This is not inconsistent with what is already known.  For men with less
than a 10 year expected lifetime, current urology practice guidelines
generally recommend watchful waiting.  In addition, Walsh in Guide to
Suriving Prostate Cancer suggests a similar strategy for men in their
late 60s with Gleason 6 cancers and other favorable signs.  This seems
to take things a bit further.  But unfortunately, the abstract doesn't
tell use the length of the followup period, which is cruical.  If it was
less than 10 years, the result is not terribly significant and wouldn't
make much difference in current practice.  If this were to hold up for
15or more years, it might mean that some Gleason 6 cases that are
currently treated aggressively could be followed safely with watchful
waiting.  That would reduce the number of unneceeary treatment.

An important point.  The nature of medical research is such that no one
study by iteslef should be taken as definitive.

There are now a substantial number of papers that all say the same
thing, namely that the percentage of low-risk men (T1c, GS<7, PSA<10)
who have stable PSA characteristics (e.g. negative PSA slope or
doubling times > 8 years) is somewhere in the 25-50% range.  I've
previously posted some of Moul's and Hopkins' work in this area.  Some
of these studies are now out past the 8-year mark.

Many men in their 50s do practice Expectant Management or Active
Surveillance (more accurate terms than WW).  These men often have
routine color dopplers or MRI-SIs, along with PSAs, run to stay on top
of their disease.  As the studies move further out in time or, as Moul
is now analyzing, if waiting 8 years does not alter the disease
characteristics, then more younger, low-risk men with the appropriate
sub-category characteristics will not need to suffer radical
intervention...Best wishes and good health, Ron

ALERT              Watchful Waiting                   ALERT

Be aware that not always is PC a slow developer and that if you are
contemplating watchful waiting then think again and carefully.

In October 02 my first biopsy of 8 samples (taken as I had a PSA of 7.8 at
52 years old) concluded

           "There is one small focus of prostatic adenocarcinoma at the tip
of this biopsy specimen measuring 0.5mm across. The tumour consists of small
infiltrating glands lined by atypical pleomorphic cells with enlarged
hyperchromatic nuclei and prominent nucleoli.  Gleason grading is difficult
based on this small sample but is probably at least 4+3=7. There is no
perineural or lymphovascular space invasion noted."

Suggested the urologist advise me to undertake a wait and see how the PSA
changed over the next 2 years  with quarterly PSA checks.

The second biopsy of 12 samples taken some 8 months later concluded

"(a-g)          Right anterior lateral, right lateral, right posterior
lateral, right posterior, midline, right deep, left posterior biopsies -
Benign prostatic change.

(h, j & m)     Left posterior lateral, left lateral and left lateral base
biopsies - Prostalic adenocarcinoma. Gleason Score 4 + 4 = 8.

(k & 1)        Left anterior lateral and left deep - Benign  prosiatic
change."

Suggested the urologist confirm to me I had PC and to decide what I wanted
to do.

I elected to have a RPP on 1 Sept 03 and the prostate biopsy at that time
reflected the following.

           "MICROSCOPIC:

Type of tumour
Adenocarcinoma

Gleason Grade                                                    4 + 5 = 9

Lymphovascular invasion
No

Pcrineural invasion                                                    Yes /
extensive / within capsule, outside capsule

Location                                       All quadrants

Predominant location                                       Left anterior

Volume                                                    Abundant

Multifocality                                       Yes

PIN (high grade only)                                       Yes / moderate

Site of PIN                                       Adjacent tumour

Extra capsular invasion                                       Yes / eg. At
left anterior margin

Involved tissue                                       Peri-prostatic
connective tissue

Resection margin (< 5 mm)     < 1 mm from left posterior margin, 0 mm from
left anterior margin,

0 mm from right posterior margin, 1 mm from right anterior margin

                                       and 2 mm from distal urethral
margin.

Seminal vesicle invasion                                        No but
tumour comes very close

(c)                Radical prostectomy - Extensive invasive adenocarcinoma
Gleason Grade 4 + 5, score 9. There is extension up to the left anterior and
right posterior margins of the specimen and perineural invasion including
just outside of the capsule."

Clearly not all cancers are slow growers and my pinprick of a Gleason 7
became a death sentence (probability of over 80%) within 8 months.

IF you are contemplating a watchful waiting then only do so if the Gleason
score is LOW and the PSA is even lower. 6 months is a very small window of
opportunity to find that your waiting was in reality a fatal
procrastination.

Hank B Schokker

PSA     2000 / 2003                3.28    7.8   8.7   9.4

Biopsy             Oct 02             inconclusive But poss G7

                       Jun 03            Gleason 8       Staging estimated
at T1

RPP     1 Sep 03                    Gleason 4+5=9

 Biopsy                  Extensive adenocarcinoma;  Multifaceted;
Extensive perennial invasion

           Catheter out 16 Sep 03 and DRY

2nd opinion            that a Gleason 9 is virulent and Radiation & HT in
interim is scheduled

EBRT             Feb 04 04 to Apr 04

HT       Lucron            14 Oct 03 and 16 Mar 04 (lasting 4 months ea)

PSA Jun/04            <00.1

PSA Sept/04            <00.1 and no Testosterone (reading of 1.1)

PSA Dec/04            <00.1 and Testosterone returning (now 12.5 of normal
range of 8:- 27)