Update on A/S

Hello Roy (Fleet ) 

Thank you for a detailed and encouraging update - you are doing well to stay on AS with a PSA in double figures, however if you and your consultant are happy long may it continue.

It's a positive post and I hope help others who chose this path on their personal prostate cancer journey.

Best wishes - Brian.

Thanks 

Hello Roy

I'm glad you're doing well. Coincidentally I also received my MRI report yesterday after a 4 week wait. 

Luckily my MRI was good. No progression since 2 years ago. Still PIRADs 3.

All the best.

David 

Hi David 

Good to hear your mri was good the 4 week wait is sometimes the worse. 
Your similar to me and it’s good you’ve been on a/s for 9 years, what’s your psa levels now?

Having psa levels over 10 is slightly concerning but as consultant told me my fluctuating psa levels could be down to having enlarged prostate. 

Being on a/s as long as you have gives encouragement for many others that a/s is an option that should be given serious consideration. 

Allthe best to you also 

Roy. 

Hi Roy

My latest PSA was 8.1. That is high but the consultant wasn't concerned because the MRI was Ok. The high PSA could be due to prostate inflammation, from which I have suffered since my 38 core biopsy in 2017. I have not had any more biopsies since then.

I agree with you that active surveillance should be seriously considered by anyone with a low risk cancer who has been offered it. When I was first diagnosed with pc in 2017 my initial reaction was just get rid of it. I was offered surgery and I almost had it. However I read hundreds of posts on this excellent site about people's experiences and I chose active surveillance. 

Sounds ok Fleet

I was on AS for 4 years and started treatment when PSA and tumour had reached a certain level.

Could be just worth checking on tumour size in mm as u don't want anything too large not that I'm saying it is.

As long as they/you keep monitoring PSA and MRI everything looks fine.

All the best

Steve 

Hello Steve (Grundo ) 

The NICE Guidelines for AS are here at 1.3.14.

NICE Guidelines - Prostate Cancer.

You will see the specific instructions for an MRI scan are:

* Between 12 - 18 months on AS

* At any other time there is clinical concern or a rise in PSA.

You can ask for one but you are lucky to get one on a regular basis.

Best wishes - Brian.

Thanks Brian

Best wishes 

Steve 

Hi Steve 

Ive tried finding out tumour size but can’t see it on biopsy or mri , I spoke to consultant last year and took notes , my notes say tumour size is 1cm but I might have been confused at the time and got that wrong. 
I see 2 nodule readings on biopsy is that anything to do with tumour size. 
Hope you’re keeping well Roy. 

Hi Fleet - the journey you describe is not unlike my own.  In March 2022 at age 74 with a PSA of 10.93 I went through the usual process of MRI and biopsy at my local hospital and was diagnosed as "best regarded" Gleason 3+4 and offered, as usual, treatment radiotherapy or surgery.

I got a second opinion (essential) at the Christie in Manchester where, having viewed the slides, the pathologist said the 4 content was minimal and therefore "best regarded" as Gleason 3+3.

I've been on AS since then with three further mpMRI scans showing no change in the prostate and fluctuating PSA levels between 10 and 16 which include spikes because of UTIs at the time.

I should also point out that I have a very large prostate of 94cc which accounts for much of the PSA.  Indeed, my average PSA density is 0.12, well under the threshold of concern.  PSA density is a very important measurement in prostate cancer and often overlooked.

Gleason 3+3 is very low grade (some experts now even say it isn't even cancer) and rarely progresses.  You don't mention your age but I'd certainly suggest stay on AS which is becoming more and more the norm for our grade of cancer.  In your situation you can take your time and there are several treatment options available if you feel that's best for you.

Kind regards.