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Active surveillance for a 45 year old male?
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Active surveillance for a 45 year old male?


My 45 year old husband was just diagnosed with a T1c (2/10 cores positive) Gleason 6 prostate cancer.  Unfortunately, the PSA (3.89)that led him to have the biopsy was his first one so there are no previous comparators.

We are leaning toward surgery as a treatment option, but a Radiation Oncologist I know who specializes in prostate brachytherapy suggested that he consider active surveillance as an option, given his young age and the life-altering morbidity associated with prostatectomy.

I am a Radiation Therapist, and active surveillance goes against everything I have EVER learned regarding the possibility of agressive disease in young men with prostate cancer.  I have read several of the studies involving active surveillance of low risk prostate cancer, but unfortunately, the majority of the study patients are far older than my husband.

To add to the mix, I recently read an article linking heavy, daily alcohol consumption with an increased risk for aggressive prostate ca., and in the not too distant past, my husband was a heavy, almost daily drinker.

What would your recommendation be, based on your experience with low-risk patients in his age group?

Would it be worthwhile to have the biopsy slides re-read?

Thanks for any help or advice you are able to give me!
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Dear Klus: I had prostate cancer in 2005.  My gleason was 6 i think and my PSA was 4.5.  I had Proton Radiation at Loma Linda University Medical Center in Loma Linda, California.  I had no side effects during or after the treatments... was not sick or felt bad one single day.  Proton has a 90% cure rate and little to no side effects.. You are probably fimiliar with it. It was like I was never sick. My PSA is now .05.  Personally after having Proton treatments, I wouldnt really consider any of the other treatments if I were in a area where I could get Proton radiaiton.  I think any one who has ever had Proton Radiation for Prostate Cancer will tell you the same thing... Drs dont recommend it much and I really dont know why other than there is only 4-5 places that offer it in the US... M D. Anderson in Houston now offers it, due to the great success that Loma Linda has had with it over the last 18 years...You probably are already familiar with Proton Radiation, but if your not, I think it would be worth your while to check into it.... If you want any more info on it just send me a message and Ill get back to you.   I wish you and your husband the very best....Claytex
Thanks for your input claytex!  At this point, we are definitely exploring our options.  I'm glad you've had such a postive experience and outcome with your proton therapy....I've heard nothing but good things about it from a patient's perspective!

Currently, there is only one Cyclotron clinically used for proton therapy in Canada, and it's used solely for treating ocular melanoma.  My understanding is that going to the US for proton therapy would cost upwards of $150 000.

I think my husband pretty much knows what route he will go as far as treatment, we just need to satisfy ourselves that we are making the best possible decision based on his circumstances.  It's not easy, but we're getting there!!

Thanks again!
Thanks for the respond.  Yes, I think your figure is correct if one pays cash for the treatment.  When I had mine there were several individuals being treated at  Loma Linda from several different countries and I think at that time it was costing them $130,000 to $140,000.  I wish both of you the very best...I bet your husband will be just fine... Claytex
I am somewhat in your husband's situation- very young (40) to have PCa who is in the dilemma of accepting morbidity at this stage of life by accepting radical modes of treatment or watch the PSA movement (I checked my psa on monthly basis for the last two months) & noticed a regression (3.51 then 3.11 after the initial reading of 5.51.
I'd appreciate your feed back as your husband's age resembles mine
Active Surveillance (AS) is the option for you.The following pranayam will help to control the PSA and any cancer present in the body.You can keep checking the PSA regularly, and as you are doing something active to fight the Pca, you and others around you will feel good and let you continue with AS.
The body can control and fight any health condition - it just needs help, and that help is extra breathing to have extra oxygen in the body cells.

The Yog Pranayam (breathing exercises) are:

Bhastrika - Take a long deep breath into the lungs(chest not tummy) via the nose and then completely breathe out through the nose.Duration upto 5 minutes.

Kapalbhati -(Do it before eating) Push air forcefully out through the nose about once per second. Stomach will itself go in(contract in). The breathing in(through the nose) will happen automatically. Establish a rhythm and do for 20 to 30 minutes twice a day. Not for pregnant women. Seriously ill people do it gently.

Anulom Vilom –
Close your right nostril with thumb and deep breath-in through left nostril  
then – close left nostril with two fingers and breath-out through right nostril  
then -keeping the left nostril closed  deep breath-in through right nostril
then - close your right nostril with thumb and breath-out through left nostril.
This is one cycle of anulom vilom.
Repeat this cycle for 20 to 30  minutes twice a day.
You can do this before breakfast/lunch/dinner or before bedtime or in bed.Remember to take deep long breaths into the lungs.You can do this while sitting on floor or chair or lying in bed.

Tips : Breathe into lungs not into stomach. Do not hurry. Do it slowly. Rest whenever needed (in any pranayam).Can be done in sitting position, standing or lying in bed(if bed-bound).Try and do pranayam before meals.
How does it work:
Pranayam is about getting more oxygen into the lungs and sending it around the body via blood to aid in body repair. With extra oxygen more platelets and red blood cells are formed in the blood to build up the immune system.All this happens naturally without side-effects.People with all types of ailments including incurable ones will benefit.  
Tell the medical advisor that you are doing pranayam and also tell others. Only by trying you will discover the benefits.
Keep doing kapalbhati(15min) and anulom vilom(15min) once a day after you are completely well for the rest of life to keep the body healthy. You will notice many improvements in your body and mind over time.
Keep doing pranayam for at least 30 minutes a day after you are well to stay healthy.

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