Active Surveillance versus Treatment

Hi AH

I think the following words from your link should be noted :

‘addressing the “right management” of prostate cancer patients in the early detection and active surveillance settings’

i take this to mean those whose cancer has been detected, not too aggressive and before spread outside. the prostate. Is that correct ?

Hi Worriedwife .

Yes you are correct. The cohort studied were men with contained prostate cancer but sub divided into low and intermediate to high risk eg. 3+3 vs 3+4 or with aggressive traits. The thing that I got out of the study was that the AS group are increasingly needing active treatment and for longer than those who opted for treatment at initial diagnosis, plus there is double the incidence of developing metastatic disease. One of the main criteria of the trial was overall survival for which there was little difference. Quality of life is still being evaluated. If anyone wants a more detailed look at the results I have attached this link.

www.ncbi.nlm.nih.gov/.../

Yes, that’s what I understood from the talk at our local support group on this research by the consultant oncologist. What the consultant omitted to say was the need to have hormone therapy with the radiotherapy. I’ve not had the time to read the full report- mega busy here! Thanks for the clarification. 

Hormone therapy with radiotherapy is not a necessity but the combination has been shown to have a better control for longer. What this study is good for is quantifying low and high risk factors such as initial PSA below or above 10. Anyone with mainly low risk characteristics is a good candidate for AS. For those with some higher risk characteristics then it is a more difficult decision.

For info, and as has been said it has to be a personal decision, I have been on AS for 2.5 years now, I am Gleason 3/4 and my PsA at diagnosis was 8.0. However, following the biopsy only a tiny amount of grade 4 was found, and my PSA subsequently has dropped to 4.0. I have just had another MRI on the latest 3 Tesla MRI machine and had a call with my consultant, my last PSA was 4.06. We have agreed to stay on AS, keep checking the PSA 6 monthly and have another MRI in 2 years UNLESS my PSA goes above 5.5, at which point we would schedule another MRI. 

Inwould say being on AS is a mental challenge as much as anything but I am comfortable with the situation.

good luck whatever your decision

Thank you for your reply. 

Hi Skeggiered

i just noticed your post. My husband (60) and also was T2 Gleason 6.  First indication was PSA 5.something that he asked to get back in December. After MRI and biopsy he was advised against active surveillance and bravely took the decision to have Da Vinci robotic prostatectomy last Friday.  Ive written more info on my profile. Happy to ‘lend an ear’ if you have more questions.

Wife Winnie 

Morning Winnie I just wanted to wish your husband and yourself all the best after his operation hope everything turns out well at this worrying time for you both sending hugs xxx Robert

Thank you for your reply & good luck for the future. 

Thanks Robert. He’s doing really well. Wounds healing nicely, no major pain and taking it steady.     A friend posted some amazing pics of the northern lights up in Scotland. Hope you saw them!