Another twist ~ The US study lead doctor backs off?

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Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/28/2009 12:38 AM (GMT -6)   
Gerald Andriole, MD, the lead study doctor of the PLCO Study that showed no improvement in mortality has lessened the blow of the "no benefit" study release.  First he indicates that the study is only for years 7 to 10 after diagnosis of patients 55 and older screened.  You can read it below.
 
 
Dr. Andriole goes on further to say he encourages screening in men aged 50 and above...
 
Huh?  So why didn't they say that?
 
Here's my take... I was diagnosed at 44.  I believe that men should start testing at 40.  Now many organizations are using this study to verify what I already know and that it is entirely possible that men who screen at an earlier age will benefit more than an older man from screening.  This is quite a twist from the US study when released showing that it is so flawed that it may be in itself 'indolent'?  As this study continues we may see an entirely different results at 15, 20, 30 years...
 
Arrrrgggggghhhhh!
 
I wish these guys would think these things through more before releasing contraversial stuff...There was a better way to announce these results IMHO.
 
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) : 3/27/2009 11:46:37 PM (GMT-6)


nasso
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 3/28/2009 6:55 AM (GMT -6)   
Tony,

My opinion as well that testing should start at 40. In my case I was diagnosed at 43 by pure luck (a new doctor after we moved to Florida ordering a PSA test without any symptoms on my end) and with my stats, I just dont believe the cancer would have been contained by the time I am 50. Also looking at the stats in this forum, seems most of the men diagnosed in their 40s do have a more advanced cancer indeed.

Study or not, the PSA tests do save lives.
Age at DX: 43
PSA: 11/08:15.6, 01/09:16.6, 02/09:17.1
Biopsy 12/08 at USF Tampa
8/12 cores positive, GS 3+3,
perineural invasion in 2 cores
Staged T1c
CT, Bone, XRay negative
03/04/09 - Open Surgery at Johns Hopkins by Dr Patrick Walsh
Path Report: GS 6, Tumor Contained, margin clears, nodes+vesicles clean
Both nerves spared,
Catheter Out: 03/18/09
Incontinence : Resolved from day one, cant believe it
ED : some signs of life
Diet : Vegetarian, No-meat, no dairy diet since 01/09


Bluenose
Regular Member


Date Joined May 2008
Total Posts : 260
   Posted 3/28/2009 7:57 AM (GMT -6)   

 

 I with ya' on that Tony. I've probably mentioned it before but I started testing at forty. I had an older cousin dx'd in the early 90's, hence my own and my uro's dedication to the yearly test(I was three months late last year, finally getting into the office in Feb 08', whew)  .....My first PSA was 5.1 @ 40yo, 3 months later it was down to 3 somthing and three months after that it had settled in around the 1.5 range where it remained until Feb 08 when it went back up to the 5.0 mark....I've told my son and nephews they should start at forty, with one at thirty, thirty-five...wouldn't hurt a thing. Give em' a good baseline ya' know...


 
  age: 53  Pre-op PSA Feb 08' 5.0, April 08' 4.1
  Biopsy 5.1.08, 5 of 15 cores postive, T2a, Gleason 3+4=7
  DaVinci performed 7.29.08
  Bladder sling installed, umbilical hernia repaired during surgery.
  Path report, "cancer fully contained, margins clear".
  Cath removed 8.8.08, ED therapy begins 8.9.08
  100mg Viagra three times a week, pump for ten minutes daily
  and hold for ten minutes.
  8.16.08 switched to Levitra 20mg, immediate results
  9.15.08 Pad free at night, one thin (light) pad during the day
  9.18.08 1st Post-op PSA Undetectable Zero's....Yes!
  12.22.08 2nd Post-op PSA  Zero's still...
  Pads gone 1.3.09, finally found the courage...Thanks ya'll
          ".....tryin' to reason with hurricane season...."
       


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/28/2009 8:06 AM (GMT -6)   
I too think all men should be screened at 40, to get an accurate base line.
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
 
 


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 3/28/2009 3:56 PM (GMT -6)   
I agree with the testing at age 40. I was diagnosed at age 48. I know I sound like a broken record but I believe the PSA test saved my life.
 
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


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 375
   Posted 3/28/2009 11:14 PM (GMT -6)   
Geesz, I hope you guys are right about screening for prostate cancer at such an early age. I started with colonoscopies every 5 years and yearly PSA with DRE at age 35 due to my father dying of colon cancer in his 50's. That did freak me out, no doubt. I feel now that I overreacted but that's just me. The first time I had a DRE  at 35 I thought I'D DIED! Over the years it got easier, until at 52 I got so sick of doing the test I was ready to skip a year or two. Why bother with this grief?  Then a friend of mine 3 years older said he recently had prostate ca with surgery and that goaded me into getting my yearly test. Bingo, second biopsy showed prostate cancer, went ahead and had the surgery too. No recurrent cancer so far but no real sex again without injections. I hope we are all doing the right thing here turn   
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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/29/2009 12:24 AM (GMT -6)   
mspt,
You have a valid question for so many in the younger groups. But how can the 40 year old group use any studies? My concern in the US "prostate mortality" study is that it's based on information gathered in men 55 and older and over a 7 to 10 year period. When you are my age and diagnosed with advanced disease I can't help but think I didn't have a choice and had to intervene, thus I can live with it. my life expectancy still had 39 years to go. But for guys with lesser tumor, the decisions are excrutiating. And getting a study to help us younger guys is next to impossible. For so long the study takers are stuck on the recommended 50 and older patients. That's just great when the system ignores the younger patients.

Peace.

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!


justus1292
Regular Member


Date Joined Feb 2009
Total Posts : 63
   Posted 3/31/2009 12:32 PM (GMT -6)   
skull  Too freakin bad I didn't read that B 4 the freakin surgury.  I told my uro, if I had a chance to do it over...I wouldn't.  Sometimes, doctors can be bad for your health. skull

Roger G
Regular Member


Date Joined Apr 2008
Total Posts : 150
   Posted 4/1/2009 10:52 AM (GMT -6)   
Tony,
 
I could not agree more with you.  It's the fact that we, god willing, still have another 35+ years to live.  Without early detection and treatment making 50 would have been iffy at best.
 
Roger


Age: 43 (2008)
DRE Small Ridge on prostate, PSA 1.5
07/2007: Diagnosed cancer, T2c, Gleason 3+4=7
09/2007: Laparoscopic prostectomy @ Hamilton General, 4 hrs.
01/2008: Still working on ED.
 
 

Post Edited (Roger G) : 4/1/2009 9:55:22 AM (GMT-6)


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 4/1/2009 11:08 AM (GMT -6)   
This subject has been debated as much as the back and forth debates over vitamins and diet have. It's the debate of the which study gets what attention debate. The fact is, no one seems to know what PCA will do if left in its more non agressive form except spread when given enough time. Common sense tells us the rest!

Swim
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/1/2009 12:13 PM (GMT -6)   
Swim, I agree with you again. Cancers don't ever sit in a holding pattern of non-growth, they either grow real slow over a long period of time, or they grow at agressive rates, but the point being, they are growing all the time. That's what I don't understand in the infamous "watchful waiting" or "active survience" debate here, what is it that men are waiting for? Yes, waiting will delay unpleasant side affects that any treatments will cause, but the same waiting is just allowing a potentially killer cancer a free pass to grow, whether it be slow or fast.
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
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4181
   Posted 4/1/2009 2:06 PM (GMT -6)   

Hi David:

Re watchful waiting, I can certainly understand your point as it is certainly likely any PCa is growing if even at a slow rate.

In my case, with an intermediate grade cancer, I didn't qualify for WW and would not have done it.  However, I can understand the logic of men who do.  If my cancer had graded out at a 5 or 6 with 1 core out of 16 at 5%, I think I probably would have waited for treatment (WW).  In the ongoing Johns Hopkins WW program, 2/3 of the men in the program have not shown disease progression that would indicate that treatment is needed (of course that means that 1/3 eventually did need treatment). 

As I have said before, I think that there is also a pyschological aspect of treatment choice that has to do with the willingness to take risk. Any WW patient would have to have the ability and willingness to put some of the worry aside because, clearly, the cancer is still there and may be growing to "treatment size".  Or, it may grow to an advanced stage. 

And, if I was 75 instead of 62 years old...I think it would be an easier choice to WW with an early stage cancer since the odds would be high that something else would kill me first.

Anyway, this remains an interesting topic of debate...

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.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/1/2009 4:01 PM (GMT -6)   
I agree Tudpock, if I had been 70 instead of 56 at my dx, might have had an entirely outlook at my choices for treatment or not being treated. Also, having had 3 bouts of a previous dangerous and rare cancer in my past didn't leave me much room to ponder.

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
 
 


wd40
Regular Member


Date Joined Jan 2008
Total Posts : 218
   Posted 4/2/2009 9:33 AM (GMT -6)   
Nothing angers me more than the news media pulling snippet from a study and yelling "Danger Wil Robinson, Danger"

I would think removal of the prostate by surgery will slow considerably but treatments like Proton therapy will increase. Knowing what I know now the Proton therapy might have been a better choice.

The choke hold lawyers have on doctors will still control their suggested methods of treatment.

I have an appointment Monday. I will ask my doctors point of view on all this.

Hard not to be a little pissed with all this.
12/06/07 DaVinci and open prostate surgery after difficulties in breathing stopped the davinci.
Walked a lot
90% control the day the catherter removed.
pad only for a sneeze before the week was out
No pads most of the second week.

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