Health Scare Starting Right After Retirement

[grasshopper]

I've seen Gleason 6 referred to as the hard six and it actually lives up to that name because while it qualifies for Active Surveillance due to its low grade not known to spread nature, you still have prostate cancer so making a decision for treatment become a gray area. Obviously this is the point of Active Surveillance retesting. It doesn't mean you aren't doing nothing. The problem I'm seeing is take someone my age of 55. Lets say in AS the numbers advance as we all know they likely will. Do I want to wait until say 65 or 67 when I may be less healthy to have a major surgery?

.

It seems as if you have carefully your decision. I have now been on AS for 9 years. 2 biopsies at 61 and 62 one core GS 3+2 yea there is no 2 anymore. First 3T MRI guided biopsy at 70 same area now 3+4 with mostly 3's. I was sure I could stay on AS with exercise, diet and weight loss. My PSA hovers around 4.3 for the last several years. My urologist isn't pushing any action and is fine with AS still. He also notes that surgery at 70 isn't a walk in the park.

 

[bmcgonig]

Thanks. Yes If I were 15 or 20 years older I would better be able to deal with AS I think. Still haven't decided but they say you have plenty of time to make a decision with Gleason 6. Obviously if I did wait and say the next MRI and biopsy in six moths showed advancing changes, then I'd have no choice but to treat.

I've seen Gleason 6 referred to as the hard six and it actually lives up to that name because while it qualifies for Active Surveillance due to its low grade not known to spread nature, you still have prostate cancer so making a decision for treatment become a gray area. Obviously this is the point of Active Surveillance retesting. It doesn't mean you aren't doing nothing. The problem I'm seeing is take someone my age of 55. Lets say in AS the numbers advance as we all know they likely will. Do I want to wait until say 65 or 67 when I may be less healthy to have a major surgery?

The thought of possible incontinence, erectile disfunction dry ejaculations scares me. My wife hasn't done as much research on the subject and looks at it a bit more simply. Are you more concerned with sexual function or living.

Have you given any thought to Focal Therapy? Things like ablation? I’m not up to speed on it but it’s seen as an option instead of AS. It’s controversial in that some urologists don’t think results are guaranteed, and others think it’s unnecessary.

 

[Teacher Terry]

My ex chose the radiation seeds because at the time that had the least side effects and was a minor surgery. It’s caused some urinary incontinence. Once he has to pee he can’t wait too long. He needs a penile implant which insurance won’t cover in order to be able to have sex. We tried injections but it either didn’t work enough or so well that his erection wouldn’t go down and had to be drained. The whole situation sucks of course but it’s better to be alive.

 

[RetireeRobert]

I second some earlier advice to don't let the 3.97 PSA score panic you, nor the resulting fishing expedition which "caught" a Gleason 6 "fish" (bet the urologist was bragging about that one).

Watchful waiting. Get some periodic (maybe once or twice a year) follow-up PSA results for a few years.

Also, remember that as men age, PSA "normally expected" results increase the older one gets (Google for age-adjusted PSA "acceptable" ranges.

Also remember that the medical profession has in the last several years revised their advised protocols as to prostate cancer ("less" routine treatment).

 

[watchman3135]

I second some earlier advice to don't let the 3.97 PSA score panic you, nor the resulting fishing expedition which "caught" a Gleason 6 "fish" (bet the urologist was bragging about that one).

Watchful waiting. Get some periodic (maybe once or twice a year) follow-up PSA results for a few years.

Also, remember that as men age, PSA "normally expected" results increase the older one gets (Google for age-adjusted PSA "acceptable" ranges.

Also remember that the medical profession has in the last several years revised their advised protocols as to prostate cancer ("less" routine treatment).

Thanks. I guess the hardest concept about Active Surveillance is that it is so foreign in thinking in that you now know you have cancer and you are doing nothing to treat it. Yes, I know that is technically untrue as you or retesting every six months looking for for changes which will then trigger active treatment but the fear of it spreading outside the prostate truly feels similar to have a hand grenade in your pelvis with the pin three quarters pulled out. That's the real phycological problem with many including myself with AS.

 

[Koolau]

Thanks. I guess the hardest concept about Active Surveillance is that it is so foreign in thinking in that you now know you have cancer and you are doing nothing to treat it. Yes, I know that is technically untrue as you or retesting every six months looking for for changes which will then trigger active treatment but the fear of it spreading outside the prostate truly feels similar to have a hand grenade in your pelvis with the pin three quarters pulled out. That's the real phycological problem with many with AS.

All very true! Yet another reason to live life as if it's finite, because it is.

 

[JJpop]

At 68 my PSA suddenly was 5.3 after being normal before.
Had the MRI posters have mentioned which showed a lesion.
Had a biopsy and cancer was a 3-4.
Docs at Stanford said I need to do something. The urologist/surgeon recommended surgery because I was in good health otherwise.
I did not like all the possible side effects.
I decided on HDR brachytherapy which is 2 procedures one week apart.
I had them in Nov 2019. My PSA has fluctuated between mid 2 and mid 3’s.
6 months ago it went up to 3.6 and they said I need to do an MRI, full body bone scan and pelvic CT.
The MRI showed a suspicious lesion but the the other tests were good.
They wanted me to do another biopsy after my PSA test in May was about 3.2.
In June I had my yearly physical and blood work and my primary agreed to order another PSA even though I had one 4 or 5 weeks earlier. It came in at 2.0.
They agreed to wait on the biopsy, which are the worst. I hated the biopsy procedure.
I am going to get my OSA done next week, 3 months since my last one.
Fingers crossed.
The HDR brachytherapy did have side effects, but not bad.
Prostate cancer is very confusing.

 

[RHailey]

My experience, my dad had prostate cancer in his 60's and had an RP. Then at age 46, I had a slightly high PSA (I think in the 4's). My wife wouldn't stop worrying about that PSA until I had another screening at age 48. The new PSA was in the normal range, but the urologist thought he felt something abnormal. They didn't have the advanced MRI back then, so the recommended step was the biopsies. They took 12 needle biopsies, 11 were normal and 1 was a 3+3. Not much to go on, but the doctor said it was like "being a little pregnant". My wife was panicked and going to stay that way. We discussed all options, but at that time the only "cure" was surgery, the doctor called it the "gold standard". This was at a major university medical center. I was young, healthy, had a very experienced doctor skilled in "nerve-sparing" techniques, and I just wanted to not keep worrying, so we did the RP. The surgery back then was fairly brutal without the robotics they have now. Recovery was not fun with incontinence and ED. Fortunately, ED went away within a year. Had stress incontinence for several years until another urologist performed a sling procedure with great success. Bottom line, I am now 66, very healthy, retired at 64, work out every day, and never even think about prostate cancer. However, with today's new diagnostics, I'm not sure if I would have gone the same route. I don't know. We took what at the time was the most conservative option, and I guess still is, just to make sure it was "gone". Side note, based of the pathology report on my removed prostate, the urologist said the area where he felt something appeared normal (I almost wish he never told me that). However, the abnormal area was very close to the "capsule", so perhaps the cancer could have escaped sooner than later. We'll never know. My suggestion, if you elect the surgery, use a highly experienced urologist/surgeon who does this all the time. The skill of the surgeon can make a huge difference. Also, multiple MRI's and second opinion reads might be a good idea. My son is a radiologist, and he will be the first to say some of the radiologists are better than others (he's one of the good ones, of course!). I wish you all the best and peace of mind, whatever your decision.

 

[Old Microbiologist]

PSA levels are indicative and not diagnostic. Many things can raise the levels. A rectal digital exam for prostate size can triple the PSA level. So, having the blood test right after examination can cause false high levels. Things like riding a bicycle with a saddle seat can also raise the levels as can large bowel constipation that presses on the prostate. So, a PSA level is just a screening tool and needs to be considered that way. MRI's are also very dependent on the skill of the radiologist. This is why you need to see a specialist with a lot of experience in this area.

I also read way back an interesting paper looking at autopsies on men and they found that by the age of 95 99% of men had prostate cancer but didn't manifest symptoms. So you die with it but not from it if you live long enough. This complicates things a lot.

I am at the opposite end of the spectrum and have suffered from enlarged prostate since age 30 and have had benign prostate hyperplasia (BPH) since then. I have an enormous prostate but so far no cancer. My PSA levels are generally normal now.

Because my wife is Russian we go to Moscow every couple of years and have a complete body check with a full body MRI and exams by a plethora of specialists. It is a business and it is done in a private clinic that caters to the wealthy. That said, I think it is a good system and not all that expensive and it runs around $1,000 depending on what they find and how many specialists you need to see. I wouldn't bother with it but she likes to do it and it isn't all that expensive plus we need to go visit relatives anyway.

 

[sn2792]

My husband was diagnosed with 3 + 3 prostate cancer a year after retirement at age 57. Urologist recommended active surveillance or brachytherapy if he couldn’t handle the watching and waiting. He decided to have the brachytherapy about 8 months later.
Side effects were pretty minimal.

It’s 10 years later now and his PSA is barely detectable. There is a really good community website that has a lot of information that helped him decide what was the best choice for him.

https://www.healingwell.com/community/default.aspx?f=35

 

[Koolau]

PSA levels are indicative and not diagnostic. Many things can raise the levels. A rectal digital exam for prostate size can triple the PSA level. So, having the blood test right after examination can cause false high levels. Things like riding a bicycle with a saddle seat can also raise the levels as can large bowel constipation that presses on the prostate. So, a PSA level is just a screening tool and needs to be considered that way. MRI's are also very dependent on the skill of the radiologist. This is why you need to see a specialist with a lot of experience in this area.

I also read way back an interesting paper looking at autopsies on men and they found that by the age of 95 99% of men had prostate cancer but didn't manifest symptoms. So you die with it but not from it if you live long enough. This complicates things a lot.

I am at the opposite end of the spectrum and have suffered from enlarged prostate since age 30 and have had benign prostate hyperplasia (BPH) since then. I have an enormous prostate but so far no cancer. My PSA levels are generally normal now.

Because my wife is Russian we go to Moscow every couple of years and have a complete body check with a full body MRI and exams by a plethora of specialists. It is a business and it is done in a private clinic that caters to the wealthy. That said, I think it is a good system and not all that expensive and it runs around $1,000 depending on what they find and how many specialists you need to see. I wouldn't bother with it but she likes to do it and it isn't all that expensive plus we need to go visit relatives anyway.

I think I've mentioned that my PCP and I had "the talk" this spring after I turned 74. He's recommending cutting back on some things with PSA being the primary one. I've had VERY low PSA tests for many years. PCPs concern is that a "jump" in the results might send us on a wild goose chase (wait, that doesn't sound too good) er., down a rabbit hole (scratch that one too). Let's just say he convinced me that I'm much more likely to die WITH PC than OF it. Plenty of other health stuff to "worry" about right now, so unless I get symptoms, I'm gonna go with the flow (er., do what the doc recommends). YMMV

 

[googily]

On the bright side, 88-year-old Dad used the prostate cancer that we all don't even think about anymore (old guy = slow growing = something else will probably get him first) to get his third Pfizer shot this week.

 

[teej1985]

On the bright side, 88-year-old Dad used the prostate cancer that we all don't even think about anymore (old guy = slow growing = something else will probably get him first) to get his third Pfizer shot this week.

my dad is 65 and he called CVS, he doesn't have any health issues, they asked when he had the last shot, they told him to come on down.

 

[Tetto]

How exactly do they do the biopsy? The thought of that procedure gives me pause….

 

[lawman]

Reading this makes my head spin..I am 65 years old and have had BPH for many years. Last time it was checked My p.s.a. was either 1.2 or 1.4. I used to have regular urologist that I would see every year of two just to be able to refill my alfuzosin prescription..He would check my prostate digitally and check my blood and tell me he would see me in a year. We moved last year and I had to find a new urologist. I went in for a routine visit and answered the standard questions about how often i pee and how many times I get up at night etc. etc. and he insisted I schedule all kinds of tests where i measure my pee, get a urodynamics test and and biopsy and ultrasound. He did this without so much as p.s.a. test or a digital exam..I was alarmed but began to schedule the tests. I completed most of the tests but stopped just before doing the biopsies. Last time i saw him he wanted to do an Ultra Lift.. They scheduled me for another visit in April..I have no idea what for. Does any of this sound right to you guys?

 

[RetireeRobert]

Don't know. Did this guy get your prior medical records when you signed up with him? If I were you and felt uncomfortable--like you obviously feel---I would find another urologist for a second look, and also to see how they function.

Ultra Lift (I presume same as Uro-lift) I have read about. It is a somewhat common procedure that can alleviate many of the problems men get as they age from BPH. Helps you pee better and more completely. I think there is a thread here on this forum somewhere just about Urolift! Whether you are at the point of needing something like that is another "medical" question. You could also ask this current urologist why he is recommending Ultra Lift at this time. What will it supposedly do for you. What are complications or side effects. And so on.

 

[lawman]

Don't know. Did this guy get your prior medical records when you signed up with him? If I were you and felt uncomfortable--like you obviously feel---I would find another urologist for a second look, and also to see how they function.

Ultra Lift (I presume same as Uro-lift) I have read about. It is a somewhat common procedure that can alleviate many of the problems men get as they age from BPH. Helps you pee better and more completely. I think there is a thread here on this forum somewhere just about Urolift! Whether you are at the point of needing something like that is another "medical" question. You could also ask this current urologist why he is recommending Ultra Lift at this time. What will it supposedly do for you. What are complications or side effects. And so on.

I should have said Urolift...This urologist never asked for my records..

 

[RetireeRobert]

I should have said Urolift...This urologist never asked for my records..

Well, all that he is suggesting for you then seems to just be the way he operates (no pun intended) for any client of his. The fact he has no prior medical history for you and is suggesting all that anyway would make me uncomfortable too.

I think perhaps trying out some other urologists and their modus operandi is in order post haste. You could let this current guy try to explain the "whys" and "whats" for his suggestions, but not sure I would give him even that chance. I would look for someone I was comfortable with and who would explain his rationales for anything they proposed.

One of the best pieces of "medical" advice I ever got concerned our infant son. I went to a general practitioner for help trying to make sense of some different pieces of medical proposals we had gotten from specialists. The wise old Doc advised--"whatever they propose, push them, and prod them, and make them explain and justify what they are proposing. Do this until "you" are satisfied."

As non-specific and non-comital as that advice might sound, it actually made a lot of sense and helped us decide how to handle our situation. I should look that guy up if he is still around and thank him for that advice.

 

[Koolau]

One of the best pieces of "medical" advice I ever got concerned our infant son. I went to a general practitioner for help trying to make sense of some different pieces of medical proposals we had gotten from specialists. The wise old Doc advised--"whatever they propose, push them, and prod them, and make them explain and justify what they are proposing. Do this until "you" are satisfied."

Good advice. I had an "impinged shoulder" (according to the x-ray and symptoms.) Doc (an ortho guy) said I can fix that up with surgery. I said "what about trying physical therapy first?" He said, "Well, okay, if you want to try that." The PT therapist took one look at my movements and "diagnosed" the issue herself. "Yep. You've got a Yuppie disease. You sit at a computer all day and the muscles that hold your scapulas in place are weakened. We'll strengthen those and you'll be okay in a month." I was okay in a month. YMMV

 

[lawman]

My days of being a passive patient are over..

 

[watchman3135]

In the video clip I posted on the first page, the Doctor said that 40% - 50% of men 50 and older have some prostate cancer but only 3.5% die from it. And if you have a higher than normal PSA that leads to a biopsy which then finds PC in other words "If you look, you find".

Active Surveillance was derived out of data that the medical industry has been over threating Gleason 6 or lower for decades yet I'm not sure there is a clear easy answer and I would never fault someone with Gleason 6 who wants more aggressive treatment such as a RP or Radiation. I'm almost two weeks into my diagnosis and still feel I want my prostate out so I can move on. The hardest part is hearing you have CANCER and you are not doing anything about it other than waiting if and when it turns into something more aggressive.

 

[NewEnglander]

Sorry for your diagnosis Watchman3135, my case is very similar to yours, I was 55 years old at my cancer diagnosis with similar numbers to you.

My father and two uncles passed away from Prostate cancer so I started watching my PSA many years ago. Each year as part of my annual physical I’d have the digital exam as well as a PSA test. For years it was in the 1.6-2.0 range then in 2017 when it increased to 3.0. Three months later it was 3.4 so we decided upon a biopsy. I tried to get an MRI and/or MRI guided Biopsy but my insurance would not cover it. I did the normal Biopsy which came back 2 of 12 cores positive 3+3= Gleason 6. After positive cancer diagnosis the insurance then approved an MRI. The MRI was done on the newest technology MRI machine which was installed just months before my appointment. The MRI saw nothing, PIRADS 1.

I spoke to multiple Urologists and Radiation oncologists from Yale and Sloan Kettering in NY. I looked into all of the options but decided on Robotic Prostatectomy with a doctor who had done over 3500 robotic prostatectomies using the DaVinci machine. This decision is not to be taken lightly as the odds for permanent side effects are more common that not. Erectile deficiency and incontinence issues in many if not most cases.
I didn’t like Active Surveillance. The two friends of mine who were on Active Surveillance both had to eventually get treatment so what was gained by waiting, at least in their cases?

During/after my surgery it was found that the cancer tumor was about 8-9mm and it was already outside the prostate wall. But luckily there were “no margins” in my case as the doctor cuts outside the prostate wall and everything was contained within the area he cut out. I was surprised at the finding; how could the MRI completely miss the tumor? but it did in my case.

I followed all the post op suggested recovery walking a minimum of 5 miles per day starting less than a week after surgery, doing kegel exercises daily. I took a medical leave from work for 12 weeks.

I’m happy with how things turned out for me. I’ve got no side effects at all and my PSA numbers remain at zero. During the healing process I did have some minor urinary leakage, what they call stress incontinence, but this went away after a couple of months.

I swear that I’m without the common side effects because of the skill of my surgeon but he says it’s because I’m in relatively good shape and followed all his instructions. Who knows maybe I was just lucky, at least so far.

My brother had not been checking his PSA numbers so at my urging and his girlfriends too he finally got his checked. Unfortunately, he found cancer too. He selected Proton Radiation therapy and so far, he’s had no side effects and no further PSA increases.

I’d suggest that you get 2nd, 3rd and maybe even 4th opinions with Drs from differing treatment options, read as much as you can then decide for yourself. I wish you well with whatever option you chose.

Although I was already planning on retiring my cancer diagnosis definitely helped push me to retire on 12/31/20. And my DW joined me retiring the same week! We are very happily retired and loving life.

 

[bmcgonig]

Sorry for your diagnosis Watchman3135, my case is very similar to yours, I was 55 years old at my cancer diagnosis with similar numbers to you.

My father and two uncles passed away from Prostate cancer so I started watching my PSA many years ago. Each year as part of my annual physical I’d have the digital exam as well as a PSA test. For years it was in the 1.6-2.0 range then in 2017 when it increased to 3.0. Three months later it was 3.4 so we decided upon a biopsy. I tried to get an MRI and/or MRI guided Biopsy but my insurance would not cover it. I did the normal Biopsy which came back 2 of 12 cores positive 3+3= Gleason 6. After positive cancer diagnosis the insurance then approved an MRI. The MRI was done on the newest technology MRI machine which was installed just months before my appointment. The MRI saw nothing, PIRADS 1.

I spoke to multiple Urologists and Radiation oncologists from Yale and Sloan Kettering in NY. I looked into all of the options but decided on Robotic Prostatectomy with a doctor who had done over 3500 robotic prostatectomies using the DaVinci machine. This decision is not to be taken lightly as the odds for permanent side effects are more common that not. Erectile deficiency and incontinence issues in many if not most cases.
I didn’t like Active Surveillance. The two friends of mine who were on Active Surveillance both had to eventually get treatment so what was gained by waiting, at least in their cases?

During/after my surgery it was found that the cancer tumor was about 8-9mm and it was already outside the prostate wall. But luckily there were “no margins” in my case as the doctor cuts outside the prostate wall and everything was contained within the area he cut out. I was surprised at the finding; how could the MRI completely miss the tumor? but it did in my case.

I followed all the post op suggested recovery walking a minimum of 5 miles per day starting less than a week after surgery, doing kegel exercises daily. I took a medical leave from work for 12 weeks.

I’m happy with how things turned out for me. I’ve got no side effects at all and my PSA numbers remain at zero. During the healing process I did have some minor urinary leakage, what they call stress incontinence, but this went away after a couple of months.

I swear that I’m without the common side effects because of the skill of my surgeon but he says it’s because I’m in relatively good shape and followed all his instructions. Who knows maybe I was just lucky, at least so far.

My brother had not been checking his PSA numbers so at my urging and his girlfriends too he finally got his checked. Unfortunately, he found cancer too. He selected Proton Radiation therapy and so far, he’s had no side effects and no further PSA increases.

I’d suggest that you get 2nd, 3rd and maybe even 4th opinions with Drs from differing treatment options, read as much as you can then decide for yourself. I wish you well with whatever option you chose.

Although I was already planning on retiring my cancer diagnosis definitely helped push me to retire on 12/31/20. And my DW joined me retiring the same week! We are very happily retired and loving life.

What a great story with a happy ending. Well done. Can you share the name of your surgeon?

 

[bmcgonig]

Reading this makes my head spin..I am 65 years old and have had BPH for many years. Last time it was checked My p.s.a. was either 1.2 or 1.4. I used to have regular urologist that I would see every year of two just to be able to refill my alfuzosin prescription..He would check my prostate digitally and check my blood and tell me he would see me in a year. We moved last year and I had to find a new urologist. I went in for a routine visit and answered the standard questions about how often i pee and how many times I get up at night etc. etc. and he insisted I schedule all kinds of tests where i measure my pee, get a urodynamics test and and biopsy and ultrasound. He did this without so much as p.s.a. test or a digital exam..I was alarmed but began to schedule the tests. I completed most of the tests but stopped just before doing the biopsies. Last time i saw him he wanted to do an Ultra Lift.. They scheduled me for another visit in April..I have no idea what for. Does any of this sound right to you guys?

All those tests wouldn’t bother me except for the biopsy. You give no clues as to why he would order that. I’m assuming it’s a prostate biopsy? If so I’d definitely recommend a new urologist. You need to have some suspicion to order one of those. They’re incredibly invasive.

 

[watchman3135]

Sorry for your diagnosis Watchman3135, my case is very similar to yours, I was 55 years old at my cancer diagnosis with similar numbers to you.

My father and two uncles passed away from Prostate cancer so I started watching my PSA many years ago. Each year as part of my annual physical I’d have the digital exam as well as a PSA test. For years it was in the 1.6-2.0 range then in 2017 when it increased to 3.0. Three months later it was 3.4 so we decided upon a biopsy. I tried to get an MRI and/or MRI guided Biopsy but my insurance would not cover it. I did the normal Biopsy which came back 2 of 12 cores positive 3+3= Gleason 6. After positive cancer diagnosis the insurance then approved an MRI. The MRI was done on the newest technology MRI machine which was installed just months before my appointment. The MRI saw nothing, PIRADS 1.

I spoke to multiple Urologists and Radiation oncologists from Yale and Sloan Kettering in NY. I looked into all of the options but decided on Robotic Prostatectomy with a doctor who had done over 3500 robotic prostatectomies using the DaVinci machine. This decision is not to be taken lightly as the odds for permanent side effects are more common that not. Erectile deficiency and incontinence issues in many if not most cases.
I didn’t like Active Surveillance. The two friends of mine who were on Active Surveillance both had to eventually get treatment so what was gained by waiting, at least in their cases?

During/after my surgery it was found that the cancer tumor was about 8-9mm and it was already outside the prostate wall. But luckily there were “no margins” in my case as the doctor cuts outside the prostate wall and everything was contained within the area he cut out. I was surprised at the finding; how could the MRI completely miss the tumor? but it did in my case.

I followed all the post op suggested recovery walking a minimum of 5 miles per day starting less than a week after surgery, doing kegel exercises daily. I took a medical leave from work for 12 weeks.

I’m happy with how things turned out for me. I’ve got no side effects at all and my PSA numbers remain at zero. During the healing process I did have some minor urinary leakage, what they call stress incontinence, but this went away after a couple of months.

I swear that I’m without the common side effects because of the skill of my surgeon but he says it’s because I’m in relatively good shape and followed all his instructions. Who knows maybe I was just lucky, at least so far.

My brother had not been checking his PSA numbers so at my urging and his girlfriends too he finally got his checked. Unfortunately, he found cancer too. He selected Proton Radiation therapy and so far, he’s had no side effects and no further PSA increases.

I’d suggest that you get 2nd, 3rd and maybe even 4th opinions with Drs from differing treatment options, read as much as you can then decide for yourself. I wish you well with whatever option you chose.

Although I was already planning on retiring my cancer diagnosis definitely helped push me to retire on 12/31/20. And my DW joined me retiring the same week! We are very happily retired and loving life.

Thanks for sharing your story. I'm nearly two weeks into my diagnosis and active surveillance is consuming my thoughts with worry and I don't see myself going the distance even if there is no change and like you said, It would seem sooner or later that treatment would become necessary but I know most in the field would say that's not true with every case and I have heard of Gleason 6 men on year 12 with no changes.

Disappointingly I did tons of research prior to my first Urology visit knowing I would likely be pushed towards a TRUS biopsy and everything and everyone pointed to 3T Multi Parametric Prostate MRI as the first next step rather than a biopsy and if nothing is found, no biopsy was needed or if something was found, a targeted biopsy could be performed. Yet in Europe, a prostate MRI is the "Gold Standard" and a stopping point for avoiding further testing like a biopsy. Can't help but wonder if there will be higher incidences of men getting PC although the following year PSA will still be high in those men where the MRI showed nothing and should be raising red flags for further testing. I've also read that some PC's can hide from MRI. Maybe Europe will be soon adopting America's protocol of that a biopsy is still necessary even if MRI shows nothing.

My urologist assistant called last Thursday on a question I had and when she asked If I had any other questions I asked for the name of the Surgeon the Doctor recommend at my prior visit if I consider AS to much to deal with and she paused and said hold on. The Doctor got on the phone and when I told him I don't think I'll be able to do AS for long he assured me that it was the right treatment now and it doesn't mean we aren't doing nothing, etc...and followed up by saying "I would recommend this for his Father or other Family members if it were the same". We discussed re-reading the slides which were originally read in Chicago and he said he could send them to UCLA who they use when patient's recommend a second verification. Still waiting on that.

I have had a colonoscopy in the past which as you may know are given a twilight drug and lay on your side but never had full general anesthetic surgery which ironically is my biggest fear I have having life long mild COPD (though never smoked) and sleep apnea and I cannot breath while laying flat on my back. I know I will be closely monitored and a breathing tube would be placed down my throat so I will be assisted breathing but the fear is very high ironically more so than the possibility of ED and some incontinence if you can believe that.