When to give up on active surveillance

[purplepeter]

Hello - I am a 57 year old man who has been on an active surveillance programme for the past few years - my PSA has been fluctuating a bit and indications all over the place so wanted to get some advice on how to proceed....

October 2012: PSA 5.7 then 2 weeks later PSA 7

For the next 3 years PSA reduced naturally to between 1.6 and 2.3 until Nov 2015, when it rose to 3.3 then 3 months later 3.4.

I have had two biopsies to date:

* 1 core out of 12 Gleason 3 + 3, Stage T2 (contained within the prostate).
* A year later another biopsy which found no cores with Pca out of the 12 samples taken.

I've had an MRI 4 months ago which found a small area of concern in which my urologist suspects cancer.

Today had a PSA test and was 5.7 up from 3.4 twelve weeks ago which seems a big leap. I asked the Consultant Urologist for advice but they are quite reticent to tell me what I should do, instead offering me potential treatments and asking me to decide. Not very helpful, I want an expert to tell me what to do! As you can see, I have a rising PSA (which has been up and down over the years) but the MRI found cancer, but biposies only found cancer in 1 core out of the 24 samples. So really mixed messages here.

What do you think of this and is there anyone out there who can just give me a straight up recommendation as to what to do? Thanks. Peter.

[professoreden]

Peter

The 3 scenarios that commonly cause men to abandon active surveillance and seek definitive treatment are:-

PSA progression.
Gleason progression.
Wanting to end uncertainty.

If I understand your post correctly, your PSA in 2012 was 5.7 and is still 5.7 in 2016 but has fluctuated significantly between these dates, which is not unusual. What I would like to know is your prostate volume, as a conventional 12 core prostate biopsy tends to under-sample the prostate, especially anteriorly (at the front), where tumours are commonly missed by transrectal biopsy because it is too far from the biopsy needle.

I don't think that there is enough evidence that you should abandon active surveillance, unless you want to, but would advise you to get a transperineal template prostate biopsy so that you have a better idea of your tumour burden and location. that will better inform you about what to do next.

By all means come back to this forum and re-post further information if/when you have it in the future.