My primary doctor referred me to a local urology group due to an elevated PSA of 4.3. A 14 core biopsy was performed showing PC in 3 cores (2 <5% & 1 <10%). All with a Gleason 6. Stage T1c.
Following my biopsy results the urologist stated "We caught it early. You have time to decide on treatment.", but within 30 seconds he was trying to have me set-up appointments with their cancer treatment group for either radiation or surgery. He said that Active Surveillance (AS) was not recommended, as they follow NCCN guidelines.
My wife and I were both in shock and needed time to regroup. We were uncomfortable with immediately committing to a treatment. We went home and started our research. We took time to read this wonderful site, reviewed the NCCN guidelines, went to many PC sites on line, and talked to everyone we could that had experience with PC. We decided to seek out as much info. on my specific PC, first, before deciding my treatment plan. This included the following:
1. Made an appt. at a local cancer research institute. Met with 2 doctors who reviewed my previous biopsy slides. Both doctors felt that AS would be OK, but the urology staff, as a group, felt the best treatment was surgery as they also follow NCCN guidelines.
2. My wife, who is an RN and researched extensively (I'm so lucky!), felt I should have an MRI done to better evaluate the extent of my PC. No doctors at this point had recommended an MRI.
3. Decided to seek a third opinion based on advice from a family friend who worked for a well-known urologist. He is the chairman of the urology department at a local university medical center. We were immediately impressed on how thorough and knowledgeable he was. He recommended I have an MRI with a follow-up fusion biopsy 3 months after my last biopsy.
4. Prior to the MRI I had a repeat PSA (4.8) and a Testosterone Level (normal).
5. MRI revealed a hotspot. 12 core fusion biopsy performed in hospital the next day. Results showed 2 positive cores (<5%), each Gleason 6. The hotspot was also biopsied and revealed 2 of 3 cores positive (<5%), each Gleason 6.
We followed-up with the urologist who suggested we speak with one of their top surgeons for his opinion, as well. However, my urologist supported AS as a viable option.
We met with the surgeon to discuss the pros and cons of surgery. To our pleasant surprise, he recommended additional testing be done to determine if my PC is aggressive or slow growing. This is a new genetic test that many hospitals and doctors are now starting to use. The test is called Oncotype DX by Geonomic Health. (Great article in the Wall Street Journal on May 10, 2016. I can give anyone a copy if they need it.)
I had very positive results which downgraded my PC from low risk to VERY low risk. This test confirmed my decision that AS was the best option for me.
Since this test (March 29, 2016), I had a repeat PSA in June -3.9
My doctor has recommended PSAs & DREs at 6 month intervals, and repeat MRIs (possible biopsy) every 18-24 months if nothing before that changes.
As this site says, do your homework, study and research, because every man's PC is unique. Don't make quick decisions on treatment if you have time. Finding a doctor you feel comfortable with is critical.
PSA checked on September 6, 2016 is 3.8. Follow up with my urologist who performed DRE and checkup. Supporting my decision for AS and recommended PSA and exam in 6 months. Feeling blessed.
PSA was checked on March 6, 2017-3.8. Phone call from NP from my Urologists office who said "no need to come in, follow up PSA in 3 months." Living near Buffalo, NY fortunate to have many great doctors and medical facilities.
Dan's e-mail address is: email@example.com