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Having agonised about what to do for over a year now I have finally decided. Nothing. Well, not quite nothing but what is termed ‘watchful waiting’. My PSA has steadily increased over the past two years from 5.4 to 7.4 and in September my GP referred me to a urologist. The urologist, who arrived very late to the surgery, did a quick DRE then said that he would refer me for a biopsy. I wanted to discuss the options, including MRI as I didn’t want to undergo an invasive procedure without proper discussion. Also, I had read that in a test conducted on 223 biopsy-naïve men that biopsy was no better at detecting PCa than MRI. The link to the study is here http://www.europeanurology.com/article/S0302-2838(14)00211-5/fulltext/prospective-study-of-diagnostic-accuracy-comparing-prostate-cancer-detection-by-transrectal-ultrasound-guided-biopsy-versus-magnetic-resonance-mr-imaging-with-subsequent-mr-guided-biopsy-in-men-without-previous-prostate-biopsies and the conclusion reproduced below.
We found that mpMRI/MRGB reduces the detection of low-risk PCa and reduces the number of men requiring biopsy while improving the overall rate of detection of intermediate/high-risk PCa.
Unsure how to proceed I asked my GP to refer me to a private urologist with the hope of being able to discuss the alternatives.
In the meantime I did some extensive research and discovered two further studies which concluded that for low grade PCa (PSA<10) the outcome for watchful waiting was no worse in terms of morbidity that invasive treatment and the outcome in terms of quality of life was much better. Both studies were conducted over at least 10 years by reputable agencies. One, conducted by the New England Journal of medicine is here http://www.nejm.org/doi/full/10.1056/NEJMoa1113162 . The other can be found by searching 'PIVOT'. Also, a number of well-known doctors have published articles in favour of doing nothing – Dr Mark Porter in The Times and Dr Sarah Jarvis in this very website, not to mention other articles in The Daily Mail, Telegraph and Independent. I got to thinking that if invasive treatments did not improve my outcome, what was the point of a biopsy?
I finally got to see a private urologist who discussed the options and, although he was marginally in favour of a biopsy, did not object to my proposal. So now I am going to monitor my PSA and I will reassess the situation if/when my PSA goes into double digits. I have since gone on a no-dairy and low red meat diet and my latest PSA (Dec14) was down marginally to 7.2 – still high but moving in the right direction. I appreciate that this course of (in)action is not for everyone and not knowing is frustrating at times, but for me at least, I feel it is the best current option.
I am 56 years of age and my father, who is still very well had an RP for PCa about 15 years ago. All DREs have reported ‘enlarged but benign-feeling’.
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