In my previous article, I provided some of the details of my prostate cancer diagnosis in 2015. In this article I talk about what has transpired in the first year since that diagnosis.
At the time I was given the prostate cancer diagnosis, the urologist explained that there were a number of treatment options available and that we should take the time to research and investigate these options. We were introduced to a patient representative who could assist us with our research. We were provided information about a local support group and subsequently provided appointments with professionals that would explain each of the treatment options in detail.
Naturally, all of this felt a little overwhelming in the beginning. By participating in the support group, getting more information about the treatment options and doing my own research I was able to gain a better perspective including a better understanding of the nature of my particular diagnosis. In one of the support group meetings I was introduced to a book that proved to be very informative. It is “Invasion of the Prostate Snatchers”, written by Dr. Mark Scholz and Robert Blum. I will refer to this book again. Dr. Scholz is the founder of a medical practice in Marina del Rey, CA, called Prostate Oncology Specialists. As the name implies, their practice is exclusively focused on prostate cancer which has gained world wide respect.
In my research I found that I could send the tissue samples from my biopsy to Johns Hopkins University Clinic to have a second opinion on the pathology diagnosis. I did this and their results were completely consistent with the diagnosis I have been given by my health provider.
I learned that the primary available treatment options are radical prostatectomy (surgical removal of the prostate) and two forms of radiation: external and brachytherapy (the implantation of radioactive seeds into the prostate). During my research, I began to understand that all of the currently available treatment options have the potential for undesirable side effects, most commonly incontinence and/or impotence. And, somewhat surprisingly, the outcomes for these treatments, ie. the rate of return of cancer after 5 years, 10 years, etc., are fairly consistent. Then there is the other treatment option, Active Surveillance or Watchful Waiting.
In the past 10 to 20 years, more and more physicians are embracing this treatment option. They have defined specific criteria for patients who can be considered candidates for this option. I began to understand that my diagnosis was completely consistent with this criteria. The research behind Active Surveillance is that low risk prostate cancer does not necessarily need to be treated. In many cases, men with this diagnosis can live the remainder of their lives with no adverse impact on their health from prostate cancer. If the cancer changes course and becomes more threatening later, then all other treatment options are available, including some that are being tested now. Some of these new treatments have the potential to provide superior outcomes with fewer unpleasant side effects.
As I read “Invasion of the Prostate Snatchers”, I became more comfortable with the idea of following Active Surveillance. Their premise is that there are thousands of men subjected to unnecessary treatments each year. My final treatment consultation was with a surgeon. I had been told by others in the support group that this physician would not always reach for the knife. He would consider each situation objectively. I was prepared to argue my case for Active Surveillance. Very early in our discussion, he said that he would recommend Active Surveillance for me and that he would be my primary physician through the process. Naturally, this was welcome news since it fit with my own conclusions.
The Active Surveillance protocol is to have a PSA test every 3 months and repeat the biopsy after one year. My PSA test at 3 months and 6 months showed no significant change. At this point I began to think about options for additional confirmation of my diagnosis. Prostate Oncology Specialists make use of two types of imaging that can be used to characterize prostate cancer in a non-invasive fashion. I made an appointment with one of their physicians for a consultation. This would not be covered by my insurance but I felt it was worthwhile. They agreed that based upon my biopsy results Active Surveillance was the right course. They recommended a Color Doppler Ultrasound. This is one of the imaging techniques they use to add more perspective to the biopsy results. Since the biopsy is an inexact procedure, I felt this would be helpful. The Color Doppler Ultrasound showed a tumor that is small and low risk, again consistent with the biopsy. This provided me with an additional level of comfort.
The PSA test result at 9 and 12 months again showed no significant change and now it was time to repeat the biopsy. The pathology results from this biopsy, which was taken at the end of April 2016, were once again consistent with the initial biopsy, no change. So now, I will continue to repeat the PSA test every 3 months. If there is no change in the results then the protocol would be to repeat the biopsy in two years. I may choose to have another imaging evaluation in the meantime.