Has anyone been on AS for several years?

Hi, I’ve been on A/S for nearly 8 years, I was diagnosed when I was 50 with 3 + 3, PSA 6.8, my diagnosis has recently changed, recent MRI has shown pirads 4 and last biopsy was 3 + 4, I’m now having surgery next month to remove my prostate, I was happy to be on A/S, I had a MRI every year, PSA every 3 to 6 months and a Trus biopsy, template biopsy and a perineal biopsy in that time. 

Anyone on AS can change to active treatment at any time on the NHS, even if the cancer hasn't changed. Your consultant was wrong to say AS was the only way forward, but could be correct that any treatment would be over treatment in your case.

AS is not a risk-free strategy, because we are not good at accurately diagnosing the Gleason or staging of prostate cancer. What probably is a relatively risk-free strategy is to take AS if offered for a few months and see how your PSA is changing at the next 3-monthly PSA test, although an issue in your case is that the cancer isn't really showing up in your current PSA, which also casts a question over how effective PSA monitoring in the long term might be in your case. Giving it 3 months will also give you time to get over the initial diagnosis and rationalise things, which to be fair, is going to be difficult to do just 2 days after being told.

Much of this is dependent on your attitude to risk and confidence in the diagnosis, and hence varies from one person to another even in the case of an identical diagnosis.

You could perhaps use your BUPA cover to get a second opinion, although you can do that on the NHS too.

Edited by member 08 Mar 2025 at 23:20  | Reason: Not specified

I'm Gleason 3+4 T2b and was recommended AS but after much deliberation have decided on RARP. I think if I was Gleason 6 I'd have stayed on AS but made absolutely sure the monitoring was accurate and timely including having additional MRI's at my own cost if necessary. A lot has to do with ones state of mind, some men are OK to live with cancer whilst on AS, some aren't. Good luck

There won't be many, if any, blokes on here who've been on AS for years and needed no further treatment. They will have no need to be on a forum which is heavily biased towards problematic treatment and poor outcomes.

https://www.healthline.com/health-news/surveillance-is-an-effective-way-to-manage-some-types-of-prostate-cancer-new-study-finds#Half-of-patients-using-surveillance-did-not-have-cancer-progression

The Canary Pass trial shows the effectiveness of the active surveillance protocol in the real world.

The study was conducted with more than 2,300 patients across 10 treatment centers in North America. Patients were recruited between 2008 and 2022, with an average follow-up period of 7 years. The majority were white (83%), while a small proportion were Black (7%).

Researchers found that using the protocol effectively managed the cancer and reduced overtreatment.

Ten years after an initial diagnosis, nearly half (49%) of all participants did not experience cancer progression, nor did they receive treatment. Within the entire cohort, less than 2% developed metastatic cancer. Less than 1% of patients died from the disease.

Edited by member 23 Mar 2025 at 08:07  | Reason: Additional text