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kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 3/19/2009 9:49 AM (GMT -7)   
The Washington Post published this article by Post reporter Rob Stein this morning.
 
The stats are sobering. They can now claim that 10,000 men would have to be screened for 10 years to prevent one death.
In my situation, I am firmly convinced I am that one.
 
The bottomline is, prostate cancer is the #2 cancer killer of U.S. men - and as somebody on this board recently noted, most men are walking around with prostate cancer already. I just don't see how you can ignore that. You can DECIDE to do nothing once you know the PSA results, but wouldn't you want to know? This is different than altzheimer's (sp?) where there is no cure. I would not want to know that. But if PSA gives you a warning, and you have a chance for a cure - or greatly increased longevity - via multiple treatment paths, wouldn't you do something?
 
 
 
Just my opinion
kcragman
 
Age: 53; 52 at DX
March 2006: PSA 2.5
Dec 2007: PSA taken for insurance application. I did not see the results until late
Jan '08 - after I was rejected. Their lab said PSA 4.5.
Feb 2008: PSA 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were
cancerous and the 6th was suspect.
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph node and nerve samples taken, and appeared to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.
Feb 2009: PSA at 9 months was undetectable.


kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 3/19/2009 9:50 AM (GMT -7)   
Sorry - I misspoke:

10,000 men screened for 10 years to prevent 7 deaths. So 100,000 screens saves "only" 7 lives.

kcragman
Age: 53; 52 at DX
March 2006: PSA 2.5
Dec 2007: PSA taken for insurance application. I did not see the results until late
Jan '08 - after I was rejected. Their lab said PSA 4.5.
Feb 2008: PSA 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were
cancerous and the 6th was suspect.
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph node and nerve samples taken, and appeared to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.
Feb 2009: PSA at 9 months was undetectable.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 3/19/2009 10:25 AM (GMT -7)   
I am with you on this one , kcragman
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 3/19/2009 12:37 PM (GMT -7)   
kcragman said...
Sorry - I misspoke:

10,000 men screened for 10 years to prevent 7 deaths. So 100,000 screens saves "only" 7 lives.

kcragman


This one of those if it saves only 1 life is it worth it?

No not when the odds are that astronomical.
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 
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 3/19/2009 2:06 PM (GMT -7)   
It's always easy to talk about mortality statistics when you yourself, aren't that one person who's life is on the line. I value all human life to be equal in worth, personally. There are good reason why the death rate from Prostate Cancer has been stedially reducing in recent years, and more testing, particularlly PSA, and the treatment options that are available are a good reason for that.
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 3/19/2009 2:44 PM (GMT -7)   
Purgatory said...
It's always easy to talk about mortality statistics when you yourself, aren't that one person who's life is on the line. I value all human life to be equal in worth, personally. There are good reason why the death rate from Prostate Cancer has been stedially reducing in recent years, and more testing, particularlly PSA, and the treatment options that are available are a good reason for that.


You claim to have been a chief financial officer so let me ask you. If your company was deciding to evaluate the cost effectiveness of PCa screening to possible death resulting without it. How would you rationalize the death percentage rate of .069% above to your boss? Or how would you justify taking that cost from somewhere else medically? If I was one of the 7 I would think of it as my fate.

I'm not really all that against Pca screening as long as the results are explained honestly as to the likelihood of death from Pca. I'm for screening and monitoring I'm not for knee jerk responses of radical treatments that are proving to be unnecessary for the vast majority.
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) : 3/19/2009 3:54:10 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 3/19/2009 2:58 PM (GMT -7)   
My most recent position was that of CFO for a firm that only does Foreign Exchange transaction, in fact, we were the only "non-bank" in this state that offered those kind of services. I certainly don't have to prove my resume to you, its on-line in enough places, be easy enough to find.

If you really, absolutely knew 100% sure that you were one of the seven, I assure you, you would have a whole different attitude on the subject. Not convinced you would simply call it "fate" at that point, not if you could do something to change that status back to being one of the living.

I'm for 100% PSA screenings for all men over 40, to at least get a baseline. Its' just a simple blood test, not invasive at all. And if PC runs in your family, or if you are African-American, then I think the age for the first test should be moved back to perhaps 30 or 35.

Remember, it's what you don't know that will kill you inside. Four bouts with a serious cancer has taught me to be real pro-active in what I can and can't do to help myself, I make no apologies for that.

In the time I've been here at HW, I can't think of a single man that I would say reacted in a "knee jerk reaction" to his PC dx. If I am wrong on that point, refresh my memory. I respect each and every decision that the men here have made, and are making. It is their life and their body we are talking about.
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 3/19/2009 3:23 PM (GMT -7)   
And I say with the current Pca studies that have been released recently that for the public good it would be much wiser to use said funds to test all peoples blood pressure and cholesterol on a regular basis That would save far more lives than mandatory Pca tests for men in their 40s on. There is only so much money to go around medically.

No you don't know me if it was my time with those odds I would consider it to be fate and would enjoy the time I had left . I had both parents die at a young age, friends from High school in war,and was next to a buddy who blew up on a land mine and was killed while a tree blocked me from most of the shrapnel in Nam. Death does not terrify me as it does some others.

As the recent survey shows most who have opted for radical Pca treatments after a low risk dx would never die of it anyway. Once again I'm not talking about advanced Pca. I'll admit that even my less invasive Pca treatment may have been unnecessary too. By knee jerk reaction there have been a few here who just had to get rid of it asap so in less than 8 weeks after dx they go under the knife without much study or learning of other options. Then there are of course the majority who believes it will kill them if they don't take any action. Once again I must use the disclaimer I am just talking about low risk men.

Yes you're correct it is their lives and bodies we are talking about. I'm for not mutilating them or drastically changing their lifestyles be it only temporary for the lucky ones when it's becoming proven more and more it's not needed for most with a low risk dx. I can empathize with your past cancer and that may have some bearing on your individual Pca I don't know. But for most here Pca is all they have cancerwise and for most it is by far the slowest growing and least threatening cancer of all. Just because you post here 10x more than most doesn't make you any more compassionate or correct than anyone else 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 
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 3/19/2009 3:34 PM (GMT -7)   
I don't believe I have ever indicated that I was either more correct than anyone else, and certainly don't have a monopoly on compassion, where ever did you get that from? As far as posting quantity, don't you think that is an individual thing? Is there some daily or weekly limit or ration I don't know about? Why does that bother you anyway, it's really not any of your business if I post once a year or once an hour.
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
 
 


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 3/19/2009 4:21 PM (GMT -7)   
Am I missing something here, Ziggy?

What's the big deal with giving every man over the age of 40 a PSA test? Us women get pap tests starting at the age of 18 or so, and mammograms every year over age 50. As the wife of a PC survivor, I can tell you that my husband and I are delighted that his "regular" doctor has been charting his PSA results for years (husband is now 58) ... we believe that this diligence may have saved hubby's life.

As for cholesterol and blood pressure screening, I agree that everyone should be checked. If they go to the doctor on a regular basis, they are checked. Even my gynocologist takes my blood pressure each time I visit. If you go for a physical, drawing blood is part of the check-up. If the lab is checking out everything else in the blood, why not run a PSA test ... it doesn't require any preparation (like a cholesterol check does). What is the big deal?

Your take on low risk vs. high risk prostate cancer is not totally correct. My husband was diagnosed with a "low risk" cancer - stage T1c with a Gleason 7 (3+4), PSA of 6.4 and 2 out of 10 biopsy samples testing positive. He choose the surgery to find that his cancer was not as low risk as we thought - he was restaged to stage III (t3a). Upstaging is very common after the surgical pathology report is completed, hence the reason why many men choose this route - to have a definitive answer about their cancer. If he had decided to watch and wait - as you seem to suggest for his supposed low risk cancer, the cancer would have broken through the prostate capsule eventually and spread - no doubt about it.

While prostate cancer is one of the slower growing ones, it is still cancer and whenever possible should be treated as aggressively as possible.

On side note, Purgatory is one of the best on this board, and did not deserve your rudeness. If he posts frequently, it is because he cares about his fellow man (and woman) and is a wealth of information for those of us who are making this journey.
Husband diagnosed in February 2008 (age 57). Cancer discovered during routine annual physical. Clinical Stage T1c, Gleason 7 (3+4), with 2 out of 10 cores testing positive. Perineural invasion identified on biopsy. DRE was negative.

Robotic surgery in March 2008. Pathological stage upgraded to T3a, Gleason still 7 (3+4). Miniscule invasion into prostate capsule but no cancer found outside capsule (surgical margins and seminal vesicles were clean).

1st PSA 3 weeks post op: 0.1; 2nd PSA 7 weeks post op: 0.0. PSA remains at 0.0, and will continue to be checked every 3 months for the first 2 years due to capsular penetration.

Currently on Enablex to control frequency of urination (tried Vesicare but stopped due to heart palpitations) and on Viagara 2 - 3 times a week. Recuperation from surgery was uneventful.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 3/19/2009 4:30 PM (GMT -7)   
Sephie, you were able to say in smoother words than I have been able to say on the subject of testing, etc. Must have been tounge tied on my end, lol. You are quite right, upstaging is a very common situation, and not a good one, my dr/surgeon said even the best biopsy is just an estimate of what is going on, it takes the post surgery pathology where they have the entire prostate and other removed parts to analyze. There are rare times that there is a downstaging, but not often. Just like your husband, my dr. said mine was right on the edge of leaving the capsule, I feel fortunate that I started doing PSA testing on my own at age 50, or else I would have never known a thing until it was far gone. Again, just a simple blood test, and if a man gets an annual physical exam like he should, it's usually part of the bloodwork. My best to your husband.

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 3/19/2009 4:34 PM (GMT -7)   
Sephie this discussion and some others here revolve around new Pca studies released in the last few days on the ineffectiveness in screening and treatments. Your view that any Pca should be treated aggressive is dead wrong according to the most recent released clinical studies.
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 
 
 
 


coxjajb
Regular Member


Date Joined Nov 2008
Total Posts : 184
   Posted 3/19/2009 4:43 PM (GMT -7)   
I don't understand how one knows if the prostate cancer one has is of the type that will kill you or the type that is slow growing enough to allow you to die from something else. I hear reports and stats that suggest that many men are over treated. How do they know that? I don't remember my urologist saying after my prostatectomy, "well, I have good new and bad news. The prostate came out fine and had cancer just as we knew from the biopsy. Bad news, should have left it alone, It was cancer that would not have killed you". Can someone help me understand that?
Age 51, (50 at DX)
Pre - Op PSA, 4.3
Gleason 3+4=7
Stage T1C
da Vinci Prostatectomy 8/1/08
No issues with incontinence since day 1 after catheter removal
ED, need a little help from Levitra
First post op PSA 11/11/08, 0.00
Second post op PSA 2/10/09, 0.00


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 3/19/2009 4:54 PM (GMT -7)   
OK before I go here's just one of the news releases about what we're discussing. I'm gone after this...
 


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) : 3/19/2009 6:00:02 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 3/19/2009 5:50 PM (GMT -7)   
This is right from the American Cancer Society, am I still missing something here on this thread, they are still expecting 28,660 American men will die of prostate cancer this year alone (2009). Still the 2nd leading cause of cancer death for men after lung cancer. If widespread testing and men being treated that have PC dx keeps bringing this terrible number down, then so be it in my opinion.


Overview: Prostate Cancer
How Many Men Get Prostate Cancer?

Prostate cancer is the most common type of cancer found in American men, other than skin cancer. The American Cancer Society estimates that there will be about 186,320 new cases of prostate cancer in the United States in 2008. about 28,660 men will die of this disease this year. Prostate cancer is the second leading cause of cancer death in men. Lung cancer is the first. One man in 6 will get prostate cancer during his lifetime, and 1 man in 35 will die of this disease. More than 2 million men in the United States who have had prostate cancer at some point are still alive today. The death rate for prostate cancer is going down, and the disease is being found earlier as well.

Last Medical Review: 09/26/2008
Last Revised: 01/22/2009


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
 
 

Post Edited (Purgatory) : 3/20/2009 6:54:19 AM (GMT-6)


Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 3/19/2009 6:50 PM (GMT -7)   
I believe this is retoric spawned by the epidemic fear of rising medical costs for the nation. As others have pointed out, the PSA test itself has virtually no negative effects or harms. The statement about how many have to be screened to save a single life needs a little clarification: X men would have to be screened to detect, treat, and save one man whose Prostate cancer was sufficiently aggressive that it would kill him within 10 years. We already know that most prostate cancer takes longer than 10 years to be fatal from our current typical detection point. So, it may be that the 15 or 20 year number could be much higher than the one man at 10 years.

Personally, I think it's a bad plan to bet that something else will likely kill you before your prostate cancer will, so you should just ignore it. What's the value of ignorance?
50 YO
PSA at Dx: 8.2
DaVinci RALP: 10/31/08 -- Great MD in New Haven, CT
Negative margins, no extra-capsular involvement
One nerve spared
6 Wk PSA - 0 
 
 


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 3/19/2009 10:26 PM (GMT -7)   
Its too bad that people use statistics such as come from studies to make life decisions. These numbers are the result of testing a certain population then generalizing the results to the population as a whole. This is allowed by the Law of Large Numbers and is a mathematically correct procedure. However, these numbers have absolutely nothing to do with the outcome that a single individual will experience. (You can flip a coin 10 times and come up with heads 10 times in a row yet we know the probability of a head is 1/2.) Likewise you can test 10 men and come up with 0 cancers. Would this mean that all testing is a waste of time? What about the next 10 to be tested that could all have cancer?

After reading the recent threads on this forum dealing with studies, I conclude that the best course of action is to be tested and go with your gut about treatment. If your test is positive for cancer then deal with it in your own way. Basing your decision on the studies is plain foolishness and a misuse of the statistics...

Jim
Age 74. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06. Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
50 mg Viagra + .04 cc Trimix = Excellent Results
PSAs from 1/3/07 - 7/17/08 0.00.
PSA on 1/28/09 - 0.02
Lung cancer dxed on 5/16/08. Surgery on 6/25/08 T1N1M0 - Stage IIA Finished 4 cycles of chemo on 11/7/08.
CT scans on 12/2/08 & 2/25/09 - in remission!!!
Next scan in May 09.
Biker90's Journey
Jim's Space
"Patience is essential, attitude is everything."


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/19/2009 10:52 PM (GMT -7)   
There has been an 8% drop in the death rate since PSA screening began. That would be 8 out of one hundred. Somethings responsible...I don't think it's screening. I think it's treatment as a result of screening. That 7 in 10,000 is not 10,000 cancer patients....it's ALL men. We are just talking mortality. How many lived longer because they were screened? Not mentioned.

We are not talking a major procedure here. Just a tablespoon of blood for screening.

If there are 50,000,000 (million) men aged between 40 and 75 in the US (They're are at least) and for only 10 years they were tested...that would be 3,500 lives saved. For a median of twenty years it's 7,000 men saved. But no note about how many had their lives extended a decade or two...or more...

This reporting is flawed.

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!


kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 3/20/2009 4:33 AM (GMT -7)   
Wow, I did not mean to create such a firestorm. A few comments:

My wife, the PhD anatomist, says the studies are flawed to a certain extent, and that more certainly more research is required to bring this issue into sharper focus. It is really tough for one study to cover all the variables in a case like this, and eventually enough studies will pile up that the medical community can study the studies and come to a more definitive conclusion.

Biker90 - You are absolutely right to say that all the stats in the world don't impact one individual case. They can help you make a decision, but I think it should be YOUR decision.

Coxjajb: Doctors go by 2 things: the PSA number, and the "velocity" or the rate at which it is increasing. My PSA numbers were never very high, but but what raised the red flag is that I went from 2.5 to close to 4.0 in about 18 months. That led to increased testing, a biopsy and etc... My understanding is that Gleason 6 and below is considered "slow" and the patient has a wide range of options. A Gleason 7 and above is considered "aggressive" and most doctors would recommend a more limited, more aggressive range of actions (surgery, radiation, etc.).

Selmer and Realziggy: You are both sort of proving my point. From the limited info I see in your profiles, you are both monitoring your PSA, and you have decided on a course of action. That's all I'm saying. Men should be tested, and if they pop positive, they should make a decision based on the best info available. I personally don't think "not testing" is a good answer. And Selmer, wow, your dad carried a T3 tumor for 25 years? To my limited understanding, that has to be exceptional. Good for him.

Live on!
kcragman
Age: 53; 52 at DX
March 2006: PSA 2.5
Dec 2007: PSA taken for insurance application. I did not see the results until late
Jan '08 - after I was rejected. Their lab said PSA 4.5.
Feb 2008: PSA 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were
cancerous and the 6th was suspect.
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph node and nerve samples taken, and appeared to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.
Feb 2009: PSA at 9 months was undetectable.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 3/20/2009 5:07 AM (GMT -7)   
To Purgatory: I doubt that you were tongue tied in your response...but happy to help you out for a change!

I have a question for you: your path report was very close to my husbands - my husband's cancer was encapsulated (into but not out of the capsule) yet he was staged T3a. I did some research about the criteria for stage III and had my husband discuss this with his uro because, from what I read, he looked to be a II. The info I had said that stage III had extracapsular extension but my husband's path report cited extraprostetic extension. Maybe I'm misunderstanding the definition of extraprostetic vs. extracapsular but it would seem to me that cancer that moves outside of the prostate proper (e.g., into the capsule) is extraprostetic whereas cancer that breaks out of the capsule becomes extracapsular. Oh well, the important thing is that his PSA is 0.0 12 months postop!

Take care, David, and have a great weekend! For those who care, it's snowing here in New York (I'm about 50 miles north of New York City)! Welcome to Spring!!
Husband diagnosed in February 2008 (age 57). Cancer discovered during routine annual physical. Clinical Stage T1c, Gleason 7 (3+4), with 2 out of 10 cores testing positive. Perineural invasion identified on biopsy. DRE was negative.

Robotic surgery in March 2008. Pathological stage upgraded to T3a, Gleason still 7 (3+4). Miniscule invasion into prostate capsule but no cancer found outside capsule (surgical margins and seminal vesicles were clean).

1st PSA 3 weeks post op: 0.1; 2nd PSA 7 weeks post op: 0.0. PSA remains at 0.0, and will continue to be checked every 3 months for the first 2 years due to capsular penetration.

Currently on Enablex to control frequency of urination (tried Vesicare but stopped due to heart palpitations) and on Viagara 2 - 3 times a week. Recuperation from surgery was uneventful.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 3/20/2009 5:45 AM (GMT -7)   
Sephie,

My dr. fully expected my biopsy to be a T3 without a doubt, it wasn't, but he speculated that it would probably be upstaged upon surgery. It wasn't, it ended up being a T2C, not great, but contained. He said it was about the closest he'd ever seen that didn't escape the capsule. Going into surgery, the gleason was 4+3, coming out 3+4, that gave me some real relief, there's a lot of difference between the two types of gleason 7's as you probably know. Because my T2C was right on the edge so to speak, my dr. is sober enough to know that we will have to watch the PSA closely over the next couple of years. He was a little disapointed that my first PSA post was .05, he was hoping for lower, so was I. So like many men here, I am thankful for where I am. I am 4 months, 4 days out of surgery, no longer have any incontinence problem, and by some miracle, didn't have any ED problem right out of the box. But I do feel like I have to keep both eyes open at all times, for many months or perhaps years to come. When the year 2008 started, I was happy in that I had reached the 8 year mark of being cancer free from my 3 bouts of porocarcinoma, I needed to get to the 10 year mark to be considered cancer free. Then later, of course, I get the PC dx.

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
 
 

Post Edited (Purgatory) : 3/20/2009 6:53:37 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 3/20/2009 5:51 AM (GMT -7)   
biker90,

my hat is off to you. your description of how odds and probability really works is right on target. add that logic to my continual point in that once a man has a genuine dx. of PC, then sitting around trying to circumnavigate the fact that you have an active cancer in your body makes no sense. A baby rattlesnake is just a poisonous as an adult snake, just less venom. One day, perhaps not in our lifetimes, perhaps for our sons or grandsons, mabe there will be an accurate test or scan performed on men, that could tell the most critical question of all: is the PC agressive and prone to grow, or will it like "dorman" so to speak and cause no harm in the man's lifetime. Until that happens, to me, it's like playing russian roulette with a gun with 5 bullets loaded out of six, hoping you pull the trigger and nothing happens. by not testing, you are not knowing, kind of a modified "don't ask, don't tell", but we know in our world of PC, not knowing, can be signing your death warrant, or at the least, leaves you in a much more terrible treatment protacol with worse side affects, not a good trade off.

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
 
 

Post Edited (Purgatory) : 3/20/2009 6:58:00 AM (GMT-6)


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 3/21/2009 4:00 PM (GMT -7)   
kcragman, I support PSA testing. As I said on many posts the PSA test saved my life. I went from a PSA of 2.7 to 3.5 in one year. Bingo - antibiotics brought PSA to 2 (how did that happen? below the baseline - I think it was a faulty test). I tested 4 months later and PSA up to 3.8. I had the biopsy and surgery and had a gleason 8. The only symptom I had was peeing a lot. Looking back I should have suspected something but didn't. Had I waited for more symptoms, I think I would be dead now. So if the PSA saves one life, I am for it. I am biased because I feel the test saved my life. I agree with testing for cholesterol too and am tested regularly. Knowledge is power.
 
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
decision - surgery (robotic)
Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8
margins clear
9 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue


kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 3/21/2009 8:19 PM (GMT -7)   
Rob2 -

You and me too, bro.

kcragman
Age: 53; 52 at DX
March 2006: PSA 2.5
Dec 2007: PSA taken for insurance application. I did not see the results until late
Jan '08 - after I was rejected. Their lab said PSA 4.5.
Feb 2008: PSA 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were
cancerous and the 6th was suspect.
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph node and nerve samples taken, and appeared to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.
Feb 2009: PSA at 9 months was undetectable.


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 369
   Posted 3/21/2009 9:56 PM (GMT -7)   
I don't really have much to add to this discussion except that it really interests me as a prostate ca survivor, and as a guy who tends to second guess his decisions down the road. The NY Times article is certainly disturbing, there seems to be no vindication or approval of the course of action I took after diagnosis of prostate ca. I too am one of those guys with a low gleason score and low prostate ca volume. My family's history of colon and breast cancer inclined me to some kind of action, either surgery or radiation. 6 months out from surgery there is no sign of recurrent cancer, no incontinence, but ED remains along with mild case of Peyronies Disease, presumably from the trimix injections. Would I have surgery again knowing what I do now from all these recent studies?  Honestly yes I would, there is some kind of satisfaction in knowing that I did the best I could to rid myself of cancer, even though the studies don't really show in the long run it improves 10 year survival. I am really disappointed about the ED issue though, especially for my wife who has to suffer the consequences of my actions. Some decisions in life are pretty gray in terms of end results..........
 
my age=52 when all this happened,
DRE=negative
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/14/08, 2/12 cores positive for Prostate Cancer on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 3+3=6 both cores,
Clinical Stage T1C
 
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery,
No signs of spread, organ contained,
First post-op PSA=.01 on 10/15/08,
Second post-op PSA <.01 on 01/15/09,
Incontinence gone in early December '08,
ED remains, using daily Viagra and 2x/wk bimix/trimix injections for penile rehab

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