A second take on "PSA screening is worthless" etc.

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 7/2/2009 11:47 AM (GMT -6)   
The full text of the referenced article and accompanying editorial is now on line, and it seems that (surprise!) the popular press read in the research what it wanted to read. Summary and pointers to the original docs here: prostatecancerinfolink.net/2009/07/02/brawley-et-al-on-prostate-cancer-screening/#more-6242
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 0.006


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 7/2/2009 12:05 PM (GMT -6)   
I guess the thousands of lives saved and suffering from prostate cancer victims not having to have advanced problems isn't worth anything?

Always the same answer to me, get PSA tested, if you have it in your family or if you are African-American, I would say between 30-35 for the first one, and age 40 for everyone else. Not a radical move, not an expensive move, but one that can save lives and suffering. If a PSA test cost thousands of dollars, like an MRI or CAT scan can, I could see looking at it closer, but geez folks (the critics), its a simple blood test.
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, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/2/2009 12:08 PM (GMT -6)   
I saw this post this morning. 
 
Again Mike puts a great reply to a study.  Clearly, the biggest confusion is using "averages" instead of individual cases.  With an average 12 year life expectency after diagnosis at the average age of 64, and a US life expectancy for males at 78, you can see how a general statement on the benefits might discount traditional therapy.  But each case is NOT the same.  Thise that are younger than the median age point, or with more aggressive cancers clealy benefit from therapy.  And the watchful waiting argument is seriously flawed as it is based on averages as well. 
 
In time, I remain hopeful to see a test that determines the differences between indolent and aggressive prostate cancer.  Until then, each case should be dealt with individually.
 
Tony
 Age 47 (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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 7/2/2009 12:14 PM (GMT -6)   
Tony, that is excatly the kind of test that is needed, and quickly. The other stats don't comfort much if you are dx. with an agressive strand of PC at age 40-55 or so, add 12 years to those ages and you don't get too far.
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, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 7/2/2009 1:47 PM (GMT -6)   
TC-LasVegas said...
I saw this post this morning. 
 
Again Mike puts a great reply to a study.  Clearly, the biggest confusion is using "averages" instead of individual cases.  With an average 12 year life expectency after diagnosis at the average age of 64, and a US life expectancy for males at 78, you can see how a general statement on the benefits might discount traditional therapy.  But each case is NOT the same.  Thise that are younger than the median age point, or with more aggressive cancers clealy benefit from therapy.  And the watchful waiting argument is seriously flawed as it is based on averages as well. 
 
In time, I remain hopeful to see a test that determines the differences between indolent and aggressive prostate cancer.  Until then, each case should be dealt with individually.
 
Tony

 
Every cancer is different and I think we are getting to the point where watchful waiting becomes a good alternative, taking into consideration all of the variables---age, GS, psa, biopsy results. Borderline cases should not opt for WW unless one's age is very advanced.
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4185
   Posted 7/2/2009 2:32 PM (GMT -6)   
The problem is not the psa testing, but the uninformed doctors and patients that think every instance of prostate cancer must be treated immediately. Right now watchful waiting is the only way we have to distinguish indolant cancer from agressive cancer and it's imperfect. I do think that a large proportion of men with G6 and small volume are being overtreated and live with the life altering side affects of treatments without any benefit to their survival. We need to find better methods of distinguishing agressive cancer rather than quibble about psa testing.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/2/2009 3:05 PM (GMT -6)   
In general, that is very true, John,
I also know a few cases that were G6 small volume that went metastatic in two years after watchful waiting. It's back to my point that averages should not be used in case by case occurances. We do know that many cases take a sudden and uncontrollable turn as well. We have no tools to define when that might happen. But in general, we are over treating many cases of prostate cancer...

Tony


 Age 47 (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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4185
   Posted 7/2/2009 8:02 PM (GMT -6)   
Tony,
I certainly agree that a few cases of G6 go out of control, but I also think if one takes the time to get color doppler or MRIS and gets a psa test every 3 months this will reduce those cases even more, I would speculate to the 1% or 2% level. The trick is to get a doctor that specializes in watchful waiting:
There are a few of them and they have the skill to identify if and when the PC is becoming agressive. If the current PC treatments didn't have such a high probability of permanent side affects and complications it wouldn't be a problem.
It just makes me angry that many doctors automatically recommend a radical treatment when any small cancer shows up. I understand that the decision to treat may be a lot different for a 35 year old vs a 60 year old, but the 35 year old may still be able to safely delay treatment for a good number of years. In many cases he is not given enough information to make an informed decision.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/2/2009 8:17 PM (GMT -6)   
As much imaging as possible is very sound advice before moving forward with watchful waiting. It is tough enough to make that the call as a patient, I don't entirely fault the doctors. Some of us, can't weather the do nothing idea, and some of us would prefer it when it's not a good idea. I believe that when a better prognostication tool comes out, doctors will use it gladly. Until then, it's our own call.

As a 35 year old, is it best to wait with moderate grade cancer or move now to remove it? No one can answer or make a recommandation about it scientifically. Why? Because a 35 year old is never included in prostate cancer studies. And anywhere below the median age of 64 years old for prostate cancer would anyone like the average time for prostate cancer to become life threatening if they have a life expectancy beyond the average.

We do know that intervention of some kind has it's benefits.

Tony
 Age 47 (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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 7/2/2009 8:36 PM (GMT -6)   
John,

But at what costs would these color dopler's run and I know how expensive MRIs are, lot of difference between justifying PSA tests frequently as opposed to adding in expensive alternative testing. Will most people's insurance cover these extra tests? I honestly don't know.

If cost were no object, then I think what you are saying would make sense.

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, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4185
   Posted 7/2/2009 9:51 PM (GMT -6)   
There is a paper published by Dr Laurence Klotz, Professor of Surgery and Urology at the U or Toronto that does a good job of summarizing alot of the studies on active surviellance. It seems that PSA doubling time is the prime factor in low risk progression. As long as it stays over 3 years the chance of a progression that will kill you is virtually nihl.
In one large study 66% are still on AS after 7 years with no progresssion. 12% opted for treatment with no progression, because of the psychological stress of not treating it, so 78% showed no progression. 1% died, but their PC progressed within 6-11 months and was most likely mestastic at the diagnosis, so no treatment would have helped. The rest underwent treatment when their PSA progressed or gleason went to 7.
These results are comprable to any treatment options with a G6, low core, low PSA.
The tests are a lot cheaper than any treatment option and most insurance covers them. If PSADT is the true indicator of progression vs indolant then the tests are really cheap.
To me this is a very good low cost, low risk option for patients who meet the AS criteria. A 78% no progression rate vs a 100% chance of side affects from treatment sounds like a good risk reward tradeoff to me, especially when an excellent chance of cure still exists if the PC progresses.
I know there is always the psychological issue of living with PC, but a Swedish study showed no psychological difference in those who were treated vs those who were not. PSA anxiety and worry about reoccurrance existed in patients who underwent treatment.
David and Tony, I don't think we have any disagreements except that I believe that AS should be considered in many more cases than we are currently seeing and many patients are not given enough information to seriously consider this option.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/2/2009 11:45 PM (GMT -6)   
I think the bottom line here is most PCa survivors want to see men and their loved ones be informed about the signs and risks of PCa.

The level at which people want to be informed and want to take action based on information is totally up to them.

Many people are more afraid of the side effects of treatment than they are of cancer.

In a situation for many of us where there is freedom of choice and freedom to act, our eventual choices and final decisions are up to us.

Those of us who have the disease are somewhat afraid for the uninformed and we are therefore pretty vocal about getting informed, which includes interviews with health-care professionals and often some level of testing or exam.

The beauty of this forum is the ability to express opinions and offer support and then support the individual in whatever decision they make. That final decision of what action to take or taking no action at all is a very personal decision. It is hard for me to second guess someone.

If I have on occasion, in almost two years, appeared as if I have been second-guessing someone's personal decision, I apologize and will try to do better.

Thanks to the participants for a great forum and to our moderators who work so hard to keep this a productive enterprise!

Barry
Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 7/3/2009 8:07 AM (GMT -6)   
And in some people's way of dealing with cancer, is they like the confidence of working with a good, experienced doctor that they trust, and they like to have a game plan that makes sense for them, they like to have good local medical facilities to be treated in, and they like knowing that they are being pro-active at their own level to start dealing with their own personal reality of having a cancer in their body.

Not everyone we run across here is interested in every technical aspect, every possible available treatment or theories about future treatment. They have cancer, they are scared, they want to live, they want to act, and they want to feel like they have some say and control in the matter.  And some people are just simply good at making quick decisions, where others take forever to decide the simplist of matters.

Once they decide, and some decide on their primary treatment quickly by choice, they find a certain level of relief.

It's most important that we support everyone's personal decision. It is not our place to question their intelligence, their motivations, etc. In our format here, we will never know the whole person we are dealing with, we don't fully know their full medical histories, their family histories, their threshold to pain, their generalized feelings about medical care, their personal economic situations, and even the specifics of where they live and what medical facilities they have "real life" access to. There are so very many factors.

You are right to say, there are men that are more afraid of potential side affects then the means to get a cure. That is kind of the cart before the horse. Going into what was to be a non-nerve sparing open surgery, I never ever expected to have "regular" sex again, my wife and I were ok with that, and with all that said, I didn't and still don't suffer from any evidence of ED, never had to use even a pump, or not a single sex pill. I know that I am in a tiny minority, but I didn't know that ahead of time.

Judging the fear of others is hard too, what scares me won't scare you. I told my dr. on the night of my dx., that I had no fear of surgery (having had many), but I was terrified of radiation due to a bad exprience with 35 days of radiation less then 10 years ago at the time, so for me, my own fear quickly limited my choice of treatment. open vs. Robotic, easy to eliminate robotic for me, only 15 had been done in my area at the time, and I didn't want travel and logisitical problems for my loved ones, so that is how I went to open.  Our choices are often made and tempered by our current realities in our lives.

Best bet is to warmly welcome all here, to encourage all, to help abate their fears, and our own, and to support whatever choices are made by each individual man. That's my opinion.

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, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 

Post Edited (Purgatory) : 7/3/2009 8:14:29 AM (GMT-6)


engineer55
Regular Member


Date Joined May 2009
Total Posts : 121
   Posted 7/3/2009 1:50 PM (GMT -6)   
This is what I don't get, clearly Prsostate Cancer is a big killer, also since PSA they have doubled the number of people indentified with PCa. So are they actually saying if you have prostate cancer it is better to not know about it. None of the 3 doctors I consulted ever suggested that I need to rush into a procedure, but I would think any doctor would agree that if you have the condtion it is better to know than not know. The day I got biopsied I guy with small kids walked in with a 300 psa. I bet he wished he was tested 10 years earlier.
Dx'ed 5/08 one core 2%  out of 12  3+3 gleason
DREs all negative
PSA was in the 3-4 range then jumped to 7
I have the enlarged prostate, on the order of 100cc.  After taking Avodart for 3 months  my
PSA was cut in half.
I did Active S for a year but concluded that I didn't want a life
of biopsies and Uro meetings.
DaVinci on 6/24/09  UCI Med Center  Dr Ahlering, long surgery based on size and location
Final was 5% one side all clear, but had a huge 90 grm prostate
Now we work on pee control, ok at night but sitting is a big problem.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 7/3/2009 2:24 PM (GMT -6)   
Engineer,

You are thinking right about this. Not knowing is never a good answer. Makes you wonder if they are blaming the PSA for being such a good inexpensive indicator of what might be going on in one's prostate gland. It is what it is, not testing won't make cancer go away, it may just make it worse by not knowing.
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, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 7/4/2009 7:43 AM (GMT -6)   
I will always support early detection testing. Lives are worth saving and men should be able to be men without this disease eating at the very core of our being because testing is discouraged. I do not see the education that I think PCa deserves for the public. Tony, like myself are huge outspoken advocates in favor of educating the public about PCa. I could rant about this for ever, but for the sake of time I will just pray that God will bless us all abundantly as we continue the united fight against cancer.

peace and love
dale
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) 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 .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


engineer55
Regular Member


Date Joined May 2009
Total Posts : 121
   Posted 7/4/2009 8:30 AM (GMT -6)   
livin-  looks like a $30 blood test saved your life.   In my case sure I could have waited, but I really do not see the damage in taking care of something now as a bad thing.  It still has to be done.  Annual testing and monitoring with an eventual final in  5-10 years  would have cost a lot more in the long term.  Lets thank the lucky stars we have a winner in the PSA test, much better than the colonoscopy, and there are so many with no  way to get an  early tell.
Dx'ed 5/08 one core 2%  out of 12  3+3 gleason
DREs all negative
PSA was in the 3-4 range then jumped to 7
I have the enlarged prostate, on the order of 100cc.  After taking Avodart for 3 months  my
PSA was cut in half.
I did Active S for a year but concluded that I didn't want a life
of biopsies and Uro meetings.
DaVinci on 6/24/09  UCI Med Center  Dr Ahlering, long surgery based on size and location
Final was 5% one side all clear, but had a huge 90 grm prostate
Now we work on pee control, ok at night but sitting is a big problem.


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 370
   Posted 7/6/2009 4:23 PM (GMT -6)   
Engineer said it it all for me. I am one of those low risk PCA guys, G6 with only 2 positive cores, low volume.  My robotic surgeon didn't really press me into surgery,  he said I could take at least 6 months to weigh out options. I could have done active surveillance too. Now that I appear to have permanent ED and need to use Trimix for sex, I sometimes wonder. But I didn't want a life of watching PSA rises and  repeat biopsies either, too nerve-wracking.
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 on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 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,
3 0's in a row now, 10 months out
Incontinence gone in early December '08,
ED remains,  still taking daily viagra for penile rehab, uro said try oral meds and then trimix for sex only now, Peyronie's Disease a problem now


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/6/2009 8:29 PM (GMT -6)   
I owe my future to PSA testing.

A G9 won't wait .
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03


Bob D
Regular Member


Date Joined Mar 2008
Total Posts : 199
   Posted 7/6/2009 9:03 PM (GMT -6)   
If you had cancer in a toe on your foot, would you perform watchfull waiting or would you have it removed?
While some feel it is okay, if cancer is in my body I want it removed not watch it and risk it spreading which is
the nature of cancer.
 
    1. Age 59, psa 4.7 in Jan. 08. Biopsy: one positive sample out of 13. 1% of one sample cancer. Prostate removed on 3/5/08. Open Surgery. Northeast Georgia Medical Center, Gainesville Ga. Nerves spared. Cath out 12 days later. Continence good. No pads needed since 6/10/08. First PSA: Less than 0.1 on 6/17/08. First erection five days post op and have been improving well since then. Full erection now possible (less than four months post op) with the assistance of Cialis.  Post Op Biopsy : No malignant cells in lymph node. Gleason 3=4=7. Tumor on both lobes. Urethral margins/apex free of neoplasia. Right and left seminal vesicles free of neoplasia. No invasion of prostatic capsule of the resection margins are noted by the tumor. Tumor occupies 10 to15% of the prostate gland. Path staging T2c, NO, MX- Group staging II.  Focal areas of perineural invasion by tumor are noted. 80% natural erections and full erections with 10mg Cialis. 9/22/08-Took 10mg Cialis on Monday night, had very usable full hard erection at night, the next morning, and the following Thursday morning, 60 hours after original dose !! Orgasm quality Excellent.!!!!! I am pleased with the progress so far. Married to same wonderful woman for 39 years. She is still beautiful and sexy as ever. A great help in my recovery !!: 3/12/09: Full natural erections with penetration. 10mg Cialis makes them easier to maintain but I have had several med free full erections lately, Yipieeee !!!!!!!  3/24/09: One year PSA <0.1.  3/28 & 3/29: had sex with full naturals with no meds. Erections are gained and maintained with very little manipulation. Getting more like pre op every day. 5/30/09, I take only 5mg Cialis every 2 or 3 days. This greatly assists my full naturals and provides great staying power and no manipulation required and allows sex anytime !! Lenght and girth are back to pre op size due to regular "workouts".
    1.  


      CapnLarry
      Regular Member


      Date Joined Apr 2009
      Total Posts : 75
         Posted 7/10/2009 9:01 AM (GMT -6)   
      The "widespread screening" and "this cancer is overdiagnosed" discussion has metastasized...to breast cancer. See www.bmj.com/cgi/content/abstract/339/jul09_1/b2587 and a discussion at prostatecancerinfolink.net/2009/07/10/screening-and-cancer-the-controversies-are-spreading/.

      Now the feathers will hit the fan!
      Larry Shick
      Personal homepage incl. PCa story: www.sv-moira.com.
      01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
      03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
      Followup: 05/09 0.006


      Purgatory
      Elite Member


      Date Joined Oct 2008
      Total Posts : 25364
         Posted 7/10/2009 10:14 AM (GMT -6)   
      I saw that too on the news, Larry, you are right, now that they are hitting the sacredness of breast cancer, perhaps that will enbable a way for all this nonsense to end. The woman that runs my local credit union is fighting for her life with breast cancer, already had surgery, had chemo, and now finishing with radiation, and never was any in her family ever. Get tired of hearing about any cancers being over dx, over treated, etc.
      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, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
       
       


      geezer99
      Veteran Member


      Date Joined Apr 2009
      Total Posts : 990
         Posted 7/10/2009 10:36 AM (GMT -6)   
      This has been a great discussion topic. Different points of view presented in ways that are both thoughtful and respectful of the opinions of others. I sometimes worry that those of us on this board have a bias in favor of active treatment rather than active surveillance (myself included) but this thread illustrates an even stronger bias: Active and informed consideration of all alternatives.
      Age at diagnosis 66, PSA 5.5
      Biopsy 12/08 12 cores, 8 positive
      Gleason 3+4=7
      CAT scan, Bone scan 1/09 both negative.

      Robotic surgery 03/03/09 Catheter Out 03/08/09
      Pathology: Lymph nodes & Seminal vesicles negative
      Margins positive, Capsular penetration extensive Gleason 4+3=7
      6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
      10 weeks: no pad at night -- slight leakage day/1 pad.
      3 mo. PSA 0.0

      New Topic Post Reply Printable Version
      Forum Information
      Currently it is Thursday, April 19, 2018 9:12 AM (GMT -6)
      There are a total of 2,953,121 posts in 323,973 threads.
      View Active Threads


      Who's Online
      This forum has 162053 registered members. Please welcome our newest member, luisitodiaz.
      446 Guest(s), 15 Registered Member(s) are currently online.  Details
      countingstarsx, RoxyRR, notsosicklygirl, slick7, 81GyGuy, Kent M., DougW, PeterDisAbelard., BillyBob@388, Dadeen, Thomarann, Saipan Paradise, Dave T, straydog, Runninheid