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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Hi again,

It’s always a lot easier to be away from the action, which is where I am now, rather than to be facing a need for a decision – here, for your husband and you, whether to do more now or sit tight for six months. Where you are can be a worrisome place. But for what it is worth, here is my impression.

If your husband is being seen by a doctor who is highly regarded for prostate cancer, especially if at a major center that is highly regarded for research and treating prostate cancer patients, you can relax - for six months anyway. Your husband’s PSA is still fairly low even if the cause of the elevation is prostate cancer. Moreover, if my PSA “doubling time” calculation is close to the mark, which I believe is the case, his doubling time, which should be close to the time it takes the cancer, if there is cancer, to double, is fairly slow. My calculation is 40 months (39.8), which is 3.3 years, based on a formula (“nomogram”) made available by a very well-known institution that researches, manages, and treats prostate cancer. I guessed at the exact dates, using June 15 for 2016 at 2.7, June 15 for 2017 at 3.5, June 16 for 2018 at 4.1, and January 10 for 2019 at 4.7; if those dates are fairly close to the real dates, the calculation should be pretty accurate. This result, plus all the other information and clinical impression available to an experienced doctor, would be enough to justify relaxing and enjoying freedom from the inconvenience of a biopsy, possible side effects of treatment if needed, and time for technology to keep improving. Chances would be strong in this case of very little (though not zero) risk that the cancer would advance enough that choices or successful treatment would be less likely when looked at again in six months.

If your husband is being managed by a doctor who is doing his or her best but is not that familiar with prostate cancer – not seeing that many prostate cancer patients and not keeping up with the field, then you and your husband might want to consider additional, earlier steps. The simplest would be getting another PSA test in three months instead of six. Another simple step would be getting a genetic test for some of the more problematic gene mutations, especially BRCA-1 and BRCA-2 (which are meaningful for prostate cancer as well as for breast and other cancers); this might be difficult to arrange or expensive prior to a diagnosis of prostate cancer (and likely covered and easy to do afterward). Another step, this time not difficult and easy for the patient but fairly major, would be to have a multiparametric MRI scan, which is increasingly done before a biopsy and which actually gives better information than the now standard 12-core biopsy. Of course you both could insist on a biopsy; that would be reasonable, but, to me, in my easy chair, overly aggressive at this point.

If your husband does turn out, eventually, to have very low-risk or low-risk prostate cancer, that is a fairly mild condition that we now know is best handled by “active surveillance” (AS) rather than immediate treatment. Many AS patients never need treatment for prostate cancer throughout their lives; some others turn out eventually to need treatment, but they have gained years, often many, free of side effects and have gained time for technology to improve, which is happening at a rapid pace for prostate cancer. These lower-risk kinds of prostate cancer are kind of like having high blood pressure or elevated cholesterol; there is a need to monitor (surveillance), and some mild tactics (such as mild and inexpensive medications or lifestyle changes) sometimes are all that is ever needed. :cool:

If your husband turns out to need treatment, there are highly effective treatments with ways of reducing side-effects. :)

Good luck! :wave:

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