Dad - Active Surveillance

Hi

I am sorry to hear your father's news. Unfortunately any diagnosis of cancer is life changing. 

Active surveillance can be a good option for prostate cancer when the patient has a low risk prostate cancer. Low risk usually equates with being low grade and slow growing. Usually it will also mean the cancer is small and localised within the prostate.

Active surveillance involves regular monitoring of the cancer through PSA tests  and possibly  MRI scans. If the cancer begins to grow or become more aggressive, treatment such as surgery or radiation therapy may be recommended.

if the cancer remains stable, the patient can avoid unnecessary treatment and its associated side effects. It is very fortunate to have this option as it does not preclude the possibility of falling back on one of the other options at a later date.

For what it's worth I am 62 and diagnosed at 61, I did not have the option of active surveillance and had to move to treatment.

It sounds like your Dad is one of the more fortunate in that the cancer has been detected early and is low grade. With a low grade cancer being monitored, which will probably only require a blood test and PSA check, 3 or 6 month intervals  will make no significant difference either way as the cancer will be slow growing and is unlikely to change significantly over such a short timescale. Moreover there are other factors which can distort a PSA and cause it to fluctuate over the short term. Remember if it brings certainty and consolation, a second opinion is always an option.

Good luck. 

Rens

Hi I've been on active surveillance for two years now and in that time I've had blood test in the first year every 3 months and MRI with my PSA in the 5 marker then the second year have blood test every 6 months another MRI which showed no change 

Hello, because of a strong family history of prostate cancer my husband has been having PSA testing for many years. He did not have MRI scanning etc because in those days the first action was the old fashioned Truss biopsy which was more risky and less reliable. His PSA has always been just over the top limit for his age and the recommendation was that action should be taken when his PSA reached 10. It achieved this unwanted figure in July 2022 when he was 75. The cancer was bulging against the prostate wall with a concern that the cancer might have broken through. He had no symptoms at all and no secondaries. He was steered down the radiotherapy and hormone therapy but surgery was not dismissed. he had the Rt and HT.

so in all those watchful waiting years we just got on with life - travelling , enjoying our hobbies and children and grandchildren - quality time with no side effects of treatment etc.

the treatment has not been easy - especially the hormone therapy. That said, he seems to at long last be adapting to the lowered testosterone. 

So, looking back as we are and forward as you are, we had many trouble free years at an age when we could do whatever we wanted - no worries about ED , incontinence etc. but, would he have tolerated the treatment better at a younger age? We don’t know. Would earlier treatment have had a chance of being more successful? Again, we don’t know because we are just 6 months out of radiotherapy. We are told he was treated with the intention to cure but there is a lingering concern this might not be the case but would that have been the same situation some 10 years ago? We don’t know. I found an in line calculator last year. You can key in age and all diagnostics and it calculates your chances of survival. At age 75 with treatment my husbands chance of surviving prostate cancer for 10 years was 98% ie to age 85. Given the life expectancy for men in this part of the country is something like 82 years we will take that! Of course, statistics are for the population as a whole not for one person!

so, the real answer seems to be that there are no guarantees . The important things are that your Dad reaches his own informed decisions about what feels right for him.  Treatment now in the hope of getting it over and done with but having side effects which may or may not be more severe and longer lasting than he wishes. Or treatment in a few years potentially after some good quality of life but would be that much older to withstand the treatment but will have enjoyed some years of quality life - albeit having the nuisance of regular testing.

Apologies for the bold font - I don’t know how to get rid of it! Also I wish you, your Dad and all your family the very best whichever way your Dad chooses to go

Hi WW

Cracking and informative post as ever.

(When posting to remove bold - click on Format at the bottom and then "clear formatting" - you must have clicked on "bold" without realising!)

Best wishes - Brian.