I am not sure what you are waiting for?
Biopsy shows cancer.
Waiting for an increase in PSA would indicate a spread of cancer.
The cancer is much more difficult to slow down or stop when it is spread.
I do understand your position and diagnosis, but do not understand waiting.
Kind of like watching a slow fuse to a bomb.
I do wish you the best and respect your choice and anyone's choice in this
battle.
john loomis

Sy, it's really difficult to assess what the best choice is.  My
numbers were similar to yours at the same age except my PSA max was
4.9.  I chose surgery in 2003 and all is well (inspite of the side
effects) although I probably still fret over the upcoming PSA's as
much as you will.  I can't help but think that there must have been
thousands of men in past years who had our numbers and never knew they
had prostate cancer (pre-PSA days), men who went on with their lives
and eventually died of something else.  It's a real dilemma for those
of us in those middle ranges.  All the best with your choice.
Dave Perry

This isnt' mine but a person from California. He has done what he
calls agressive watchful waiting now for over 12 years. He was
diagnosed with a PSA of 7.6 it went down to 2.1 then up to 19. It is
currently 17  Gleason 3+3=6. He swears by the protocol. I do some of
these things but not all. Just wanted to pass this along. Good luck.

The Protocol for Watching Waiting
1.)  Vegetarian type low fat diet:  No meat, poultry or dairy
products.  Occasional fish but I minimize bottom fish & shellfish. I
Avoid processed foods when possible, and eat primarily organically
grown produce.
2.) Low Caffeine / Minimal Alcohol :  I consume pomegranate juice
daily. I also try to drink wheat grass at least once per week. And
always drink filtered water. My body goes not get along with caffeine
so I do not drink green tea. I do however drink rooibos tea, this tea
has higher concentrations of antioxidants and phyto-phenols, but is
caffeine free.
I drink a very occasional beer or red wine.
3.) Meditation: I practice Qi Gong regularly, not only a healing art
but a way to reduce stress and gain inner peace. (Qi Gong is an
ancient healing technique from China, it is a combination of
accupressure, breathing techniques, and movement exercises designed to
restore energy as well as heal the body.)
4.) Exercise:  Moderate daily exercise.  Walking or running for at
least one half hour everyday.  A weight training program is practiced
every other day emphasizing flexibility.
5.) Support Group Participation:  Cancer patients in support group
settings live twice as long as non-members. I started my own local
group with emphasize on "healthy life-style"
6.)  Aggressive Vitamins & Supplements: See below.
7.) High Performance Hygiene Regimen:  Designed to remove stress from
the immune system and allow it to concentrate on healing. Kenneth
Seaton, PhD has designed a hygiene program that reduces bacteria from
the high concentration areas: under the fingernails, the tear ducts,
and nasal passages. The program not only has kept me from colds, flu,
and allergies, but has also increased my serum albumin level, a
barometer of longevity.( Average American albumin level is 4.3, cancer
patients generally have albumin levels of less than 4.0. My albumin
level 3 years ago was 3.6, my latest albumin test showed a level of
4.4)
8) Personalized Metabolic Nutrition: I have been tested to determine
which of the four Metabolic Types I am. I consume foods appropriate to
my metabolic type. I am a Group I, sympathetic type, this means that I
metabolize carbohydrates well, but have difficulty with fats and
proteins. This is a common type for people diagnosed with cancer. I
have been eating for my Metabolic Type for over five years, with good
results.
9) Enhancing the Immune System: My primary goal has been to bolster
the immune system and make it as strong as possible. I take a number
of immune enhancing supplements.
SUGGESTIONS:
Minimize:
Candy        Sugars        Fats        Poultry        Processed food
Sweets        Caffeine    Tap water    Meat                Dairy products

Maximize:
Organic Produce    Beans         Fermented Soy Products (miso, tempeh)
Whole Grains        Brown Rice    Fresh Vegetables and Juices

Supplement & Vitamin List:
DAILY
Multi-Vitamin                                                   Daily
Healthy Prostate & Ovary Formula                9 caplets per day, 3
at each meal
Artemisinin                     2 capsules, 2 times per day / away from food
Bakers Chocolate - no dairy or sugar        1oz. daily
Vitamin D-3                    2000 IU
Curcumin/Tumeric                                         2000 mg
Ten Mushroom Combination                          12 capsules, 4 at
each meal
Selenium                            200mcg
Arctic Omega 3 Fish Oils                                1000 mg
Modified Citrus Pectin (Pectasol)        12-18 capsules per day
Vitamin C                    6000 mg
Maca Root Extract                As per label instructions
Lycopene                    15 mg
Boswellia / AKBA                1-2 capsules daily

Supplement Strategy:
I have learned over the years that I get best results with my prostate
related supplements when I take them on an intermittent basis. I
rotate a number of prostate specific men's supplements on a regular
basis.

The Keys:
Have faith
reduce stress levels
eat a healthy low fat, whole grain vegetarian type diet
get a minimum of eight hours of sleep a night
never get complacent, even after treatment
do your due diligence and homework before you make a protocol decision

My cancer was not discovered until it was beyond being curable. I have
gone through a number of treatments knowing that a cure was not very
likely with current technology. You on the other hand, could likely go
through far fewer ordeals, and have far fewer side effects,  and be
cured!!!  Whatever you do, I hope that you do it before the cancer has
crossed the line between curable, and not. It might be very painful
someday to look back and know that if only you had reacted a year
sooner, a month sooner, you could have been cured. Best of luck to you,
I hope you have 100% success with whatever route you pursue. It is not
an easy decision, I know.

Sy, all of us have had to make our own decisions about treatment based
on what we know and how we feel at the time.  While many in this group
would probably choose a different course of action based on what we
know about you, I'm sure we all respect your decision and wish you the
best.  Please continue to keep us informed of your PSA results and
know that we will continue to support you in your future decisions.

Burney

Burney dot Huff at Mindspring dot com

Sy,  it would be interesting to some of us with similar PSAs to know
why your 3.17 psa score led to a biopsy.   Could you include your
prior psa's over the preceding years.   Apparently you were about 1.6
22 months earlier.  So was the biopsy done entirely because of the
acceleration "jump" in psa rather than the 3.17 number?

I'd say your "watchful waiting" is very reasonable.  Or perhaps it
should be called
EXPECTANT MANAGEMENT OR ACTIVE SURVEILLANCE as they do at the John
Hopkins program.
http://urology.jhu.edu/prostate/advice1.php

They have some interesting criteria and surveillance protocols they
follow.

My last psa dropped to 1.6 after having a  blip up to 2.9   I feel
lucky no one wanted to rush me into a biopsy or I may well be in your
position of uncertainty after getting a 3+3=6 score.   I have no doubt
there is some PCa in my prostate now,(unknown Gleason)  but as long as
my PSAs stay low and slow I'm just going to keep doing my own version
of "surveillance" along with some of the "reasonable" dietary
changes.  I don't believe in the kitchen-sink approach to natural
cures, supplements, etc.

MY list of "reasonable" changes with some scientific basis include the
following.  I might add that almost all of them are good for general
health, especially cardiovascular health, even if they don't slow PCa
that much, and far more men, even those with PCa, are gonna die of
heart disease rather than PCa.

1. Fairly to very low animal product diet except for some fish such as
salmon
2. Fairly high fruit and veggie intake (especially the cruciferous
ones)
3. Some soy, tofu and soymilk,  but not overboard
4. Teas, green and black
5. Vit-D3 supplement (or more sunlight....)
6. Pomegranate juice pure 8 ounce per day
7. Curcumin 500 mg per day  (only about double what people get daily
in India in their diet)
8. Keep body weight low/lean
9. Exercise

The only one that costs much is the Pomegranate juice (about $1.00 per
day from Trader Joes)  Two reports address its affect on PSA doubling
time which may interest you.  I figure if it slows doubling time post-
surgical,  then why wouldn't it slow doubling time pre-diagnosis?

Well, good luck.  Keep reading the news.  If the weight is way up
there, slowly bring it down.  It seems the  more I read on many cancer
issues,  excess weight is one of the main things associated with
"inflammation" leading to some cancers beginning and advancing.
Even the famous Dr. Walsh is apparently coming to the "inflammation"
conclusion and cites the following researchers in a CNN interview
http://transcripts.cnn.com/TRANSCRIPTS/0301/04/smn.22.html
http://urology.jhu.edu/newsletter/prostate_cancer75.php
http://www.webmd.com/prostate-cancer/news/20070315/0besity-may-up-prostate-cance
r-deaths

gvk2six

Sy, follow whatever treatment plan to desire. It's your plan and no one
else's.

I do have a question/cpmment. Seems that your approaches have centered
around non-invasiveness; Cyberknife where there is no long-term result known
and Watching Waiting/Active Surveillance where there is a known long-term
result. At the surface the choicees seem in conflict. Is non-invasive
treatment the most important thing in your life today?

What is known, is that you have cancer. How you deal with that fact it is
your business. At some point a micro-fiber of cancer will leave the
prostrate bed and float around most likely through your vascular system or
lymphatic system until it lands and grows. The result then is Advanced
Prostate Cancer.

Some day your Gleason will not be 3+3, but rather 4+3 or 3+4, etc. The
higher the Gleason, the greater the percentage that a micro-fiber spreads
your cancer.

Note that I have not mentioned PSA. PSA score is only an indicator. I am
reminded of a good friend and co-worker who at age 40 insisted on a PSA test
and again at 41. PSA went from 1.3 to 2.7 in a years time. The resulting
biopsy was Gleason 3+4.

I remember when my Radiation Oncologist told me that his only concern was
that a micri-fiber (and by the way, I mean not so small that in present day
medicine is not viewable) escaping. The odds were 92% that it had not.
Twelve months later we found out that it had escaped. So I was in the eight
percentile group.

Recurrent cancer is usually attributed to the above process, regardless of
the length of time it floats around in the body. I suggest that you ask your
treatment specialist what you odds are.

I wish the best for you and many years of good health. Take care.

Gourd Dancer

Sy,

It sounds to me like you know what you are doing and have
made an informed and intelligent choice.

Best of luck with it.

   Alan

I here these things and wonder what is it the people wait for.  To be hit by
a truck?  Crash in an airplane?

I'm surprised you know the PSAD already, and I'd wager it will be decreased
next time you're tested.  But, even if not, do you feel better going into a
possible curative treatment with a PSA of 6.34 in 22 months and a Stage of
T2c?  Or T3c?

Your choice and if you enjoy gambling, maybe it's better than the SEs of
treatment.  But, one of the SEs is 'life'.

   We all join in hoping for your success. Thanks for being our personal
guinea pig.  Let's hope it doesn't come down to a tougher surgery at 65,
with a more aggressive cancer to deal with.  Afterall isn't that the reason
we have the surgery early?  I had my beast removed 5 years ago at 53, and if
I had the chance to do it over, I'd do it again in a heartbeat.  Good luck
and keep us posted Sy.

There are valid reason to do some watchful waiting. For most men it won't
hurt to spend a few weeks or even a month or two learning all they can about
prostate cancer, deciding on a treatment, and locating a doctor with whom
they feel comfortable.

Watchful waiting (active surveillance) will buy time if for some reason
treatment needs to be postponed because of other health problems.

WW can be an excellent way to deal with PC if someone is "elderly" and the
odds are greater that their life expectancy is less than the PC's.  Of
course elderly has taken on a whole new meaning lately, at least for me. The
older I get the more I find "elderly" folks with more energy then I have and
they are in very good health.

I have a friend whose husband is in the "watchful waiting" category and that
is because ALL biopsies have come back negative. His PSA bounces around and
is often temporarily lowered with a round of antibiotics. So yes, he's under
"active surveillance" and waiting for the shoe to drop. He's waiting for a
biopsy to come back positive and has been in this predicament for several
years now.

But watchful waiting for a healthy man with a positive biopsy is nothing
more than waiting for cancer to become advanced. Hedging bets that a heart
attack, stroke, or a truck doing 75 MPH hits first. When caught early PC is
very curable by a number of treatment options.

Yes, options. Pick your poison! Surgery is constantly improving and great
strides have been made using radiation (IMRT, brachy, cyberknife). We are
even seeing cryosurgery and some other new treatments surfacing. Nothing is
perfect. They all have some side-effects. But the ultimate goal is to stop
the PC. Life instead of a slow painful death.

Some men fear loss of erectile function. Right now, I know of no treatment
that can 100% guarantee that there will not be any loss of EF. No man wants
to lose his EF, but it can happen. How someone chooses to live without it is
a different matter and there are options to help overcome ED.

PC is treatable and a normal healthy male should be treated.
Bev

Hello, Sy:

My, what a lively thread.  I am sorry I missed it as it was happening, and I
hope I can avoid stirring up any more polemics.

It just seems to me that active surveillance is an incomplete strategy.
What you've really done is to agree with your docs to postpone a treatment
decision until later on.  That's your choice, of course.  Indeed, when men
first come to this group after learning about their PCa, people here often
counsel them to take their time and research their options.  That's what I
heard from the folks here when I first cam a little over a year ago, and I
have in turn said it myself since, both here and elsewhere.

What I would think would be a more complete strategy that involves active
surveillance is this:  
(1) Agree with your docs to do the PSA test frequently; my understanding is
that you're doing this every 3 months.  
(2) Also establish some threshold values:  if your PSA or your PSA velocity
gets to some number, or if you become symptomatic, then you will abandon
the surveillance and get aggressive.  
(3) Why not also consider now what that more aggressive treatment might be?  

And I do not mean to stir up a divisive thread; I just didn't see this point
in the rest of the thread and thought it was worth offering.  

--charlie