Blood work for yearly physical resulted in a PSA of 8.3 so my family physician prescribed two weeks of CIPRO. This brought it down to 6.2 resulting in a referral to a Urologist. While waiting for my appointment I read up on PSA to see what the implications were. I understood my chances of having prostate cancer were somewhere around 25%. This left me with a very uneasy feeling.
Because of the length of time to get my appointment with a urologist and not understanding the nature of most prostate cancer, I decided to get a consult while in the states and possibly a biopsy. I ended up getting a 16 core TRUS biopsy that yielded three cores positive for adenocarcinoma, all G6 ranging for 5 to 15% involvement. Shocking news.
The physician in the states said I had time to evaluate my options that included surgery, radiation and active surveillance. When I did get into to see my physician in Canada, he reiterated my options: AS, surgery, radiation. I also got a second opinion here and active surveillance was recommended with the other two option also mentioned. I gave myself a month or so to make a decision and during this time continued to access relevent resources and contact various specialists, many of which were kind enough to weigh in on my situation.
I also contacted Prostate Oncology Specialists (POS) in LA to arrange a consultation as they specialise in PC. They arranged to have my original biopsy results sent to Dr Epstein at Johns Hopkins for a second opinion that resulted in a downgrade of one of the three positive cores to suspicious for but not meeting the criteria for cancer (now 2/16 cores positive). They also noted that a 3T multiparametric MRI and / or colour doppler ultrasound would be important if I chose AS.
Although leaning heavily towards AS, I had second thoughts after discussing my situation with a friend and colleague who was diagnosed at 49 with G6 low volume however was upgraded on surgery to G7.
I finally decided to go the AS route on the basis I was considered very low risk with my PSA density being lower than .15. It would also be subject to a negative MRI, negative CDU and confirmatory biopsy.
I had the 3T mp MRI in New York, the results of which were ambiguous. This gave me source for stress as there were two large "lesions" detected. I found out later that "lesion" does not mean "prostate cancer". I got second opinions on the MRI, both of which indicated a negative result. A colour doppler at POS was also negative. This put me more at ease.
My confirmatory biopsy was scheduled for late Sept, and went as good as can be expected. It was 12 core trus and focused on the suspicious areas with additional cores at the anterior area. Results came back with one core positive at 10% G6. My PSA was 4.3, down from the 5.6 at diagnosis.
I then realized that over the previous 7 months, I had spent significant time on this (and justifiably so), however I realized I could not devote this much effort on an ongoing basis. I had made my decision and it was time to move on, striking more of a balance. I continued to stay on top of my AS program, basically acting as quarterback and as long as I was still within AS criteria for low risk I was comfortable. My latest PSA in June 2015 was 5.8, up a bit but not a concern yet.
I would be remiss not to thank the organizers of this site. It has been one of my go to resources as it represents unbiased views from prostate cancer survivors and I cannot thank them enough.
The remainder of 2015 was uneventful with regular PSA tests every 3 months. I continued to monitor available resources for updates on relevant aspects of my journey...particularly making sure that a higher grade cancer was not missed and trying to decide what might be the best treatment when the time comes as I view AS as "buying me time".
In January 2016, my PSA test came back at 7.9 (a noticeable spike) however I felt what I thought was pain my perineum area. My Rad Onc suggested it was temporary and to wait until next PSA (I thought he would prescribe CIPRO). I started taking Celebrix for its anti-inflammatory properties. Next PSA was 6.7 so it came down however the overall trend is up.
I was coming up to my 2 year anniversary on AS so I figured the prudent action would be to have another biopsy. I met with my urologist who agreed but suggested to make it targeted as we knew from the two previous biopsies where the positive core(s) were from. Within two weeks I was in for my third biopsy and I got the results back a few weeks later.
To our surprise, there were no positive cores....negative. There were however two cores that were noted as ASAP by the pathologist. My Uros view was that this was good news. His recommendation was to start taking a 5 alpha reductase inhibitor to stabilize my PSA with the upside that there is mounting evidence that it slows the progression of prostate cancer. One of Snuffy Myers videos also mentions this.
In the path report, he noted that he was seeking a second opinion on the ASAP so I am waiting to hear back before I decide. If no bad news then I will start on Finisteride as its half life is short (so if I am having adverse side effects they should disappear right away after I stop taking it). I will update when I get the second opinion on pathology report.
Since my last update, I received the results of the 2nd opinion on the two ASAP cores and one ended up being 5% Gleason 6. So all in all I am not surprised and it appears that progression is slow. My PSA is now consistently between 6 and 7 so the trend is increasing albeit slowly. My PSA was 3 when I was 49 do the doubling time is around 7 years. It's coming up to 4 years on AS and I am very comfortable with the choice I made. I am still reading any updates on the various AS programs at medical institutions around the world. They are starting to get longer term data now which is consistently supporting AS as safe, even for young men.
I will probably go for another biopsy in two years from now. I haven't exactly followed the strict diet I promised myself I would follow when I started AS however I am planning to and will see if it translates into a lower PSA. Next PSA in a couple of weeks.
Greg's e-mail address is: greg.mckenney AT bellaliant.net (replace "AT" with "@")