This is a follow-up to my January and February posts. In January I reported that an increase in my PSA would necessitate a prostate biopsy and in February I reported that the biopsy was inconclusive and would require another biopsy in April. In March at the suggestion of our friend Jeff Marker, who has been living with prostate cancer for several years, I had a 3-D Doppler ultrasound of my prostate taken by the only radiologist in North America who does them. The radiologist told me I had a non-active prostate cancer of insignificant size and suggested I adopt a strategy of watchful waiting/active surveillance including eliminating dairy from my current pescetarian diet, taking nutritional supplements that are beneficial to the prostate and having the 3-D Doppler ultrasound again in six months. There are treatments for small prostate cancers, however, that can target the tumor in a way that does not impair the entire gland, have fewer side effects than treatments that might be required later if the tumor grows larger, and unlike those other treatments can be repeated should other tumors develop. But to have the option of such targeted treatments required I undergo the second biopsy scheduled for April. The radiologist advised against the biopsy warning that biopsies can actually spread cancer. My urologist said that the radiologist was mistaken and probably basing his opinion on outdated research (the urologist also expressed the opinion that the reason no other radiologist uses 3-D Doppler imaging of the prostate is that it is inaccurate). My own on-line research on biopsies indicates that if the cancer is as small and inactive as the radiologist said it is then it could not survive outside the host organ. Thus having the biopsy posed little risk and would give me more options.
The January prostate biopsy took 12 samples; the April biopsy took 14 samples and was more painful than the first one both during the biopsy and in the weeks since. Only one of the 14 tissue samples had cancer, cancer was found in only 5% of that one sample, and the cancer cells in question are moderate (3 on a scale of 5) and not lethal. Three other tissue samples showed pre-cancerous growths. Prostate cancers are measured on the Gleason Scale (2-10): anything under 7 is considered favorable and non-lethal, and my Gleason score is 6. By and large my April biopsy confirmed the radiologist’s scan the previous month, but it also gave me additional information. My Gleason 6 makes me a candidate for what is known as a male lumpectomy (targeting part of the prostate instead of the entire gland). The method that most accurately targets the tumor with the fewest side effects, High Intensity Focused Ultrasound (HIFU), is available abroad (for about $20K in Toronto) but is not yet FDA approved. If my prostate gland were a bit smaller (25 mm or less) than it is (32mm) my urologist could get me into a local HIFU clinical trial. Another form of male lumpectomy is Partial Cryosurgery (freezing half the prostate and leaving the other half intact), but that would destroy one of the two nerves responsible for sexual function. So I decided I will adopt a strategy of active surveillance which includes PSA tests every three months, biopsies every six months, following the no animal fat diet mentioned above, and continuing to take meds and nutritional supplements that may shrink my prostate sufficiently to qualify me for a HIFU clinical trial or in a best case scenario may shrink the tumor itself so that treatment other than continuing active surveillance becomes unnecessary. Active surveillance can continue for decades and has no side effects. I prefer giving up dairy cheese and ice cream and enduring the biopsies to over-treating an as yet non-lethal condition.