Active Surveillence ~ more study numbers!

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Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/16/2009 9:42 PM (GMT -7)   
Thanks to Mike Scott at the Infolink for this post:
 
 
This study is on early low grade cancer.  95% that waited and did well.  I still ask who wants to be in the 5% who went to disease progression. 1 went to bone mets.  This is out of 260+ patients in the study. 
 
Likely to do well....but no guarentees anywhere.
 
Great post by my friend, Mike!
 
Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 3/17/2009 6:00 AM (GMT -7)   
The results shown, might be based on just that particular mixed of men in that group. Take another group of me, same number, and perhaps the outcome would be all over the place. And like you said above, do you want to be the unlucky 5%? I know I wouldn't.

Statistics can show everything, been working with them for a living all my life.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 3/17/2009 9:14 AM (GMT -7)   
Just confirms what I've been saying. These are the days of much over treatment for cases of low risk PCa.

Denial is not only a river in Africa.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study 
 
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4014
   Posted 3/17/2009 1:23 PM (GMT -7)   

Selmer, nice analysis.

I think the key is in the fine print, i.e. "carefully selected prostate cancer patients".  That means "real early" stage for which most of us didn't qualify.  I'll post below something I posted before re Johns Hopkins qualifications for their program:

1.  Age 60+.

2.  T1C, i.e. nothing felt on DRE.

3.  PSA density of .1 or less (this is PSA divided by size of prostate, e.g. PSA of 3 divided by prostate size of 35cc equals PSA density of .086 which is less than the .1 threshhold.

4.  Gleason 6 or less.

5.  2 or fewer cores of cancer.

6.  No core with more than 50% cancer involvment.

This is a little stricter, in some respects, than the study.  However, it still points outs that active surveillance is only for a small subset of PCa patients whose cancer is small and likely to be non-aggressive and contained.  Those who are in this subset and still choose treatment "might" meet the definition of overtreatment....this would be an interesting quandry for someone who meets the qualificaions...

Tudpock

 


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 3/6/09.

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 3/17/2009 3:25 PM (GMT -7)   
tudpock, that is a little too strict IMHO. Plus I believe a 3D saturation biopsy to be far superior to the normal 10-12 core. Hell I wouldn't even fit in that and I consider myself low risk. That said by your or mine standards that is by the numbers much larger than a "small subset"

Also let me turn around another's comments. How would you feel if after going through years or possibly permanent incontinence, ED and dry orgasms to later learn you could've had a 95% chance that your PCa had no effect on your longevity, would you consider that ordeal worth the 5% risk? That of course is up to the individual but there would be some regret I'm sure. What percentage would be debatable.

The quoted study is just another recent one to show similar results. They are not all questionable. Many other urologists agree with them. My local university where major Pca research is currently taking place (TFT Hifu...etc) Urological Oncolgy's senior staff also believe there is much over diagnosis resulting in a wave of over treatment currently. I feel those here to be geographically fortunate to have more modern less invasive treatments available.

Bottom line is my Pca had far less impact on my life than almost all here. Isn't that what this is all about? Or is it to keep propping up what is quickly becoming archaic medicine and lets say it possible butchery for many here who are just dx as low risk from the start. Again I stress this only applies to those with low risk and not advanced Pca. Although I say the former is a much larger than just a small subset. I'll go along with that one study 23- 42%...That's thousands of men annually. Roughly 46,000 -84,000 in the US.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study 
 
 
 

Post Edited (realziggy) : 3/17/2009 4:36:30 PM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/17/2009 3:40 PM (GMT -7)   
20% incontinance or ED rate against a 5% life threatening situation? Tough call? I'd rather take the IC ED risk...That's me.

Also are we not just talking about a delay to intervention? As Mike's numbers show risk increases with time. What I would like to know is HOW long can you safely delay treatment. This is the cuswp of the argument. A guy at the median age of 64 might be fine with this approach as long as he doesn't live to 90. And a guy at 44 like me? Even with a G6 2 of 12 positive and a PSA at 4 has a tough call. I feel pretty lucky (sic)...I was G7 with a PSA of 20, 4 of 8 at 80%+ positive. Watchful waiting was a terrible idea IMHO.

Thus to Tudpocks statement ~ Most have more cancer than the study arm.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Uncle Harley
Regular Member


Date Joined Feb 2009
Total Posts : 78
   Posted 3/17/2009 4:03 PM (GMT -7)   
No body WANTS to be the unlucky 5%. No body WANTS to deal with a lifetime of ED or Incon. I'm in Active Surveillence Mode because I CHOSE to be there. My surgeon didn't even come close to suggesting otherwise when we last talked. If things change then I'll rethink my position. Till then, I'm satisfied with my decision.
PSA History
3/99 1.2
3/00 1.04
3/01 1.16
7/02 1.24
2/06 1.59
3/07 1.79
3/08 2.54
8/08 2.3
12 needle prostate biopsy Jan 09
Dx of (1) core adenocarcinoma 20%
All other cores benign
Gleason 3+3 T1C
Age 60


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 3/17/2009 4:12 PM (GMT -7)   
Uncle Harley,
And from looking at your long-term low psa, 1 gleason 6 core, etc, your stats look like what you are doing is a safe bet for right now, and I hope it stays that way for you long term.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/17/2009 4:41 PM (GMT -7)   
Uncle Harley,
I think you are a perfect example of a great choice for this option. And it looks good in your PSA history. Certainly, there are many G6 1/12 guys that should consider this option. And the study does indicate that this is working out well for most. But I think the misunderstanding is that somehow there is the belief that all who undergo surgery have ED and IC. That simply is not true. Most have difficulty immediately after surgery with one or the other, but most recover. And intervention does not mean just surgery alone as an only option. So "living with ED and IC" versus Active Surveillence is not the correct equation.

But what about larger tumors? What about 3 in 16 cores, or 4,5,6,etc. When does one call it a day and get treated?

I do not think most should wait. Maybe a third? But that may be generous. I would bet that most biopsies had more than either 2 of 16 core, a G6 or a PSA over 10...And many had PSA spikes that had not yet reached 10 but were steadfastly increasing PSA's over just months...Then there is the psychological affects. Many can't wait even with Harley's numbers.

I am absolutely assured of this being discussed when I am on the "open Discussion" panel in Miami. Mike will be on it as well, and I can throw rocks at him....lol

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 3/17/2009 6:04 PM (GMT -7)   
TC-LasVegas said...
20% incontinance or ED rate against a 5% life threatening situation? Tough call? I'd rather take the IC ED risk...That's me.

Also are we not just talking about a delay to intervention? As Mike's numbers show risk increases with time. What I would like to know is HOW long can you safely delay treatment. This is the cuswp of the argument. A guy at the median age of 64 might be fine with this approach as long as he doesn't live to 90. And a guy at 44 like me? Even with a G6 2 of 12 positive and a PSA at 4 has a tough call. I feel pretty lucky (sic)...I was G7 with a PSA of 20, 4 of 8 at 80%+ positive. Watchful waiting was a terrible idea IMHO.

Thus to Tudpocks statement ~ Most have more cancer than the study arm.

Tony

As I keep saying this is not about those with advanced Pca such as yourself. And I'm also long on record for recommending those in their 40s surgery. You can turn percentages all around by description such as how about a 95% non threatening life situation for those who aren't going to make it to 90 any way. Plus whose life at that age is really that wonderful? I say that with two aunts who died with very sad alzheimers whose deaths seemed more merciful than life their later years. They were 95 and 98 meanwhile their baby sister (my mother) died at age 48 so who knows?? We are talking about a delay for intervention for some not all. If you're diagnosed in your mid 60s or early 70s and you have a bad heart condition or other chronic life threatening disease it's unlikely many will then opt for radical prostate surgery. I know I wouldn't. It's debatable I agree but it should be taken into consideration before one panics or is panicked to choose a possible life changing treatment. It's the old quality of life vs possible longevity argument which is the basis for choosing or not choosing treatments. I have stated as one who is long divorced with grown children I do admit giving more weight to lifestyle over just possible added longevity. When I was born the expected life for a male then was like 69-71 years of age. My life style has not always been the healthiest for one thing I smoked like 35+ years so I don't see myself being 90 anyway. Thus I always had a hard time pulling the trigger for a radical treatment that would at least temporarily have me living like an elderly man be it only a few months a few years or for good in just a HOPE of possible longevity. If I do just live the expected at birth 10 more years or so why do I want to possibly risk the last decade and live any of it as an elderly old man who needs a diaper? Especially when my Pca seems to be more and more low risk. I think my TFT was the perfect compromise so there are more upcoming less invasive treatments to consider. for example I could've delayed my TFT using cryosurgery to HFT now. Would it have mad e a difference in waiting a year? I don't think so but I have no regrets there just showing an example time and medical science moves on. The "gold standard" is tarnishing and may soon be an antique, contrary to some beliefs here that will be a good thing in my opinion.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study 
 
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4014
   Posted 3/17/2009 7:01 PM (GMT -7)   

Realziggy:

Perhaps you misunderstood my post.  I was not stating those as MY requirements for active surveillance.  Those are the requirements for getting into the Johns Hopkins "expectant management" (aka active surveillance) program.  They carefully select very early stage PCa patients whom they believe can most safely "watch" with only a small likelihood of cancer progression.  You are certainly free to disagree with their standards, but the reason they have them is to select men for success in their program.

Looking at Uncle Harley's stats, this choice looks to have been a good one for him.  Had I personally been diagnosed with Uncle's stats or met Hopkins criteria, I would probably have made that choice as well.

However, I will not criticize others who have chosen the "gold standard" or another protocol because they feel that treatment is in the best interest of their personal health and longevity.  And, my own choice was made as it was because I felt active surveillance would have led to an early death for me.  My body, my choice, no regrets..

Tudpock

 


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 3/6/09.

hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 3/17/2009 8:48 PM (GMT -7)   

I could have been one of those considering "watchful waiting" just looking at my initial numbers.  Perhaps a second biopsy would have found the additional cancer not shown in the first one - perhaps not.  "Skeletal metastases developed in one patient 38 months after initiation of active surveillance."  That's one heck of a thing to happen when you don't know exactly how much cancer you have, and perhaps could have prevented the metastases with treatment.  I'm glad that I chose surgery, and then additional radiation treatment.  Had I waited, would I be be that one in 43 from the study now facing a very unknown future?  I would never take that bet with my life.

(Incidentally - last Zoladex injection today - still Zeros!)


Age 57 at diagnosis (2006),  PSA 4.7 (up from 3.2 one year previous)
Biopsy November 8, 2006 1 of 10 cores positive 5% LEFT Side Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology Stage T3a, Gleason 3+4, positive margins and capsular penetration RIGHT Side
Post Surgery PSA:  March 5, 2007:  0.01    5 month PSA  0.08
Adjuvant therapy began June 26, 2007 with Zoladex injection
Radiation began August 23, 2007, ended October 8
First post radiation PSA, December 18, 2007:  0;  March 2008 - still 0;  July 2008 - 0; Sept. 2008 - 0;  Dec 2008 - 0
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/17/2009 10:27 PM (GMT -7)   
Hawk,
Big congrats, buddy! Great news...

And you are the perfect counterpoint as well in this discussion. (Sorry about that I might add) I don't care how many samples you take, if only one core is positive, it can be peripheral in location, and it can extending from the prostate. Again, I wasn't discussing which treatment is best, but rather asking how can you be sure intervention isn't a good idea? There is no perfect biopsy or scan for this. In this study, 20% of those who waited had to change the plan at some point. Of those 25% were not expected to be able to remain in remission. Now this is about 13 guys out of 262 (5%). Again these odds increase with larger tumors to the point where watchful waiting is not an option. Who can accurately say where that is?

The nature of prostate cancer makes it tough to make that call. Again, I am not touting one way or the other. Nor a treatment modality. When I get to the panel, and I get asked are we overtreating prostate cancer, my response right now is:

Yes in many cases, but unfortunately it takes hindsight to know for sure when we didn't need to treat it. You can do Active Surveillence based on probabilities, but there are real risks that, even though the cancer can appear to be small, we are not able ascertain with clarity when using Active Surveillence will work and when it won't before making that decision. This is a very personal decision that requires a great deal of thought and understanding of your own cancer.


:-)

Tony


Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 3/17/2009 11:56:19 PM (GMT-6)


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 3/18/2009 7:52 AM (GMT -7)   
There may be no perfect biopsy or scan but I feel the 3D mapping saturation biopsies to be far superior. With those results in hand I feel there's not too much of a risk relying on the 95%. But to each their own. I believe the old standard 10-12 core biopsy to be just chance. There's a good chance it won't detect any Pca that is actually there or detect it with questionable results. That was fine if you just needed to know enough to destroy or remove the gland. But with more hopefully upcoming lumpectomy type treatments like my TFT coming in the future the old type biopsy is quickly becoming a dinosaur. The issue here is not just that 5% risk but the outcome of better detection (PSA) resulting in over treatment. IMHO that's going on in large numbers, others think not here.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study 
 
 
 

Post Edited (realziggy) : 3/18/2009 9:40:48 AM (GMT-6)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4014
   Posted 3/18/2009 5:06 PM (GMT -7)   

Dear realziggy:

I have been doing some reading up on the 3D mapping biopsy and it certainly does sound like it is a better option than the "old" kind.  It was not made available to me at the time of my biopsy and I was not smart enough at the time to ask for it. 

You have clearly studied this a lot and I have a couple of questions out of intellectual curiousity:

1.  With more samples, doesn't that increase the probability of finding PCa?  And, if so, doesn't that feed those who say there is too much overtreatment already?

2.  In looking at your stats, I see that with an "old" biopsy in 2007, your docs found 3 of 12 samples.  With the 3D mapping biopsy in 2008, they only found 1 of 45.  I guess that's a little counterintuitive to me...I would have thought more samples would at least have found as many cancers as with 12 samples.  Am I missing something?

Thanks,

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 3/6/09.

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 3/18/2009 6:25 PM (GMT -7)   
Tudpock18 said...


Dear realziggy:

I have been doing some reading up on the 3D mapping biopsy and it certainly does sound like it is a better option than the "old" kind. It was not made available to me at the time of my biopsy and I was not smart enough at the time to ask for it.

You have clearly studied this a lot and I have a couple of questions out of intellectual curiousity:

1. With more samples, doesn't that increase the probability of finding PCa? And, if so, doesn't that feed those who say there is too much overtreatment already?

2. In looking at your stats, I see that with an "old" biopsy in 2007, your docs found 3 of 12 samples. With the 3D mapping biopsy in 2008, they only found 1 of 45. I guess that's a little counterintuitive to me...I would have thought more samples would at least have found as many cancers as with 12 samples. Am I missing something?

Thanks,

Tudpock





I doubt if 3D would be offered to you. It's expensive and my insurance company initially turned it down. Reason being in the past a simple biopsy just indicating cancer anywhere in the gland was sufficient for the normal treatments to remove or destroy the prostate. The primary reason for a 3D mapping biopsy is to pinpoint the tumor for targeted focal destruction. My doctor who is the director of research won a peer to peer appeal to my insurance company I assume by illustrating it's necessity for the lumpectomy like treatment.

Because of its cost as of now it's only used on those who have had a prior normal cheaper biopsy indicating cancer already. So no at present it doesn't increase the detection any more just refines it. It is then just recommended for those with lower gleason and Psa numbers. Even after that the last I saw 43% are found to have more advanced cancer than earlier indicated and are told to persue radical treatments instead. I don't know how that compares to post radical surgical pathologies after surgery increases in further spreading and higher gleason scores, but I bet it's somewhat close.

I too asked the difference between the number of cores. I 'm trying to recall the answers for one thing the mapping biopsy is just that it's done on a grid to better locate the tumor. Compared to a normal biopsy which is kind of haphazard and not as exact at placement so a single tumor can be picked up by more than a single core. Then the university pathologist may have been better too. The fact the newsman in the video also had 3 initial cores done before his biopsy and his resulted like mine also was an explanation to me.This was over a year ago so I'm trying to exactly remember what more I was told then. I'll ask my doctor again when I see him next month before the final biopsy. Look at parts 2 & 3 video link and it will show the 3d mapping better than I can describe it.

I'm not against better detection but there's a problem I think at this time with an over reaction to it with radical treatments. Was I possibly over treated? Maybe but with TFT it has been much easier to accept and live with afterward. For one thing I still have all my valves so I'm as continent now as I've ever been. My ED problem was short lived and as my doctor stated a few viagara to kick start it and I'm back to how I was before. I will not be ordering anymore which with the current alldaychemist problems I'm fortunate. Although I took only 8 out of the 40 I ordered. I've given a few to friends and did use a couple on dates I'll admit. Hey I am turning 60 this year after all. I'm not 19 anymore. LOL Bottom line is supposedly my cancer is gone and I not only still have wet orgasms PCa for me has had the least negative effects on me compared to all others here who have had radical treatments here. Isn't that a goal for coming here? I feel so and is why I felt the need to return here to just let people know of a treatment I feel is the future. As I've said before if I had just gone with the normal treatments I'd would have left here last summer. I now still have a functioning prostate and even if Pca returns I have all treatment options still available to me. 

 
Each part is anywhere from 4 -7 minutes.
 
part 1
 
part 2 Options for Treatment
 
part 3 Deciding on Treatment
 
part 4 Getting Treatment
 
5/9/2008 Final update


Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study 
 
 
 

Post Edited (realziggy) : 3/18/2009 9:58:06 PM (GMT-6)

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