Watchful waiting

[vistacruiser]

Age 75, health quite good. Gleason 6 (3+3) 2 out of 12 cores positive (3% and 22%) PSA (08/08) 4.7 PSADT 3.34 yrs.  Do you agree with general guidance for invoking active treatment vs. observation if another biopsy done in 04/09 shows increase in positive cores to 3 or more or if any one core shows 50%+ positive for cancer?  Also, is there any current opinion regarding use of Avodart or Proscar while in Watchful Waiting mode?  I understand there would be a likely reduction in PSA, but that new PSA baseline be established and return to monitoring of PSA velocity. Not sure what, if any, benefit this would provide.  I am considering brachytherapy as an ultimate choice of treatment, but do not want my "window" for it to close. Your thoughts?

[BaldiR]

I would look into recent publications, which have obtained a fair amount of press,
that indicate that onset of positive diagnosis at age 75 does not warrant any
treatment or any further testing, given the surgery risk and the immense lowering of quality of life with treatment and the usually slow progression of the cancer that will not precede expected life expectancy.

[Ash Tewari, MD, M.Ch.]

Thank you for your question. If your repeat biopsy results are significantly different (more cores positive, higher gleason score, etc.), it may be prudent to discuss curative treatment with your urologist.

Avodar and Proscar are 5-alpha reductase inhibitors. These drugs reduce serum PSA levels. New PSA baselines can provide insight to the aggressiveness of your disease.

Sincerely,

Ashutosh K. Tewari, MD