How do you decide on the optimal treatment?

Welcome to this forum, though sorry it is because you have a PCa diagnosis.

AS can be a good option, at least for a time because it defers adverse effects that can arise from any radical treatment and gives you time to learn the pros and cons of various treatments. However, with AS it is most important that a man is closely monitored as there is a small risk that the full extent of PCa was not found with biopsy and MRI or the cancer may develop and become more aggressive. Most men with PCa who have treatment with either surgery or a form of radiation seem to come through it OK albeit with various and varying side effects which can be short term or longer.

A good place to get an understanding of PCa and treatment is to download or obtain a hard copy the 'Toolkit' from the publications section of this charity.

17mm seems to me to be quite a large tumour and this might preclude certain focal treatments which might otherwise be options, although these are generally but not necessarily only available for private patients or within a NHS trial.

Hello Martin and welcome

Having just been diagnosed and advised that AS is a definite option for you (especially as they say for 2-3 years) I think you are wise to opt to not rush into drastic action.

My husband was also a 3+4 and opted for AS and was on it for a year before he made the decision for permanent seed brachytherapy which he has never regretted.

He was signed off from the hospital at the beginning of this month, into the care of his GP and will now be monitored yearly. IF his PSA creeps up to 4.0 then they will review the situation.

He is 78 this year and had the seeds implanted about four years ago.

He was adamant from the start that he did not want an operation with all its possible side effects.

He has been one of the lucky ones as far as side effects of Brachytherapy are concerned in so far as he has had very little in the way of permanent side effects and the initial ones that went with installation were bearable.

ED is a problem but then he is 77 so not unexpected at his age, and Sildenafil makes a difference when we want to use it.

Good luck in your choice. Just do your research carefully.

What nobody can tell you, or predict for you, is how you and your body will react with any treatment choice. Many men sail through their choice. Others, on exactly the same path have not been so lucky. There is no hard and fast rule.

Who knows, AS for 2-3 years gives an opportunity for newer treatments to be made available that you could then take advantage of.

Edited by member 16 Jul 2018 at 08:57  | Reason: Not specified

I was diagnosed in autumn 2012, G6 (3+3), PSA 3.9

So I have now been on AS for almost 6 years, I've had 3 TRUS biopsies and 6 MRIs, my PSA fluctuates and last test was 5.6, the highest so far was 8.1.

The only problems I have encountered have been with appointments being rearranged due to too much demand for limited resources. I have been able to sort this out, and have always got the required monitoring.

I think it is essential to have complete confidence in your consultant and specialist nurses, and to be proactive to ensure that you get the correct level of monitoring.

A few years ago I suggested to my consultant that AS might continue for the rest of my life ( 20+ years I hope ), but was told to expect to need more treatment at some time.

Alan

Gleason 3+4=7 is borderline for active surveillance, but I would encourage you to go with it as long as you and your clinicians feel comfortable with it.

Make sure you have mpMRI 3T resolution scans and template biopsies though!

Cheers, John.