Indolent Prostate Cancer

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Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2268
   Posted 12/27/2008 3:38 PM (GMT -7)   
I've read a lot of 'urban legends' about prostate cancer.  The one that seems to have the most staying power is that most prostate cancers are indolent, and that you'll die of a bee sting at age 95 before prostate cancer will kill you.
 
On occasion, I've even second-guessed my own decision to get the cancer cut out, thinking, maybe mine was one of those indolent cancers and I could have practiced 'watchful waiting' (Read: Spin the roulette wheel). 
 
I have yet to read that there is any research that proves with confidence which prostate cancers are indolent (slow-growing) and which are not.  Has anyone read any solid evidence that can determine which cancers are aggressive and which are not?
 
I know that Gleason score is an indicator, but who is to say that a low Gleason score will not become aggressive and spread outside the prostate. Will this take a year, two years, a decade? 
 
Bottom line for me is that I am thankful for an on-the-ball internist who sent me to a urologist when my PSA increased fourfold in a year, though remaining in the normal range for my age.  We found it early, got it out, and now I can deal with living life without the Damocles sword of prostate cancer hanging over my head.
 
Comments welcome...Tim
 
 


PSA quadrupled in 1 yr (0.6 to 2.5)  
DRE neg  1 of 12 biopsies pos (< 5%) 
Open surgery June 06 at age 57
Organ confined to one small area Gleason 5   
PSA's undetectable  < 0.1  


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 12/27/2008 4:02 PM (GMT -7)   
Tim you bring up a good point that I see debated here daily. I guess there is not a cookie cutter approach to PCa nor are all PCa diagnosis the same. Gleason score is a good barameter combined with PSA. From my vantage point I believe in fighting the demon. I think there are people that watchful waiting is the proper protocol, however if someone is otherwise healthy and has a good life expectancy ahead of them I say get it out. Just my thinking.
Thanks for writing and happy New Year

peace and love
Dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .06
Testosterone keeps rising, the current number is 156, up from 57 in May
cancer in 4 of 6 cores
92%
80%
37%
28%
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 12/27/2008 4:12 PM (GMT -7)   
Tim, I guess that some of those folks that still believes the standard myths of PC don't know any of the 25,000 to 30,000 men that die each year because of it, or their families for starters.

With my pre-surgery specs, even my well experienced dr didnt want to speculate about how I would fare, he was deeply concerned that even waiting 6 months to a year could change my entire outcome downward, especially my psa velocity.

You bring up some good points.

David
Age 56, 56 at DX
 
PSA 2007 5.8
PSA 9-2008 14.9
 
3rd Biopsy 9-2008 Positive
7 of 7 cores positive, ranging from 40 - 90%
2 tumours noted, Gleason 4+3 and 3+4
 
Open RP surgery completed on Friday, November 14, 2008 at
St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon,
Non-nerve sparing, 4 days in hospital, staples removed 11/24/8,
Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08 - uncertain of what went wrong.
 
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes. Left lobe: infiltrating tumor miscroscopically appears to extend to marked left posterior margin
 
First PSA Post Surgery  Scheduled for 1/5/9
 
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/27/2008 7:30 PM (GMT -7)   
That is an excellent question which is there any good evidence for down the road or long run patients etc. There is a definition of 'insignificant prostate cancer' it is founded by Brady Urology dept of John Hopkins Hospital. Part of it is 5% or less in I think it was 1-2 cores (max.) and Gleason 6 or less, I am not quoting directly,but from my ADT3 memory the parameters were somewhere around that. Question is when or can it change to more aggressive PCa???? Generalizations perhaps it could take 10 yrs. + on average, but who wants to gamble on being a non-average patient? So, for folks who are wondering if "we are on drugs" mentioning that indolent or insignificant cancer terminology is a reality thing, it is considered as a real definition today by a leading Hospital center.

Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2268
   Posted 12/28/2008 1:47 PM (GMT -7)   
Selmer said...
Here is John Hopkins...Brady Urological Institute....."expectant management--active surveillance" site

With definitions--

http://urology.jhu.edu/prostate/advice1.php


Selmer
I read this article, which offers no solid proof that separates indolent vs. aggressive prostate cancers.  It's more of a let's-see-what-happens study based on factors which may or may not be important. 
 
I would have qualified for this study except for age. PSA velocity is also an important factor in determining whether to treat or wait.  
 
My personal opinion, based also on a lot of reading about prostate cancer, is that having a little bit of prostate cancer is like being a little bit pregnant.  


PSA quadrupled in 1 yr (0.6 to 2.5)  
DRE neg  1 of 12 biopsies pos (< 5%) 
Open surgery June 06 at age 57
Organ confined to one small area Gleason 5   
PSA's undetectable  < 0.1  


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 12/29/2008 3:45 AM (GMT -7)   
" DRE neg  1 of 12 biopsies pos (< 5%) 
open surgery June 06 at age 57
Organ confined to one small area Gleason 5 "
 
I recall reading  that some experts do not believe that scores of 1 and 2 might not necessarily be cancer and that if a biopsy indicates a Gleason score of 5 it should be viewed with some doubt.

Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2268
   Posted 12/29/2008 8:55 AM (GMT -7)   
aus said...
" DRE neg  1 of 12 biopsies pos (< 5%) 
open surgery June 06 at age 57
Organ confined to one small area Gleason 5 "
 
I recall reading  that some experts do not believe that scores of 1 and 2 might not necessarily be cancer and that if a biopsy indicates a Gleason score of 5 it should be viewed with some doubt.
      My original biopsy slides,read by Dr Jonathan Epstein at Johns Hopkins Medical Center, showed a Gleason 6.  The post-surgical pathology was read as a Gleason 5 (3 + 2). 
 
Often a single positive biopsy core,especially in a non-saturation biopsy, can end up with multiple areas of cancer.  My case showed only one small area of cancer only.
 
I am convinced that I did the right thing by having the cancer removed rather than opting for the anxiety-ridden 'watchful waiting'.
 
 

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/29/2008 9:38 AM (GMT -7)   
Hi Tim,
I am an abuser of the term indolent, while still being an ardent advocate of early detection. A Gleason 5 5% can be but at what age group? If my father, who is testing at 3.5 PSA's and is 74, were to come up with your numbers, I would tell him he could watch and wait. I believe the median age for prostate cancer is 64. Anyone before that age is indeed in their right mind to make the call based on his life expectancy. The fact remains that we are our own advocates. And I always say make a decision, then don't look back. You did the right thing because your Gleason 6 at biopsy is a gray area and you were below the median age. Good reasons to believe that removing the prostate, or radiating it for that matter, was acceptable protocol.

about 15% of prostate cancer cases die each year from the disease. So it is not indolant as a whole but rather case by case. And I fully realize that even the smallest invasion is tough to live with. This has been the argument against earlier PSA testing. But I firmly believe every guy should have been tested at 40. The chances of anything being found at that age being indolent is slim and none.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 

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