Active Surveillance and a New Wrinkle
Last updated: September 2019
As I have written in previous articles, I was diagnosed with prostate cancer in March of 2017. Given a PSA of 7, a Gleason score of 6, no more than 12% cancer cells in any of my twelve biopsy cores (the rest were 7%, 5% and 3%), and with an abdominal scan and a full body bone scan indicating that my cancer was contained, I chose active surveillance as my treatment. My doctor recommended surgery, but, without further investigation of the options available, I wasn’t ready for that option.
The active surveillance plan was simple. I would have quarterly PSA tests to track any increases and digital rectal exams to detect any changes in my prostate. At the end of one year I would have a second biopsy to determine by that method if my cancer was becoming any more aggressive. At any time during the year, my doctor assured me, I could request a change in my treatment plan; that is, have surgery.
During the first few months of my treatment, the results were good. My PSA dropped to a 6.031, no abnormalities were detected in my prostate, and I wasn’t experiencing any symptoms that would indicate any change in my status. I started to research the other treatment options available, focusing on surgery and the varieties of radiation, educating myself about the procedures and the side effects.
I joined a PC support group that has been ongoing at my local hospital for over fifteen years, one of the best choices I made, because I have benefited immensely from hearing about the unique journeys of each man in the group. Participating in the group ramped up my research, particularly about radiation and where it was offered, and about the imaging available to help guide biopsies and radiation. I remained comfortable with my choice of active surveillance.
A change of plans
However, my most recent PSA, in January, jumped to an 8.3. That sudden increase flipped a switch in my mind, made me realize that I might soon have to choose a more invasive treatment plan. My doctor and I scheduled a biopsy for March 7th with results available on the 14th.
Within days of my last appointment, realizing how much more time I was spending thinking about my cancer, I reached the conclusion that I would seek further treatment. With that thought in mind, I’ve scheduled another appointment with my urologist to precede my biopsy. I want to discuss my options and find out if another biopsy is necessary. If I choose surgery, there seems to be no point in having the biopsy, but the results might be helpful if I choose radiation.
Continuing the journey
All of my research leads me to believe that radiation is a better choice for me than surgery. In my support group, which includes men who have been attending conferences and tracking improvements in technology for the last fifteen years, each of the men who previously chose surgery said they would choose radiation if they were diagnosed today. In one-on-one conversations with friends, some of whom had surgery and some radiation, each came away feeling comfortable with his choice and outcome. Bottom line, it is a personal decision each prostate cancer patient must make, hopefully with support from his doctor and his family.
In addition to all I have learned, I value through this process blowing up the prevailing attitude “out there” that having prostate cancer is somehow not a big deal. It is a big deal, a very big deal. It changes one’s life forever. I will continue communicating my journey on this site after I get the results of my biopsy if I have one.
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