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Hello Cru08 

PSA 8.7 and age 52. Those who know me know I am not a fan of AS (the cancer isn't going to fix it's self is it?), so I would be looking at the options offered as at 52 you are fit and well able to cope with treatment. I would make as list of how RT and Surgery would affect me and my family and the pro's and con's of each treatment. Use trusted sources for your research, Macmillan, Prostate Cancer UK and Cancer Research UK (not Dr Google).

I do hope this helps - feel free to ask any questions.

Best wishes - Brian.

Thanks Brian, really appreciated, I have read so much on this forum about AS and their journey, I must say I am apprehensive about going down this route, I've heard the consultant saying it's slow growing etc but who really knows, however my consultant was very much an advocate of this pathway...I have gone private and at this stage have only had the opportunity to speak to the consultant 

Good Morning Cru08 

It's a hard choice but since I have been around here I have had a couple of Community Members go from AS to Gleason 9 or incurable.

I am very much a fan of "get it sorted - before you can't".

Keep us posted please.

Best wishes - Brian.

Hello Cru08 . This is one of the most difficult decisions to make and very often you don't have all the information on which you are supposed to make an informed decision. I found this video useful to guide in the questions you need answers to.

https://pcri.org/news/2023/4/30/347-prostate-cancer-active-surveillance-vs-focal-therapy-mark-scholz-md-alexscholz-pcri

My husband went from having AS for several years with ASAP and PIN (pre cancerous) to suddenly developing a Gleason 9 incurable cancer. OK this is rare but it is a salutary lesson that the unthinkable can happen. Like Brian, I think that once you get into the Gleason 7 grading then some form of treatment is called for but that treatment has to be one that you can live with. You have time to investigate all your options and to get a second opinion from a centre of excellence if necessary. 

Hello Cru08, yes, it’s a really difficult decision to make. I have read Millibob’s and Always Hope’s reply and thought I ought to add our experience to give you a different experience to consider.

my husband was always known as high risk due to his family history of early breast cancer on his mother’s side and prostate cancer on his fathers. He is now 77. So, he started having PSA tests in his 50s when they were less common and when biopsies were hit and miss through the back passage and risked sepsis. Biopsies were not done after a scan either - increasing the risk of missing any cancerous parts of the prostate. We watched his PSA creep up over the years. He was told there need not be any action until his PSA reached 10 - which it did in 2022 when he was 75. By this time, diagnostics for PC had drastically improved and he was diagnosed at stage T3a N0Mo. Because of his age he was recommended HT and RT with ‘the intention to cure’

active surveillance in its present form of regular scans etc was not available to him. We suspect his cancer had been present for many years given his PSA increases. We also think that with recent diagnostic improvements, treatment would now commence much sooner than it did for him. That said, we had, perhaps 10-15 years in which we could travel, in which he was symptom free and we enjoyed welcoming new members into our family and pursued our interests with few cares! 

on the downside. He was Gleason 4+3 and from the scan they were not sure whether the tumour was pressing against the wall making it bulge or had pushed through the wall. The ‘intention to cure’ was not a guarantee of cure. He was also a lot older and had developed other health problems to complicate matters. We will never know whether or not he would have tolerated the treatment better at a younger age and would have stood a better chance of complete cure.All I can say is that, unlike some lucky guys, he really struggled with the RT and HT - and so did I as a consequence! But, that said, he is still here and that is what is the most important!!!!

So, it seems to me that there is no perfect answer to your dilemma. Some prostate cancers are so slow growing that there is a risk of over- treatment. Others can suddenly become very aggressive and early treatment would have been better. The more I learn about PC is that treatment of it becomes more an art rather than a science and dependent on the experiences of both patient and doctor who should be  working in partnership. 

I do think it’s really important to do your own research, listen to your medical team and, most importantly, make the decision that feels right for you once you are fully informed. Whichever way you decide to go, you will find that nobody here will judge you or criticise in any way. What is right for one person is not necessarily right for another and we all respect that. Good luck!

Hi Cru

You have had some good replies so down to u really but I'll just say a couple of things

I was on AS for 4 years and it went ok but U do need to monitor it and get regular MRI as well as PSA.

A good argument that once u have pc then get the treatment over with however there is at least one person on here who has been on AS for about 7 years and still no treatment needed so it does happen but probably not that often

Your tumour size is low and I presume your PSA is under 10?

So u could keep on AS for a while but closely monitor which can be a bit of hassle, also the cancer centre would have to agree to a MRI at a minimum yearly.

Best wishes 

Steve 

Hello. We initially went private in order to get the results quickly. We then got abit lost in the system when we opted to go under the NHS as the treatment was the same and the private consultant was the same one we were then under in the NHS. My advice is to keep asking for advice as to why the consultant is making the decision they have. Don't be fobbed off and ask for clarification if you don't understand something. Good luck.

Hi Steve

Many thanks for the reply, current PSA level is 8.7 and tumour size 2.5mm at this stage they have stated blood tests every 4mths and a MRI annually 

Cheers

Colin

Sounds ok Colin, 2.5mm obviously small, good they are doing MRI annually.

Good luck

Steve