopsy on June 3.
Since my consult with Dr. Ehdaie I spoke with a friend who had RP in his 50's. He recommended a book called "How Not To Die" by Dr. Michael Greger who advocates a plant based whole food diet. It's a well written book and I recommend it highly. I've changed over to a vegan diet and I've lost weight and feel better. Best yet, my most recent PSA (3.6) is down and in the normal range.
So a few observations and recommendations based on my experience.
First, this forum is outstanding and a wonderful resource. I a very grateful to have found it because I don't feel alone and appreciate the support and information from smart people who have been through this (especially Tall Allen).
Second, TAKE YOUR TIME, DO YOUR HOMEWORK, and DON'T OUTSOURCE YOUR DECISION to others. There will pressure, both direct and indirect, to pursue "definitive treatment." Well Active Surveillance is a definitive treatment! So take control since it's your life and your body. There may well be a time when my condition indicates the need to do surgery or radiation or ADT and I will be ready for that if and when needed. However, I am glad to be on Active Surveillance because it can help preserve my quality of life now. If you're looking for a basic guide to Prostate Cancer, I highly recommend checking out the NCCN guidelines (nccn.org/patients/guideline.... These documents are very helpful and well written resources. Finally, please consider diet and nutrition which can really help your overall and prostate health.
Thanks again everyone. Stay healthy and strong.
On Active Surveillance - Why not non-invasive aggressive approach?
Gleason score change from 3+4 to 3+3 with perineural invasion noted under Active Surveillance 
Active surveillance has ended after one year. RP now recommended.
