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Prostate Cancer- Surveillance Then Treatment

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When a real life prostate cancer patient mirrors the experience of research I am quick to post about it. The combination is a “real world” as it gets.

John Smith (not his real name) lived the article linked and excerpted below for the most part. John’s experience coupled with the article cement three key concepts:

  1. If  you are eligible aka no strong reason to treat can be a good first step for the Prostate cancer patient-
  2. Active Surveillance means that you continue diagnostic testing (surveillance) as well as non-toxic therapies such as nutrition, exercise, etc.
  3. Progressing to therapy may be a logical next step. The longer the patient waits, the better diagnostic testing as well as therapies get. 

Hi Coach- Largely this article does describe my situation.  I set out on the Active Surveillance route after doing a genetic test of my prostate cancerr.  It came back as being 85% likely to be a slow-growing, not aggressive form of cancer.

Throughout numerous biopsies, the tumor remained somewhat stable.  I changed urologists 3 times during the 5-6 years of being diagnosed with Prostate Cancer.

Dr. Shoag, being the latest urologist, used the most up-to-date techniques using MRI that identified “rare, cribriform cells in about 5% of the sample”.  

These cells are considered to be aggressive and more likely to spread outside of the prostate.  Identifying those cells took me from active surveillance to requiring treatment, though, not immediately. I am not sure that this discovery would have been made using traditional ultrasound-guided biopsy techniques used by my previous urologists.   Dr. Shoag went over the various treatment options.  I elected to proceed with the Robotic prostatectomy for several reasons.

My belief is that Active Surveillance was a great first step in my treatment.  Considering many of the advancements that have been made recently in prostate cancer treatments, buying time can be a beneficial step to not only fully treat the disease but minimize any side effects from treatment(s).

I am a long-term cancer survivor living with a host of long-term and late stage side effects. In my experience, quality of life is equally as important as quantity of life.

John is in his fifties. Young as prostate cancer survivors go. I stressed to John the real risk of long term side effects associated with prostate cancer treatments. John took heed of my warnings and worked hard to reduce his risk of ED and incontinence after his prostatectomy.

Have you been diagnosed with prostate cancer? What is your gleason score? Your PSA reading? Let me know- David.PeopleBeatingCancer@gmail.com

I am not anti treatment for prostate cancer. I’m simply saying that each PCa patient should do everything, every complementary therapy shown to reduce his risk of short, long-term and late stage side effects.

Thank you,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Active Surveillance for Low-Risk PCa: Sprint or Marathon?

“The two cases illustrate the complicated truth of active surveillance. For some men, the strategy can prove to be short-lived, perhaps 5 years or less , or a life-long approach lasting until the man dies from another cause…

“Active surveillance is a strategy of monitoring until it is necessary to be treated. For some people, it is very short, and for others, essentially indefinite,…”

Most studies show that roughly half of men in the United States who go on active surveillance abandon it within 5 years of diagnosis. Rashid Sayyid, MD, a clinical fellow at the University of Toronto, Canada, found in a paper presented to the American Urological Association in 2022 that the number leaving active surveillance increased to nearly two thirds at 10 years…

Peter Carroll, MD, a urologist at the University of California, San Francisco, and a pioneer in the active surveillance in the late 1990s, said the major reason men abandon the strategy is because monitoring reveals the presence of a more aggressive cancer, typically a grade group 2 (Gleason 3 + 4) lesion…

Since 2013, when MRI began to be adopted as a surveillance modality for men with prostate cancer, the dropout rate began declining. The reason? According to Klotz, MRIs and targeted biopsies result in greater accuracy in staging the disease…

“There is more judicious use of PSA testing and biopsy in individuals who are more likely to have significant prostate cancer,” Leapman told Medscape Medical News. “And MRI could also play a role by finding more high-grade cancers that would have otherwise been hidden…”

Sayyid said he counsels patients aged 70 years and older differently than those in their 50s, telling younger patients they are more likely to need treatment eventually than the older patients…

Sayyid takes a more liberal approach. “I would counsel an eligible patient considering active surveillance that at the current time, I see no strong reason why you should be subjected to treatment and the associated side effects,” he said. “And as long as your overall disease ‘state’ [the combination of grade, volume, PSA, and imaging tests] remains relatively stable, there should be no reason for us to ‘jump ship’. In my practice, another term for active surveillance is ‘active partnership’ — working together to decide if this is a sprint or a lifelong marathon.””






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