In general after five years of pursuing surveillance most patients are still in the program without progression. You’ll see that various studies have various drop out rates, usually with no medical consequence.
You’ll also notice that some drop out for anxiety issues.
The other most common reason for drop out would be a more unfavorable biopsy result or change in PSA value or velocity.
So, in the properly selected and appropriately followed patient , surveillance works. The unknown question however again is …who will be that guy that will fall through the cracks…that guy that is that “low percentage guy.” I was the anxiety guy..couldn’t live with it…I had to have it out and the biggest part of my decision was based on my age. What will it be for you…” How big a boy are you?”
Prostate Diaries 
Dr, McHugh,
Thanks for tackling the tough issue of AS. Though far older than you, I made my surgical decision based on anxiety, too, and absolutely marvel at those “lucky” individuals who can simply shrug their shoulders and continue to happily move forward despite the ever present danger posed by a positive biopsy; not to mention the additional stress wrought by each new PSA, DRE, and, perhaps, second biopsy report. However, that’s the way it is, and to my way of thinking the better the AS patients do, the better we all do in the long run. So, here’s hoping the numbers keep showing no increased mortality with properly chosen and monitored AS patients.
My only issue with the AS reports attached to your post is that the word “age” never seems to be calibrated for one’s fitness and health level. Although you say — beyond the anxiety factor — that the biggest part of your decision was based on your age, it seems to me that as long you were relatively fit and in excellent health you would have made the same decision to proceed with surgery well into your seventies if not beyond. In my experience, most healthy individuals who hit seventy still have as much desire for another twenty years as do those individuals twenty years their junior.
So, although most urologists undoubtedly have an upper age number in their mind beyond which they more strongly council against surgery, that number should, in my opinion, be tempered by far more than the patient’s birth date. The reverse would also apply to younger individuals in poor health who, as you know, make poor surgical candidates. Perhaps I’m overstating the obvious, but as a bonafide senior citizen, I am increasingly distraught when a young doctor seems to focus more attention on my age than on my body.
Thanks,
Jack
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Dear Doc,
With out going into a long history, AS was recommended to me by one Doctor. At the time PSA 4.0. I had a biopsy that came back with very small amount of cancer 1 out of 12 cores. Gleason 3 + 3. Age 54, decided on Robotic surgery. Path report: positive surgical margin and cancer present in both seminal vesicles. Glad I had the surgery, AS would not have been the right choice for me. Although I am in a small percentage range for this outcome, it can happen.
Great site.
Mark L.
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Thanks for your comment. My sentiments exactly…in my heart I thought I might be just that one who was the one in a hundred. I hope you progress well. JM
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An earlier Swedish study on active surveillance showed that many men deveveloped Erectile Dysfunction after being diagnosed with prostate cancer. Evidently the anxiety alone was probably the culprit
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