One of the questions that has been nagging at Howard Wolinsky for a while now is whether he really needs to have another biopsy … ever!
To understand why this is a critical question for Howard, you need to know that — for most of the past decade — Howard has been a “poster child” for active surveillance (AS) as a strategy to manage his apparently very low-risk prostate cancer. Indeed, his prostate cancer is of such a low risk level that no one has ever been able to find it again since the original diagnosis: no sign on any MRI; no sign on any repeat biopsy; no meaningful change in his PSA level; no meaningful change in his phi level for the past 2 years.
So … looked at from Howard’s perspective, coronavirius may have been a blessing because it made it possible for him to skip his scheduled meeting with his urologist for his most recent check up. They did the “visit” by phone, and the urologist was the one who seems to have suggested that — unless there is some really significant change over time in Howard’s PSA level or his phi level or his MRI data or some other clinical indicator of disease progression — maybe there is no point to another biopsy.
Don’t take my word for it. Get the message straight from the horse’s mouth. Here’s the link to Howard’s most recent article on MedPage Today: “Prostate cancer surveillance: could I be done with biopsies … forever?”
Now let’s be very clear. This is not an option that would be appropriate for every patient on AS … or at least, not unless they continued to have stable disease and a life expectancy of < 10 years. Howard thinks he’s good for more than another 10 years. We hope he is right. Why? ‘Cos he continues to be the “poster child” for the value of AS in men with very low-risk prostate cancer in particular … and very publicly too!
Filed under: Living with Prostate Cancer, Management | Tagged: active surveillance, biopsy, low risk, monitoring, Wolinsky |
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How old is Howard? Past the age of 70, isn’t he risking permanent side effects from more needle biopsies? In the absence of other symptoms or indications, shouldn’t Howard be going to MRI only?
Steve:
He is going on to MRIs and phi tests only. That’s the point … although the ED issue wasn’t his defining concern as far as I am aware. Did you read his article? His primary concern has always been the risk for sepsis.
What is Howard’s age? Has Howard been on AS for 10 years, and is looking forward to 10 more? He addresses all these points in the article we provided a link to.
I think Howard is 72 years of age, and yes, I think he is planning on (at least) another 10 years of just monitoring his prostate cancer status on AS.
I should have read the article closer.
Good for Howard!
Having had an infection following my initial needle biopsy in 2007, and major bleeding after a subsequent one when I was given an “old” prep sheet that did not include warnings about fish oil consumption, there are risks involved with needle biopsy. I read an article once (just looked, but could not find it) saying that risk of ED also increased with needle biopsies for older men. Even when I was on a 3-year biopsy schedule, I was dreading each one more than the last. I still feel slightly nauseous when I think of that clicking noise.
I had not heard of PHI and that looks like an improvement over traditional PSA tests. I’ll talk to my urologist about that at my next visit. I had my last needle biopsy in 2014, and a prostate MRI in 2017. I’m undecided if I want to even do another MRI unless something changes.
The risk of my small amounts of Gleason 6 changing into something worse are low, and at 71 I’m starting to wonder if even AS makes sense after living with low-grade prostate cancer for the last 13 years.
Thank you. I am 74 and will have my 8-year mark, since diagnosis. I have been on AS the entire time, and have had four needle biopsies, with a 3 + 3 = 6 Gleason. I hope Howard and others the best.
Has he had his original biopsy slides re-assessed?
Yes. I think so, but you should just ask him yourself or go back and read his earlier articles which dealt with all of that stuff.