New data from Hopkins on Active Survelience

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John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 10/23/2009 8:31 PM (GMT -6)   
John Hopkins just released data on 470 Active Survelience patients of which 11% underwent radical surgery within 3 years of diagnosis. Findings:
Most disease progresses within 1-2 years, if it progresses.
This suggests under sampling of agressive tumors in the original biopsy.
Even with progresson most tumors had favorable pathology with 27% being insignificant.
A small % of men had significant disease.
Conclusion: The study indicates a strong potential of AS as a treatment strategy.
 
 
I would strongly recommend that anyone considering AS get a color doppler ultrasound or a 3D mapping of the prostate to identify any agressive tumors that may have been undersampled. This would significantly reduce the number of men on AS ever needing treatment.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/23/2009 10:28 PM (GMT -6)   
Interesting data there on AS, John. Thanks for sharing.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


IKE-D
Regular Member


Date Joined Jun 2009
Total Posts : 77
   Posted 10/24/2009 8:48 PM (GMT -6)   
I did AS for 4 years after Dx before facing the Da Vinci. While these types of studies  sometimes naturally make me 2nd guess my Da Vinci encounter, I am reassured that, if my tumor could be insignificant as the study suggests, then it gives me hope that taking it out means cure for me!

>Age 41 (At Dx-July 05) -Psa during annual physical went from previous 2.8 to 3
>Biopsy by 'primary' Urol Aug 05 - Gleason 6 low grade. 2nd opinion at  Hopkins confirmed Dx
>Chose Active Surv (AS)- modified diet etc.
>Around Oct 07 Psa moved up to 5.5. I decide to treat at Hopkins. Not sure what kind yet. My doctor decided on re-biopsy first.
>2nd Biopsy Dec 07 at Hopkins was NEGATIVE for Pca! Nothing found in 14 cores!
>'Primary' Urologist baffled. Planned a saturated biopsy (22 cores) to settle issue once and for all. I wasn't going to do 22 cores wide awake!
>July 07 - Did MRI just for comfort. Nothing significant found. No spread. I'd live! Still in AS mode.
>July 08 - Saturated Biopsy performed. Cancer confirmed again (of course, you took 22 cores)! Same Gleason score, same grade, similar numbers but Urol says treat very soon! I am thinking not so fast - numbers are same and you told me it means not aggressive! In any case I agreed with Urol that I will go the way of the Seeds. I research seeds more and I don't like it.
>July 08 - Dec 08 I re-lapse back into AS mode but seriously researching/considering treatment options beside surgery - went on to Mass Gen and Georgetown to explore proton therapy and Cyberknife respectively. Anything but Surgery! Both experts who are about my age were unanimous in strongly declaring they will chose surgery 'if they were me'. In addition, I learn that if either if these radiation methods (and seeds too!)  failed, no backup plan (or will be complicated)! I got the message!
>Jan 09. Went back to see my doc at Hopkins. I decide to put my fate in the hands  of the 'Da Vinci Robot' then!
> May 09. Had surgery. some Pain and discomfort but normal. Pathology all clear. Gleason 6 as before. Feeling very lucky. I gambled (based on my numbers and got 4 more years!) on the slow nature of the cancer and took my time. Very happy I finally did it. Hoping for a great recovery of all 'key' functions. Great wife and family helping out.
> Sept 09 - 3month PSA - Undetectable!


Franchot
Regular Member


Date Joined Jun 2009
Total Posts : 131
   Posted 10/24/2009 9:15 PM (GMT -6)   
Thank you, John, for another interesting article.

(When I was first diagnosed with PC, I started scanning for information all over the Internet. Thankfully, I found this site and more thankfully I found some pertinent posts that were written by John T. He set me on the path of looking into color doppler testing and other forms of testing which resulted in me vying for AS.)

GTA
Regular Member


Date Joined Aug 2009
Total Posts : 27
   Posted 10/25/2009 9:07 PM (GMT -6)   
Hi John,

you are totally right. Everyone should know what type of PC he has, so he can make a decision he can live with.

When I asked the doctors ( 6 ) I consulted with about doing those tests they all advised in my case it won't make a difference.

My biopsy which included several refined tests showed I have tumors on the left, middle and right of the gland. 3 cores all 5% T1C G6. AS for me would be a long shot 50/50, but still, I would liked to know how aggressive my PC is.

Thanks, John.
I included the following in case some one would like to know about the tests you mentioned.

You might need to copy and paste.

What is 3D Mapping Biopsy?
http://www.hopeforprostatecancer.com/3d.asp

What is Doppler Ultrasound?
http://www.webmd.com/a-to-z-guides/doppler-ultrasound
57 year old
1st. biopsy atypical
2nd. biopsy 7/07/09 3 out 12 cores positive all 3x3's gleason 6
PSA 3.4
T1c
Had a moderate BPH for past 4, 5 years. Medication did not help.
Deit: 98% animal fat free for past 25 years at least.
Drinks: Mostly red wine with lunch/dinner
Activity: Walking 5 to 7 miles every other day. Cycling 12 to 15 miles every other day.
Action taken: Still in the research and learning stage.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 10/25/2009 9:33 PM (GMT -6)   
GTA
http://www.prostate-cancer.org/pcricms/sites/default/files/PDFs/Is10-1.pdf

On page 3 there is an article "Monitoring AS through High Resolution Color Doppler Ultrasound"
by Dr Duke Bahn. It has a number of examples of how CDU made a difference in a patient's decision on treatment. This is must reading if you are in the research stage.
The two best CDU doctors are Fred Lee in Rochester Mi and Duke Bahn in Ventura Ca. I have also heard good results from Dr Dattoli in Sarasota Fla and Dr Sconti in NYC.
Dr Bahn's website is PIOA.org (Prostate Instutitute of America)
The skill of the doctor is paramount and Lee and Bahn are the best of the best.
My doctor's said the same thing and they were dead wrong. I would have been looking at a failed surgery if I had not had a CDU.
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


GTA
Regular Member


Date Joined Aug 2009
Total Posts : 27
   Posted 10/26/2009 10:18 PM (GMT -6)   
JOHN,

thanks for the info. It is a very educational article and a must read for everyone as you advised.

If someone wants to look up the article and could not do it with the links you provided, they can try the following link and look for February 2007 vol 10, No. 1

http://www.prostate-cancer.org/pcricms/node/59

I will be meeting again with 2 doctors to discuss my options. I will not go with any procedure without first do the Color-Doppler.

the following link tells you what recommendations the first group of doctors advised.

http://www.healingwell.com/community/default.aspx?f=35&p=1&m=1614725

Thanks
GTA
57 year old
1st. biopsy atypical
2nd. biopsy 7/07/09 3 out 12 cores positive all 3x3's gleason 6
PSA 3.4
T1c
Had a moderate BPH for past 4, 5 years. Medication did not help.
Deit: 98% animal fat free for past 25 years at least.
Drinks: Mostly red wine with lunch/dinner
Activity: Walking 5 to 7 miles every other day. Cycling 12 to 15 miles every other day.
Action taken: Still in the research and learning stage.


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 10/26/2009 11:01 PM (GMT -6)   
Below is a link from where I had my saturation 3 D mapping in a .pdf file


http://alprostate.com/Documents/TFTMAPPING.pdf
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 
 
April 2009 12 of 12 Negative biopsy
10/12/09 - Psa .30
 
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4276
   Posted 10/27/2009 9:59 AM (GMT -6)   

JT:

I finally got around to reading your links and they are terrific.  The info from Dr. Bahn continues to make a compelling case for color doppler.  As I have stated before, I had no info on color doppler before coming to this site and my one regret re my treatment is that I did not have CDU prior to my BT.

On another subject, as you brought up HDR BT in another thread, do you have any thoughts or specific advice re the use of HDR as a primary treatment for early stage PCa?  I have a friend who has recently received the "news".  He is 69 years old with G6, and a very small nodule identified via DRE...I don't know his percentages...  He refuses to consider AS but has been encouraged by the URO group he goes to to choose between surgery and HDR.  Anyway, any thoughts on HDR as a primary treatment would be appreciated.

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 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 10/27/2009 11:35 AM (GMT -6)   
Tud,
I Don't really know a lot about HD Brachy. There isn't as much data as there is for regular Brachy.
The procedure is somewhat longer and the radiation implants are temporary not permenant, like we have. Sorry I couldn't be of much help.
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

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