Doc, what would YOU do….?

This is a question that I hear at least 2-3 times/week. Early in my career, I avoided it or ignored it, or simply wouldn’t answer. In some ways that was fair, since I was at an age that men seldom get prostate cancer. Now, at age 64, it is much easier to relate to. So, when I’m asked this by a man newly diagnosed with a very low volume (< 2 cores) low threat (Gleason 6 or less) tumor, my answer is “Either I would participate in the START trial (randomizes to active surveillance or treatment) or I would simply adopt active surveillance.” If I was outside the trial, I would begin taking finasteride or dutasteride based on my understanding that my next biopsy might be more likely to reveal a higher grade gleason tumor if my prostate was smaller. Finally, on my next biopsy, I would ask for a mapping biopsy. This technique allows a very complete evaluation of what is “really there” in the prostate gland, much more reassuring than simply another 12 core biopsy.

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