Active Surveillance for Prostate Cancer How to's

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One of the best discussions about Prostate Cancer Active Surveillance you will ever hear. Dr. Lin is Professor with Tenure and Chief of Urologic Oncology in the Department of Urology, the Director of the Institute for Prostate Cancer Research, and holds the Pritt Family Endowed Chair in Prostate Cancer Research at the University of Washington School of Medicine. Dr. Lin is Full Member of the Public Health Sciences Division of the Fred Hutchinson Cancer Research Center. Dr. Lin received his undergraduate degree from Stanford University and his medical degree from Vanderbilt University. He completed his urology residency at the University of Washington and urologic oncology fellowship at Memorial Sloan-Kettering Cancer Center, followed by an American Foundation for Urologic Disease (AFUD) Physician Scholar Award at the Fred Hutchinson Cancer Research Center.
Our interviewer is oncology social worker and Malecare's Director, Darryl Mitteldorf, LCSW.
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Prostate Cancer information and support, including the active surveillance online support group: malecare.org

[@mohammadtayyab5706]

Dr. Lin's explanation of active surveillance is very informative and give great hope to recently diagnosed cancer patients. This recording is 2 years old as I write my comments in July of 2023. Based on my PSA of 6.3 and a free PSA of 0.55, a free PSA percentage of 8.7 , it was indicative of 55% chance of cancer. I was sent to a urologist. Instead of starting with a biopsy with random sampling, I preferred a MRI with and without contrast first to see where I stand. I was warned that the Medicare may not cover the cost of MRI prior to Biopsy ($2600). However we went this route. Apparently, Medicare has realized that in the long run a MRI prior to biopsy is cost effective as the possibility of infection and hospitalization is eliminated. They reimbursed. The results were not in my favor. We proceeded with UroNav /MRI ultra sound guided biopsy. This software allowed the urologist to draw samples from specific areas as pointed out by the MRI. The two out of ten results were 3+3 & 4+3 on the Gleason scale. Now the process of treatments and active surveillance has started. I am meeting another Urologist for a second opinion as well as a radiology oncologist for the radiation treatment. I have also discussed the hormone therapy prior to or after radiology with a medical oncologist. All these treatment will increase your life span by another 8-10 years but you will have a miserable life. I am about 71 and may ride it out for another 4-5 years with active surveillance or look into the option of freezing or focal treatment with laser ablation. This is a less invasive and is an outpatient treatment. Listening in between the line Dr. Lin's approach to active surveillance, where annual biopsy, DRE and PSA is to be done, I would prefer to replace biopsy with PSMA Scan (if possible). This image technology is one year old as of now but can create a starting record of cancer affected areas as I understand. The annual scan can be compared to the 1st scan to see if the cancer is progressing. It is almost non invasive and I hear it is covered by Medicare too. I also learnt from Dr. Lin"s lecture that a biopsy slide as well as a MRI can be sent to another pathologist and radiologist for a second opinion. This is a great idea, Thank You Dr. Lin and I will try to follow it up with my radiologist.

[@heehow9664]

k😊

[@user-du8yc2zw2q]

Hi, I was recently diagnosed ( actually yesterday) with low grade prostate cancer! Level 1 or in Gleason Score it's a 3+3=6 score! This was determined by first an Increase in my PSA in May to 4.1 and an MRI scan picking up a small 3mm lesion. The biopsy was just done in November 2023 and the Urologist informed of my results from the Pathologist saying it was a low grade cancer and he recommended 'active Surveillance' and having regular blood tests for PSA levels and doing MRI scans plus possible biopsy in 2 to 3 years! This whole thing is new to me! I've had 1 bloke suggest that I should get the opinion of a Medical Oncologist and a Radiation Oncologist but I thought there speciality was mainly the treating of the cancer itself and not the diagnosis or the grading?

[@hatemruby533]

As I am a diabetic person My physician asked me to do a PSA checkup test with Hemoglobin A1C .The result was a little bit high 5.54 ng/ml , and he referred me to a specialist. An MRI and a biopsy later, I discovered I was a 65 year old living with a Gleason 6 prostate cancer. I'm so grateful that my Doctor took action, knew that there was a history of prostate cancer in my family and encouraged me to do the test. I now can do active surveillance and get on with my life. Now I changed all my life style and start ketogenic diet In addition to I stop eating dairy foods and sugar and rice and and all products that feeds cancer since 3 months also I practice prolonged DRY fasting about 17 hrs for one month and i do two Psa tests one after 2 months and it was 3.54ng/ml and the other one after dry fasting and it was 2.7ng/ml . I lost about 12 KGS since 3 months That encourage me to complete fasting hoping that tumor marker will give me more good results.

[@tomslick2058]

Damn. Urologist need to learn😅perineal biopsies. They are a piece of cake. At least the one I had. Its silly to go through the rectum.

[@billgreen6263]

Wonderful. Thank you!

[@davetheman2615]

Great video

[@MrMediterrano]

My prostrate was measured to be 30ccm on ultrasound and 60ccm on mpMRI, which measurement to trust more? Or should I get another ultrasound or another MRI? FYI between the ultrasound and the MRI was 4 months during which I have lost 35pounds through fasting and exercise.

[@janetw9430]

My husband was told to take prostate suppliments from his urologist.

[@pinotwinelover]

He's obviously not talking about cancer

[@kerrynball2734]

MRI guides ultrasonic guided biopsy, seems how it works in Australia.

[@jnickulas]

Another great presentation filled with relevant details and information. Thank you Dr Lin and Daryl.

[@Malecare]

Our pleasure!

[@JAT922]

Does family history weigh-in the decision to do active surveillance? I am 55 yo and Recently had a biopsy and was diagnosed as 3+3 in one core. Currently waiting on a decipher test. How ever i have 2 older brothers that have been diagnosed with prostate cancer and both already had treatment

[@s.chaisrisuk4956]

Sir, Any way to slow or deter the aggression of the cancer while on active surveillance?

[@philipborkstrom4178]

Your thoughts on immune therapy?

[@leroyhieb7197]

I’ve been tested three times and I’ve got a 235 average rating on the test for testosterone levels. My recent psa was 6.30 and my primary care doctor said it was a little higher than the psa test in 2018. My low testosterone therapist wants to know before I start the treatment that it won’t affect my small growth on my prostate. What say you?

[@gvet47]

I am 75 and my PSA was 5000. MRI had shown my prostate was very lsrge and as rough looking as coliflower and lymph nodes looked like one clump. Do you go on hormone therapy like it might extend my life but my health would not be good from the resctions.

[@josephscherer4581]

How can I get a hold of Dr Lin's office to get a second opinion on my slides? Thanks in advance.

[@janetw9430]

My husband is on active surveillance. Im finding I'm mentally/emotionally on a train wreck.

[@kerrynball2734]

Stay on it while you can. My family all have Prostate cancer on their death notice, but it didn't kill any of them. It depends if it takes off or not. The tests that they can do on active surveillance should give you enough warning to chop in time if required.

[@dvox766]

Thanks for this info Dr. Lin. What is considered a "small amount" or "significant amount" of pattern 4 in a 3+4?

[@Malecare]

We'll try to get a reply to your question; please be patient

[@dvox766]

@@Malecare Thank you. No hurry.

[@dvox766]

@@Malecare ...and would it be possible to share a link to the "calculator" Dr. LIn referred to at 16:20.

[@davehafner948]

Tes, calculator and what isxthis canary stuff all about?

[@db_carguy4833]

I am scheduling a trip to Sperling Radiology next month for a 3T MRI. Sperling medical has proprietary software that is able to detect aggressive looking cancers. Isn’t the MRI far less invasive than a biopsy that could miss cancer in a random sample? How do I go about getting a 2nd opinion from Dr Lin on my August 2022 MRI from U of M? Really impressive undergrad and Vandy education along with Sloan Kettering experience! Thank you for the excellent interview and sharing your expert research.

[@go4it129]

I had a biopsy about 2 weeks ago. I was told how terrible and painful the were. Of course anesthesia was used. I had very little pain . None during the procedure and just a dull ache the next two days

[@jayman2261]

You're lucky or had a better anesthesia... I had mine April 15th 2023 and I felt like someone put a nail gun up my behind. I was very painful , and I had blood in my semen for week. I'm 67, and they found 4 out of 6 cores with a 3+3 = 6 score. The urologist says I'm borderline ... My PSA hit 9.2 after being in the 5's back in 2020 when they found the cancer in only one core..and also had an MRI but they found nothing.......... So either the cancer advanced to 3 more cores since 2020 , or the urologist at that time missed it.........with the prostate biopsy....I want to get the Proton Beam therapy here, but unfortunately in Kingman , Az. , they only have radiation, so I have to go to the Mayo clinic in Phoenix.. Now the Mayo Clinic has to get an exception to treat me because My HMO INS. is out of the network..............OUCH!!!! So the burning question is should I stay on active surveilance or get the treatment????????????

[@go4it129]

@@jayman2261 In one yr my PSA levels went from 2,89 to 5.02. Had them tested again and they were 6. I first had an MRI with contrast. Nothing really showed up. I got a biopsy a couple weeks later with a 3+3=6. It was two spots in the same core. For the biopsy, I got anesthesia shot in the butt and something in the prostate. Maybe topical, or a shot after the first anesthesia. The first shot could have numbed the region enough for something to numb the prostate. My urologist said Active surveillance is the best treatment. As of now it’s contained and is low grade. Any procedure comes with possible side effects. ED, inconsistence or, retrograde ejaculation . To have a procedure at this point would be unnecessary since the cancer not a high risk. With regular monitoring, he’ll determine when it’s time to have a procedure . I have a good friend who is a CEO at a biotech company in San Diego. His company deals with oncology. He himself had 3+4=7 on the Gleason scale. He is an expert in the field with the latest in prostate cancer. He chose brachytherapy. Little radioactive seeds implanted in the prostate. In I believe 4 sessions he was cancer free. He didn’t want to risk inconvenience and still wanted to stay sexually active. He was 59 at the time. I just turned 59

[@go4it129]

Incontinence

[@jayman2261]

@@go4it129 I had a prostate psa retest last week and it went down to 7.7 No sexual activity for 4 days and it went down.....I do have 3+3=6 in 4 cores, but low grade 6 , not metastatic ... Urologist says just retest every 3 months.with active survalence...... He said treatments can have bad side effects..... so wait till it jumps......I guess everyone is different as far as side effects from treatments . That's why I am opting for the Proton beam radiation...