A personal journey of active surveillance
Howard Wolinsky (former medical editor at the Chicago Sun Times) has experience with active surveillance. He has “served” 13 years on active surveillance and is pondering whether to continue or to make a break for it. In a recent article in MedPage Today, he describes his experiences that are summarized below.
Mr. Wolinsky had a single prostate biopsy sample showing Gleason 6 of less than 1mm in 2010, but never found again in five more biopsies. By his own account, Mr. Wolinsky has been a model patient, submitting to annual or semi- annual PSAs since 2016. He had a baseline MRI scan followed by a systemic transrectal prostate biopsy in 2017.At his most recent “checkup,” two days before his 76th birthday, the news was again favorable. His urologist told him he was good for another year on a “modified” version of AS. He would order an MRI scan if he wanted to know if there were any visible lesions.
Mr. Wolinsky countered with a question regarding stopping surveillance altogether. His physician asked if there was harm in watching him and asked if it made him feel better. Mr. Wolinsky is not sure and wonders if he should take up a hobby instead.
Mr. Wolinsky, as a medical journalist, AS patient, and advocate consulted the actuarial tables and found his life expectancy is 9.88 years. His urologist told him that on paper and in person, he appears to be very healthy and will probably outlive the actuarial estimates, so staying on AS would be a reasonable decision.
In making his decision, Mr. Wolinsky consulted with 16 authorities on prostate cancer from five countries (including Dr. Catalona) about what they would recommend. There was no consensus, though they leaned toward continued surveillance with PSA testing and sometimes an MRI scan.
Option 1 was favored by seven of sixteen urologists. Stay the AS course with annual or semi-annual PSA and perhaps add an MRI or molecular marker test.
Option 2 (supported by two physicians) recommended annual or semi-annual PHI tests.
Option 3 MRI’s and annual PSA test.
Option 4 Modified watchful waiting which could include PSA’s or PHI’s. No more biopsies unless the PSA shoots up.
Option 5 Jump the AS ship. Mr. Wolinsky feels he had a “bad prostate day” in 2010 and that result has dominated his life ever since. That is why he is questioning continued surveillance.
While the panel was not in agreement about the exact path Mr. Wolinsky should take, a significant proportion of experts recommended dropping AS in his specific case though most doctors strongly supported surveillance in some fashion.
One member of Mr. Wolinsky’s panel who is the chair of the national working group for organized prostate cancer testing in Sweden said, “You raise an important issue. Guidelines are needed for men of all ages.”
While Mr. Wolinsky is pondering his AS decision, he has enrolled in the Masters of Public Health program at the University of Illinois Chicago School of Public Health, and hopes to complete his degree before his 80th birthday.
Wolinsky, MedPage Today. 2023, October 18. Here is the link to the original article: https://www.medpagetoday.com/special- reports/apatientsjourney/106873