A change in thinking about prostate cancer in the Urologic world.

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Modelshipwright
Regular Member


Date Joined May 2009
Total Posts : 215
   Posted 11/24/2009 8:56 AM (GMT -6)   
This is an interesting article about the change in thinking taking place in the PCa world.


Read article here...



Regards,

Bill

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/24/2009 9:14 AM (GMT -6)   
Bill, interesting article, but heavy on the critisism side, and little on the alternative solution side. Defintely some nuggets of truth in the article. I have often thought that side effects to surgery in particular are always on the low side when you see them advertised as percentages. Thanks for posting it.
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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
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 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/24/2009 10:23 AM (GMT -6)   
Bill,

Thanks for posting this info. I went to the site and found it pretty interesting. I posted the home page link in another thread for references purposes.

Thanks for taking the time to find it and for letting us know about it.


Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative
da Vinci 9/17/09
Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
NERVES SPARED-positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT scheduled to begin Nov 30,2009 (74 days post surgery)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 11/24/2009 8:17 PM (GMT -6)   
Oncologists and radiologists have been saying this for years and it's just getting out. There was another article by urologists critizing their own field because all the research money was going to PC oncology and there were few researchers in PC urology, because everyone wanted to be surgeons. It was felt that their domain of PC treatment was slipping away because of lack of research.
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


izzard2
New Member


Date Joined Nov 2009
Total Posts : 5
   Posted 11/29/2009 9:59 PM (GMT -6)   
I browsed the article. I think that for the past quarter century the marketing departments of the medical institutions that have been doing RP's have been messing with the percentages of their "research" departments.

I had my surgery six years ago so it was not a daVinci (sp?). I don't know of any research re: daVinci's but I suppose the ED problems are lower with this method.

I went to a prestigious medical center for my RP. Got the PC news on a Friday. Went in the following Friday for a consultation. I was told that with my age (52) I was much better off getting a RP. (I did consult another highly respected urologist b4 I went back and was told the same thing). My original dr. did discuss the other alternatives that day but was negative about each one. He also said that the longer I waited to decide to have the surgery, the less my chances of getting the surgery. He did not discuss any research re this, nor did I ask. Remember, I had only found out a week b4 that I had PC so I was still in a state of semi-shock.

It is interesting that the only statistics that I was given on paper were incontinence statistics. That rate was published at 2%. The ED figure was a word of mouth thing between my dr. and me. In all of the PC publications that were handed to me there were no statistics listed re ED. The figure I was given by my dr. was 85% of the men who had RP's (at their clinic) needed no medical help in achieving an erection within 18 months of the surgery. You can bet that I was very specific in my questions re this point. He looked me right in the eye when he told me that. Almost anyone will roll the dice at 85%. I did. I now wish I would have taken more time to make such a monumental decision.

I asked my dr. if he was a "great" surgeon. He said no. He said he could get me one of the 2 best in the place if I would wait. I waited for 40" and then the hotshot surgeon came in followed by an eager and worshipful intern. This guy told me I had made the right decision about getting the surgery and that he would be happy to do the surgery. The only available time he had was for the following Tuesday. I considered myself lucky to have such a fine surgeon, so I figured maybe my chances would be even better than 85%!

That meant I had 3 days to ready myself for the biggest operation of my life. I spent those days with my wife making love. How sweet it was!

To make a long story a bit shorter, I never regained my potency after the surgery.

Five years after the surgery the institution sent me a questionnaire re followup. In the questionnaire, they stated that after five years 85% of the men who had a RP at their institution were capable of potency WITH or without medical help.

That's quite a discrepancy from what I was told five years earlier. I felt like a victim of a shell game. This questionnaire led me to the conclusion that the marketing dept. of that institution was calling the shots about the "research." This institution made $30,000 on my surgery and on my hospitalization. I was there for a total of 36 hours.

That's a lot of money. There is a tremendous amount of pressure to keep "feeding the beast" in the health care industry.

My surgery fed the beast.

My wife has left me.

Had I known then what I know now, I would not have had the surgery.

Yes, I am negative. Yes, it probably sounds like sour grapes.

That's the way I feel now.
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