Please assess my urgency for treatment

[sugardown]

I am currently in active surveillance for adenocarcinoma , a tiny one she says, found in one of 14 cores/one lobe.
Gleason 6, I am 60 years old and being checked each 6 months for velocity (currently went down from 7.9 to 5.1 PSA).  I am interested in your advice for how immediate I should consider HDR  monobrachiotherapy at
Cancer Centers of America . Thankyou

[Ash Tewari, MD, M.Ch.]

Thank you for the question. Sorry for the delay in response. Since you have low-risk prostate cancer and  your PSA has decreased, you can continue the active surveillance protocol followed at major institutions in United States:

·         PSA Every 3 to 4 months
·         Prostate ultrasound Every 6 to 9 months
·         Prostate biopsy After 1 year

To limit the risk of under-staging or under-grading the tumor, another biopsy of the prostate gland prior to embarking on active surveillance is often recommended.  The most common reason for recommending treatment is a rise in Gleason score on subsequent prostate biopsy.

However I will suggest you to discuss these options in detail with your urologist. There are various treatment options you can consider for an early stage prostate cancer like HDR monotherapy but there are very few published results on that. It is best to discuss all the options available before going for a treatment.

Thank you and best wishes for the new year.  

Ashutosh (Ash) K. Tewari, MD
www.cornellroboticprostate.org

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[hava]

You are on active surveillance and this is something you can do actively to make yourself better. You have nothing to lose, and there are no side effects.
The exercises described here will help to get the PSA down and will ease any side effects of any medication you are taking.
Do it and you will know from the future PSA test results.You can also do it alongside any medical treatment.
Build up your timing gradually.If you feel tired or dizzy,stop and resume after about one minute or later.After a few weeks at the suggested maximum duration you will start to notice benefits gradually.

The pranayam techniques:
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 15 to 30 minutes twice a day. Not for pregnant women. Seriously ill people do it gently. Can be done four months after any surgery.

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 15 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.

Bhramri Pranayam -Close eyes. Close ears with thumb, index finger on forehead, and rest three fingers on base of nose touching eyes. Breathe in through nose. And now breathe out through nose while humming like a bee.
Duration : 5 to 10 times

Only by doing you will benefit and will feel good that you can do something to help the body.Copy and print this to improve your technique and stay focused.
It is a holistic approach, and will help the body to treat itself.

[Ash Tewari, MD, M.Ch.]

HDR monotherapy has very few published results and therefore some side effects resulting from it can still be unreported.

However, side effects of prostate irradiation are related to the total dose administered and the volume of the normal structures treated. Urethral, bladder, and rectal irritation can be present for few months. Urinary leakage and impotence can be a complication in some cases.

[sugardown]

Thank you Doctor Tewari  very much.  My Urologist says any available treatment should take care of this tiny cancer.  I will show this report to her , she seems very open .    I hate the biopsy, received infections last time from it.   I would do the treatment just to get off of  the surveillance just to be done with it !   Now I am very interested in the side effects I will face with HDR  monotherapy.  This will be my final Q ,  thankyou again,   Rob