Hi Disappointed,
I was diagnosed with low grade prostate cancer in 2009 and after going through an extensive analysis of treatments decided on Active Surveillance (AS). AS is different than watchful waiting although many people use them interchangeably.
You can find out everything you ever wanted to know about active surveillance by viewing the archived webcasts from last December’s NIH consensus meeting at
NIH Role of Active Surveillance in the Management of Men With Localized Prostate Cancer Conference
If you are already familiar with this site then I apologize for being repetitious.
You can select the day that you are interested in by scrolling down and looking at the agenda. Once in the webcast you can then position to the presentation that you are interested in. For example, if you want to view the presentation at 2:10 pm on day 1 (Monday) delivered by Laurence Klotz (which I recommend) you can position the video to approximately 274 minutes. Following the Klotz presentation, there is a question and answer discussion that I think many people may find valuable. The question and answer discussions follow each of the 4 major areas addressed by the conference and I found them very informative.
Another presentation that I highly recommend is the results of the PIVOT study on day 2 at 10:10 AM by Timothy Wilt. You can position this video to approximately 93 minutes. PIVOT is the first US randomized study comparing radical prostatectomy versus observation/watchful waiting for localized prostate cancer. There are also podcasts of the presentations on the same web page as aforementioned (you need to scroll down) that are broken down into multiple segments. You can also read the final draft statement of the consensus meeting if you wish but I found that the videos and the subsequent discussions provided greater insights into the state of active surveillance.
As I read your prior posts I have some general observations that helped me and may help you. I would recommend that you always get your PSA test using the same assay at the same lab. The link
Two PSA Test Standards Are Causing Problems in Screening for Prostate Cancer from Dr William Catalona discusses the importance of using the same test standard.
Larger prostates will produce higher PSA values and therefore many institutions use the concept of PSA density (PSA value/Prostate Volume) of <.15 as entrance into their active surveillance programs. For example, if your prostate volume is 40 cubic centimeters or 40 grams (if expressed in weight rather than volume) and your PSA is 3.35 then your PSA density is 3.35/40 = .08 . Your prostate volume is determined by an ultrasound examination. About 50% of men over the age of 50 will have BPH (an enlarged prostate) and therefore a higher PSA value may not indicate cancer progression but rather BPH. Some men with very large prostates (>100g) can have PSA values greater than 10 without having prostate cancer.
Based on your interest in City of Hope I am assuming you would be open to going to Ventura California. Therefore, rather than basing your treatment decision solely on your Nov PSA, I would recommend that you consider seeing Dr Duke Bahn who can perform a color Doppler ultrasound on your prostate that will provide you with additional information such as if the cancer localized, missing cores that may not have been detected with your initial biopsy, etc. In addition, should you choose to continue with active surveillance then you may want to have a Color Doppler ultrasound performed on a regular basis to assess growth and aggressiveness. For more info see
Prostate Institute of America.
I would recommend that you consider diet and lifestyle changes as part of your prostate cancer treatment. The good news is that a heart healthy diet/lifestyle program is also good for your prostate. The attached study by Dr Dean Ornish and others is a classic one on the benefits of this approach.
http://www.ornishspectrum.com/wp-content/uploads/Intensive_Lifestyle_Changes_and_Prostate_Cancer.pdf
I have also found an excellent nutrition guide from UCSF at
http://urology.ucsf.edu/patientguides/pdf/uroOnc/Nutrition_Prostate.pdf
Lastly, I would recommend that when you are ready you consider changing your moniker from Disappointed to something more positive. When I was diagnosed with prostate cancer I read many books and articles about people who had prostate cancer and after getting over the initial shock and treatment felt it was the best thing that ever happened to them. It changed their relationships with family and friends, gave them a greater appreciation of life, focused on living in the presence.
Hope this helps and let me know if I can be of any assistance.