Behind the headlines

If you read Gary Sanders’ March 8 update to his July 2010 Prostate Cancer Journey, you noted a perfect example of a man and his urologist agreeing to monitor a low-grade, non-aggressive prostate cancer instead of going immediately to treatment.

This monitoring is called Active Surveillance (AS) and was one of the choices Gary and his urologist, Dr. Kollmorgen, discussed following Gary’s diagnosis of Gleason 6 prostate cancer.

This is a form of non-treatment for indolent (not immediately problematic) prostate cancer and the urologists at Oregon Urology Institute have long been among the leaders in utilizing it in lieu of going right to treatment.

The following is a recap for anyone who missed Gary’s update and more explicit information about AS for everyone.

The purpose of AS is to let the patient avoid immediate treatment, while monitoring the cancer so closely that any changes will be caught while there is still time for curative treatment to occur.

Does this work 100 percent of the time? Unfortunately, no.

Does it let some men avoid treatment all together? Absolutely.

We all know prostate cancer is unpredictable — a mutation here, a mutation there — and it is a whole new ball game. That’s why AS demands very close monitoring with regular PSA tests and repeat biopsies.

Despite that uncertainty, Gary was at total peace working with Dr. Kollmorgen in pursuing AS instead of jumping right into a treatment of surgery or radiation. We can look at three reasons for that peace of mind.

First, Gary had total confidence in Dr. Kollmorgen and the pathologist’s assessment of the TURP tissue which revealed the cancer. Second, he was completely at ease having prostate cancer in his body while closely monitoring it.

And third, he helped himself immensely by attending the Us TOO Florence Prostate Cancer Education/Support Group meetings. As we say, “Come with questions — leave with answers. Or, just come listen and learn.”

Having been at those meetings with Gary, it was heartening to hear him tell us over and over how the information he gained there reassured him that AS was his right choice. By attending the meetings, he had the opportunity of asking the urologist who was present, either Dr. Mehlhaff, Hoff or McKimmy, any questions that arose between his visits with Dr. Kollmorgen.

That was like being under the care of four urologists for the same disease. What a lucky guy!

With the Gleason 6 prostate cancer that Gary had, he and Dr. Kollmorgen were monitoring it for three primary results: That it remained a Gleason 6 with no spreading (the preferred result); that it remained a Gleason 6, but growing in volume (which Gary's did); that it mutated into a higher Gleason number (especially 8, 9 or 10, becoming an aggressive, spreading and potentially deadly cancer), which it fortunately did not do.

Not knowing what the cancer might do is the main reason some men go right to treatment — they aren’t going to give the cancer a chance to get away. And, since early, curable prostate cancer rarely causes symptoms until it is incurable, it is not our place to criticize a man who wants it out immediately.

Of course, that won’t stop the so-called experts from shouting “over-treatment!” They would tell the man he should never have had the PSA test in the first place. Then he wouldn’t know he had prostate cancer and wouldn’t get it treated. I think most experts will admit there is no guarantee the Gleason 6 will remain a Gleason 6 (forever).

But then, it isn’t their life at risk.

One thing we who attend Us TOO Florence meetings have learned over the years is that when prostate cancer gets a head start, we rarely catch up. We’ve seen that in the 30 plus men we have lost from our group in the last 15 years. That’s exactly why OUI says, “It is better to know than to not know.”

Us TOO Florence agrees.

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