Study: Many with prostate cancer suffer no ill effects

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Gmike
Regular Member


Date Joined Jan 2009
Total Posts : 48
   Posted 9/1/2009 8:30 AM (GMT -6)   
Just read a story on MSNBC.com about a study published by the Journal of National Cancer Institute.

They estimate 1.3 million men were diagnosed with PCa since PSA testing widely began 1986, who would not have otherwise.

Goes on to state that only 1 out of 20 men treated benefited from treatment because their cancer was growing too slowly to cause harm.

"People have to weigh the small chance of a big benefit against the rather larger chance of a harm — and that harm being told you have cancer unnecessarily and treating it unnecessarily,"

Seems to me that if you are that 1 guy out of 20 who benefited from treatment, you would be glad you were tested. My URO thinks I'm that 1 guy.

Mike
Dx: 05/21/2009 (age 58)
1 core of 12 positive (10%), Gleason 6, Stage T1c, PSA 5.2 (21% Free)
Family history: Grandfather had PCa, died at age 79 of other causes, Father had PCa still living at age 80 cancer free (11 years)
07/15/2009 TUMT (Transurethral Microwave Therapy) for BPH
08/29/2009 Started on Casodex
10/12/2009 Scheduled to start radiation at Dattoli Clinic in Sarasota


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/1/2009 9:50 AM (GMT -6)   
Mike,

I hate studies like those, they are loaded to prove their premise right from the get go. I wonder if it shows how many lives were saved during that same time period based on that many men. I wonder if it breaks it down to how many when dx. with PC had low grade PC at the time, and it was prevented from escalating to a more agressive grade because the men did have treatments.

The findings sound so ignorant in our age of infomration and technology, and why would anyone want to discourage PSA testing and early testing in general, when PC is still such a killer of men?

I guess because those that make up silly studies like that don't have PC, or know anyone first hand with it.

David in SC
 Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 9/1/2009 10:36 AM (GMT -6)   

I too am concerned that studies like these and the media's ignorant presentation of them will unnecessarily cost the lives of thousands of men.  In the ABCNews article however, There were two points made by Scrardino and Walsh that were very good, 1) the data predates increased psa testing so does not accurately portray current facts and 2) there has been a 50% decrease in mortality since increased testing.  That sounds like success to me.

You ask who is pushing this no testing movement.  It is simple, it is led by the health insurance industry, the same ones who are spending millions of dollars to stop healthcare reform. Doesn't surprise me.


PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 9/1/2009 11:58 AM (GMT -6)   
I wonder how they know that only one in twenty will benefit? And if they know who will benefit and who will not then why do they treat those who will not benefit from the treatment. The problem is not in screening but in choice of treatment. Also, one in twenty chance is not that small.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 9/1/2009 1:33 PM (GMT -6)   
The study is mathamatically correct, but it misses the point by a mile. The problem is not to do PSA testing, but what to do with the information it provides. We have a mindset to treat every single case of Prostate Cancer that is diagonosed, and the 8 billion dollars these treatments generate promote this medical mindset.
The fact is that a large % of PC diagnosed is slow growing and will never hurt you. The real issue is identifying the PC that is agressive from the non agressive and treating only the agressive forms of it.
There a a number of ways to do this; the main one is watching the PC over time and if PSA rise indicates treatment then do it. Other methods are scans like Color Doppler and MRIS which can identify large agressive tumors. The totality of information from PSA derivitives and kenetics, PCA3, and scans can give reliable information on which to make an informed decision. Of course nothing is 100% certain, but neither is treating it and the odds are definately on your side.
I'm all for PSA testing everyone over 40; but I'm not for treating every single case of PC that these test will discover.
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 DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 9/1/2009 2:31 PM (GMT -6)   

JT:

I agree with you totally.  Part of the problem is that for most patients the testing stops at the biopsy.  So all a man has to go on is PSA and the pathology.  And, most men don't know to ask about color doppler, PCA3 or other tests and most garden variety uro-docs do not offer up that info.  My uro-doc is supposedly one of the best in the greater DC area (and that includes Hopkins) but did not offer up those tests and I was not knowledgeable enough to ask for them.  Probably with a G7 I would have opted for treatment anyway but if I had been a G6 with my low PSA, low number of cores and low % of cancer in each core I might have opted for AS, especially if I had the additional info from the additional testing.

Anyway, very good points as usual, John.

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 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Gmike
Regular Member


Date Joined Jan 2009
Total Posts : 48
   Posted 9/1/2009 4:02 PM (GMT -6)   
Tudpock,

That's exactly the way it could have played out in my case. I respect the hell out of my URO, but if I'd followed his advice after the biopsy, I would have headed across the street to the radiation center and started EBRT. He raised his eyebrows when I told him of all the tests my radiation doc in Florida (Dattoli) was going to do before beginning treatment. Will it make a difference in the outcome? I don't know, but I at least I'll feel that I've covered all the bases.

Mike
Dx: 05/21/2009 (age 58)
1 core of 12 positive (10%), Gleason 6, Stage T1c, PSA 5.2 (21% Free)
Family history: Grandfather had PCa, died at age 79 of other causes, Father had PCa still living at age 80 cancer free (11 years)
07/15/2009 TUMT (Transurethral Microwave Therapy) for BPH
08/29/2009 Started on Casodex
10/12/2009 Scheduled to start radiation at Dattoli Clinic in Sarasota


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 9/1/2009 4:03 PM (GMT -6)   
Tud,
I'm continually amazed at the lack of basic knowledge about PC that most doctors have.
The following article by Stephen Strum hits the nail on the head and is one of the best I have read.
"What every Doctor that Treats Male Patients Should Know"
http://www.prostate-cancer.org/education/preclin/StrumPogliano_EveryDocShouldKnow.html

You may have to cut and pastes, because it looks like the link doesn't work, but well worth the effort.
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 DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 9/1/2009 5:02 PM (GMT -6)   
Well, a guy looking at a study like this could probably conclude that doing nothing is the best path. The incident that convinced me to have surgery and get rid of the cancer was watching my dad die from undiagnosed Stage IV PCa. Had I chosen "watchful waiting" I probably would have suffered no ill effects - YET. But I'd have spent that last three years worrying about it.

The other reason I'm glad I took aggressive action is that I later got lung cancer. Fighting it was a devastating experience and had I also had to fight prostate cancer at the same time, I probably would not have survived.

As it has turned out, both cancers are in remission. No outcome could have been better.

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 - 7/17/09 zero.
Next PSA - July/2010
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 - 6/25/09 - in remission!!!
Next scan in September 09.
Biker90's Journey
http://www.caringbridge.org/visit/jimrobinson
"Patience is essential, attitude is everything."


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/1/2009 5:34 PM (GMT -6)   
Biker,

From reading your updated stats, you are doing great, congratuations on both cancer fronts. You must be one tough bird!

David in SC
 Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 9/1/2009 6:22 PM (GMT -6)   
Biker,
Doing nothing is never a good option. Getting more information so one can make an informed decision, even if it means waiting a while is not the same as doing nothing. AS is far from doing nothing, it involves continous monitoring and futher biopsies and at the 1st sign of progression means getting treatment.
You had great results, congradulations, and for you you made the right decision.
I don't think the AS option is adequately explained to most patients, both the benefits and risks. It's an effective option and many times the best option. It should be given the same consideration as surgery, radiation and all other options for those who qualify. Most doctors won't mention it or brush it off.
As you can see a lot of doctors are now beginning to question the value of testing and treating PC, and it's hurting our cause. But again they are getting it wrong. The real question is not whether to test but when to treat.

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 DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Bob D
Regular Member


Date Joined Mar 2008
Total Posts : 199
   Posted 9/1/2009 7:32 PM (GMT -6)   
This type information is dangerous. Countless men have been saved by the psa test and surgery. I for one do not want any type of cancer growing in my body no matter how slow growing. Be wary of much you hear from the media especially msnbc.
    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.  


      biker90
      Veteran Member


      Date Joined Nov 2006
      Total Posts : 1464
         Posted 9/1/2009 7:36 PM (GMT -6)   
      Yeah JT, my views are certainly biased toward aggressive action. Not from reading some statistics (which can be biased also) but from first hand experience with prostate cancer in my family. I stand on my position that the only way to treat cancer is with early detection and aggressive treatment. Until we have a cure or at least better ways to determine how aggressive a cancer is, if you got it, get rid of it....

      Jim
      Age 75. 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 + .03 cc Trimix = Excellent Results
      PSAs from 1/3/07 - 7/17/09 zero.
      Next PSA - July/2010
      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 - 6/25/09 - in remission!!!
      Next scan in September 09.
      Biker90's Journey
      http://www.caringbridge.org/visit/jimrobinson
      "Patience is essential, attitude is everything."


      Gmike
      Regular Member


      Date Joined Jan 2009
      Total Posts : 48
         Posted 9/1/2009 8:24 PM (GMT -6)   
      I'm viewing this information a bit different than most. I don't think it's advocating less treatment. I see it as saying that the diagnostics we have today aren't near good enough. We need a way to find out which cancers need to be treated and which don't.

      Mike
      Dx: 05/21/2009 (age 58)
      1 core of 12 positive (10%), Gleason 6, Stage T1c, PSA 5.2 (21% Free)
      Family history: Grandfather had PCa, died at age 79 of other causes, Father had PCa still living at age 80 cancer free (11 years)
      07/15/2009 TUMT (Transurethral Microwave Therapy) for BPH
      08/29/2009 Started on Casodex
      10/12/2009 Scheduled to start radiation at Dattoli Clinic in Sarasota


      JoeyG
      Regular Member


      Date Joined Jul 2009
      Total Posts : 162
         Posted 9/2/2009 11:29 AM (GMT -6)   
      That article is pure hogwash. As someone else stated that is the kind of information that the insurance companies are pushing.
       
      For most men who get prostate cancer, there is a natural progression; such progression varies by individual. However, it is relatively safe to say that someone age 70 who has very minimal PCa will likely not die of PCa, as opposed to a man age 50, who is diagnosed with very limited PCa. In the end, most men who have PCa will die of PCa if they live long enough for the disease to take its course. Therefore, it only makes sense that it is better to eliminate or slow down the terminal potential of the PCa.
      Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined (T2B)
      Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
      Post Cryo Nadir 8/06 0.2
      Rising steadily to 0.7 4/09 :-(
      Steady at 0.7 (7/09) (Pomegranate???)
      Looking to take next steps soon
      Hoping to qualify for salvage cryo or radiation


      JoeyG
      Regular Member


      Date Joined Jul 2009
      Total Posts : 162
         Posted 9/2/2009 11:33 AM (GMT -6)   
      Gmike said...
      I'm viewing this information a bit different than most. I don't think it's advocating less treatment. I see it as saying that the diagnostics we have today aren't near good enough. We need a way to find out which cancers need to be treated and which don't.

      Mike

      Mike, we already have that. Watchful waiting is a worthwhile approach in many cases. Most prostate cancers will become more aggressive as time goes on. When one surveils his cancer, and with the cooperation of his uro or onco, when a cancer does show signs of turning more aggressive, it is then zapped.
      Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined (T2B)
      Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
      Post Cryo Nadir 8/06 0.2
      Rising steadily to 0.7 4/09 :-(
      Steady at 0.7 (7/09) (Pomegranate???)
      Looking to take next steps soon
      Hoping to qualify for salvage cryo or radiation

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