More on screening by Catalona and Walsh

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Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/13/2009 6:16 PM (GMT -6)   
While I am simply relaying the information sent today from the PPML, I personally am 100% for this official announcement by two of the most well known doctors in the business. I still reserve any judgement about focal therapies, however. There just isn't enough data on results at this point for me to agree with Catalona's position. But both Catalona and Walsh have some great points in this official release from Catalona's website...

www.drcatalona.com/quest/Winter2009/article3.html

My personal opinion won't change. And that is that screening saves lives and the problem in the screening controversy for prostate cancer is in those who argue about over treatment but fail to recognize that it isn't screening that leads to over treatment, it's the lack of education both clinically and in society. Therefore, it is to me, an argument on how to fix a symptom, and it does not address the problem.

I guess if Catalona and Walsh are going to make their statements, lol, I will too.

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 12/13/2009 5:22:58 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/13/2009 6:43 PM (GMT -6)   
Great post, I agree 100% with you Tony, and glad to see those two men encourage testing, may not be perfect, but definitely saving lives and getting more cases dx. before they turn real bad. That is a great service to all of men in general in my opinion.

David in SC
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, Cath #9 in 35 days, 12/7/9 - Cath #10 in place


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 310
   Posted 12/14/2009 10:05 AM (GMT -6)   

Thank you for the link to the Catalona - Walsh pieces.  I like it when posters help keep me up to date.

It's the holiday season, and I choose not to restart this argument.  nono 

Peace to all,

Zen9 


No family history of PC.  PSA reading in 2000 was around 3.0 .  Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.   
Urologist advised a repeat PSA reading in six months = 4.0 .  Diagnosed May 2008 at age 56 as a result of 12 core biopsy.  Biopsy report by Bostwick Laboratories = Gleason 3 + 3. 
Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3. 
Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist.  Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.   
Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008.  Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear.  Gleason = 4 + 3. 
Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances. 
PSA readings: 
November 2008 = <0.1 ["undetectable"]
June 2009 = <0.1   
December 2009 = <0.1
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/14/2009 10:39 AM (GMT -6)   
Zen,
These are all opinions. There is no arguing them. You are welcome to express yours as well. I will always be a screening advocate. I was below the screening age when my cancer was detected by a screening I didn't ask for. Thank goodness that no one put up a fit that my doctor checked that box on the blood test sheet.

Tony
Prostate Cancer Forum Co-Moderator


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4225
   Posted 12/14/2009 11:04 AM (GMT -6)   
Totally agree with the need to screen as many as possible.
I think the data on overtreatment and Active Survelience doesn't support Catalona's position on treating nearly everyone that is DXed.
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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/14/2009 11:57 AM (GMT -6)   
I agree with you on this point, John,
But the real problem is that there is no one who can say for sure who to treat and who not to treat. Still, education will empower the patient, and that is my point. The decisions about treatment belong to the patient, not to the industry.

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 12/14/2009 11:00:48 AM (GMT-7)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4225
   Posted 12/14/2009 12:22 PM (GMT -6)   
Tony,
There was a quote attributed to Scardino that said "we now have a 95% probability of determining if a tumor is agressive or non agressive". I haven't seen anything else that supports this. Do you know why he would have said this?
Also Klotz in his research on AS is convinced that in 2 years with 8 to 10 psa data points he can determine if a pc is agressive or not. I understand that a two year wait may be a problem for most patients.
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


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 310
   Posted 12/14/2009 12:46 PM (GMT -6)   

JohnT,

I would appreciate it if you would supply the citation or a link for the alleged Scardino quotation you mention above.

Thank you in advance.

Zen9


No family history of PC.  PSA reading in 2000 was around 3.0 .  Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.   
Urologist advised a repeat PSA reading in six months = 4.0 .  Diagnosed May 2008 at age 56 as a result of 12 core biopsy.  Biopsy report by Bostwick Laboratories = Gleason 3 + 3. 
Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3. 
Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist.  Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.   
Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008.  Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear.  Gleason = 4 + 3. 
Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances. 
PSA readings: 
November 2008 = <0.1 ["undetectable"]
June 2009 = <0.1   
December 2009 = <0.1
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/14/2009 1:11 PM (GMT -6)   
Yes I do, John,
His definition was based on using the JHU/MSK guidelines for active surveillance. This plan is strong enough to offer a good gauge but it isn't perfect. I think Klotz is a little too into his beliefs if he thinks he can accurately predict the aggressiveness of this cancer. I think it goes without saying that if the PSA rises three consecutive times, that it will continue to do so and the cancer is growing. But that still does not provide a timeline, nor a definition of whether it's aggressiveness is potentially lethal unless the increase is significant. Additionally what might be aggressive for a 45 year old might not be a concern for an 85 year old.

Tony
Prostate Cancer Forum Co-Moderator


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4225
   Posted 12/14/2009 2:01 PM (GMT -6)   
Zen,
The quote was 2nd or 3rd hand., supposedly said in a newspaper interview. I was trying to verify it. That's why I was asking Tony to see if he had heard anything.
Klotz bases his predictions on psa doubling time. He believes that as long as the doubling time remains above 3 years it is non agressive. As soon as the doubling time drops to less than three years treatment is recommended. The problem is that it takes two years of psa taken every 3 months to get a reliable trend.
I had 10 years of psa history, with about 50 data points and my PSADT was consistantly 3 years. The doubling time never increased which indicated the PC was growing at a slow steady rate. It eventually would have caused a problem years down the road, but unknowingly I was practicing delayed treatment for at least 12 years. Unquestionable I would have had a much better chance for a cure if treated 5 or 6 years ago.
JT
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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