Being Young does it mean it is Agressive Form?

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SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 2/2/2010 1:48 PM (GMT -6)   
While reading many posts for the last year and a half I have seen many survivors in their 40's mentioning to them that there Doctor has said that usually when you get it younger in age it is the agressive deadly form of the disease??
 
So being in my 30's my ? is based on my stat's being a lower Gleason Score and contained but a high tumor volume 15%....my doc hasnt said this to me that it usually behaves differently for younger patients. Not sure if he would say since when I do see him the nerves & anxiety is very high anyway., and he doesnt want me to worry over it..... Dont get me wrong I am very happy with my results so far, just wondering and thinking outloud....
Age Dx 37, 7/2008, First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008, Biopsy: 6 out 12 Postive all on right side, Gleason 7 (3+4). Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008, Prostate MRI: Normal 7/2008
Da Vinci Surgery 7/2008, PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
5 Post OP PSA's from 9/2008 to 12/2009: <0.1
 
 
 


James C.
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Date Joined Aug 2007
Total Posts : 4463
   Posted 2/2/2010 1:54 PM (GMT -6)   
Shu, one of the stats guys will have an answer, I bet. I am glad to see that you are continuing in good health.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


Steve n Dallas
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Date Joined Mar 2008
Total Posts : 4848
   Posted 2/2/2010 1:58 PM (GMT -6)   
I think buzz words like "more likely" come into play.
 
I know with breast cancer, women in their thirty's are "more likely" to have a worse type of cancer...BUT, more likely doesn't come close to meaning Always.
Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 2/2/2010 2:04 PM (GMT -6)   
SHU,
This is only my opinion, but I don't believe that this is true. But I caveat that based on the fact that a higher percentage of younger people have been diagnosed with more aggressive cancer than their older counter parts. i believe this is because the younger demographic finds their disease in a different way. The younger guys were not screened like the 50+ guys were. Thus many cancers in the 50+ demographic were detected by way of guidelines rather than by chance or symptoms. The primary reason a younger man was diagnosed is because they had history in the family thus they started testing sooner. And if it was because of symptoms, we all know that PCa with symptoms is usually advanced. I think with newer guidelines we will find guys diagnose at younger ages in the more early stages.

That all stated, it is important to note that being diagnosed earlier, means having to have to survive the disease longer. Because being the median age of diagnosis is 64 years old, most criteria for deciding treatment is not based on the young age demographic. Thus why the Epstein Criteria state life expectancy factors when discussing who is eligible for active surveillance. It's also why I am not a fan of ten year study results. A vast majority of men will survive ten years with prostate cancer. That's not great news for yours and my age groups. I would prefer to see 20 to 30 year data on modality success rates. Still, it's great to be in remission...

Tony
Prostate Cancer Forum Co-Moderator


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 2/2/2010 5:04 PM (GMT -6)   
I agree with Tony; being diagnosed young does not necessarily mean a more agressive PC.
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


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 2/2/2010 7:41 PM (GMT -6)   
Shu,
 
Being able to definitively separate indolant PC from aggressive PC is "the million dollar question."  There is important ongoing research in this area, but we really don't have an outstanding way to do this today.  Being able to tell the difference between the two forms could help men and their doctors make smarter decisions about which cancers really need to be treated, and how intensive that treatment should be.
 
The rule of thumb in place today for identifying aggressive PC is tied to the PSA velocity.  Men whose PSA had risen by 2 points during the year preceding treatment (PSA velocity greater than 2.0 ng/mL) were termed "aggressive."  This position was based on a study published in the New England Journal of Medicine, co-authored by William J. Catalona, MD, of Northwestern Memorial Hospital in Chicago.  Catalona commented, "The study results indicate that men with a high PSA velocity should not be managed by watchful waiting, and many will require more than a radical prostatectomy to prevent prostate cancer death."
 
To the point of your question, I haven't seen anything scientifically relating age to aggressiveness.
 
You've had a series of great, undetectible post-surgery PSA scores.  Perhaps easier said than done, but I would encourage for you to celebrate your successes and not worry needlessly about something not in your control.
 
---------------------------------
Added as an edit...
 
By the way, there was a recent (Jan-2010) publication linking the identification of a specific gene to aggressive PC.  This is not the answer to the "million dollar question" just yet, but it seems like a baby step in the right direction...
 
 

Post Edited (Casey59) : 2/2/2010 6:35:04 PM (GMT-7)


Cajun Jeff
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Date Joined Mar 2009
Total Posts : 4119
   Posted 2/2/2010 8:08 PM (GMT -6)   

Shu:  Tomy makes some very important comments.  I agree with what he states.  I just and one additional comment.  I was looking at you stats.  I like you had a gleason downgrade from 3+4 biopsy to post op 3+3.  I take that a GREAT news. 

You must be the youngest man on HW.  Good luck my friend.

 

Jeff T

Cajun Country


Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.
15 months out injections Caveject (success)


John T
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Date Joined Nov 2008
Total Posts : 4268
   Posted 2/2/2010 9:43 PM (GMT -6)   
Casey,
To add to yur points about agressive vs non agressive. Klotz found in his studies that as long as psa doubling time remains above 3 years it is most likely non agressive. Any PSADT lower than 3 years needs treatment.
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


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 2/3/2010 8:56 AM (GMT -6)   
Thanks Everyone!!!!
Age Dx 37, 7/2008, First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008, Biopsy: 6 out 12 Postive all on right side, Gleason 7 (3+4). Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008, Prostate MRI: Normal 7/2008
Da Vinci Surgery 7/2008, PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
5 Post OP PSA's from 9/2008 to 12/2009: <0.1
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/3/2010 10:25 AM (GMT -6)   
The downgrading of your PC from a 7 to a 6 was the single greatest thing in your pathology report, and your 5 post OP PSAs of zeros should give you some confidence that you may just be ok, better than you think.

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
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


ChrisR
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Date Joined Apr 2008
Total Posts : 831
   Posted 2/3/2010 11:10 AM (GMT -6)   

Shu,

My first PSA test when I was 38 years old was 2.4  The Dr. never mentioned it to me because it was below 4.  I had a biopsy when I was 42 and my PSA was 2.76.  I was told by several Dr. even Dr. Partin at Johns Hopkins that PCa is not more aggressive in younger men.  I still feel this hard to believe sometimes to.  However, being Gleason 3+3=6 with no grade 4 cells J.H. says that your chance of reccurence is 4 out of 1000.  In other words 99.6% of all Gleason 6 patients don't have to deal with the cancer again.  If you look yananow.net and sort by the Gleason 6 people you will see that practically none of them have failed treatment.  The J.H. study had patients that were up to 22 years out from treatment.  After reading the J.H. study my next question was O.K. great but what happened to the patients that reccured.  The answer: Nothing.  Epstien called it "so-called biochemical progression" due to the fact that no patient showed any signs of metastatic cancer and their PSA topped off at a very low number and never rose beyond that.  He said most likely they had a local reccurence that was not likely to progress.  There were no deaths from PCa of up to 22 years.  The study can be found on PCa Infolink.  If you want the link I can send it to you.  So, you probably don't have to sweat for at least another 15-20 years and then you are probably cured.

I to was Gleason 3+3=6 organ confined.  It still changes your life.  We really need to worry more about other issues, like coranary artery desease.  It is still the number on killer of men and women and it's something you can actually do something about.

You were lucky like me being Gleason 6 with no grade 4 cells. It took a long time for me to really understand that Gleason 6 really does behave much different then a higher Gleason score.  Once you read study after study you will see this to be true. 

Just to add one more thing, I agree with Tony.  Finding PCa from being screened will find it sooner in men then waiting for symptoms to show up.  I read a study once that said they found PCa in up to 40% of men in their 40's who died of something else.  Microscopic PCa, but none the less PCa.

And one more last thing,  I am not sure why with Gleason 6 organ confined you are having so many PSA tests.  J.H. does one 90 days after R.P. and if it is undetectable you go on yearly testing.  That is for Gleason 6 organ confined patients.  They feel it is not neccessary to test anymore then that.  You are at low risk for progression.  Give yourself a break from the test anexity. 



Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010

Post Edited (ChrisR) : 2/3/2010 9:23:16 AM (GMT-7)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 2/3/2010 12:22 PM (GMT -6)   
Chris,
Good information; Please post the source so I can put it in my reference files.
It's easy to see why G6s aren't dangerous if you understand how they work.
If someone is DXed with a 1mm G6 tumor with a psa doubling time of 5 years:
at year 5 the tumor is 2mm
year 10 at 4mm
year 15 at 8mm (still small)
year 20 at 16mm and the tumor penetrates the capsule and puts cells into the lymph system.
year 25 1mm in lymph system (undetectable by any scans)
year 30 2mm in lymph system (still undetectable)
year 35 4mm in lymph sysem (able to be dected by the most sofisticated scans.)
At this point we have about 10 more years for it to be symptomatic and a 45 year old is now 90.
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 2/3/2010 12:28 PM (GMT -6)   
PSADT does not collate to tumor size. Additionally, PSA doubling times are not fixed. Meaning that they can change suddenly and rapidly. There is no way to use PSADT alone as a predictor of how anyones cancer will behave over long periods of time.

Tony
Prostate Cancer Forum Co-Moderator


ChrisR
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Date Joined Apr 2008
Total Posts : 831
   Posted 2/3/2010 12:59 PM (GMT -6)   
Here is the link.
 
 
They call Gleason 6 disease "virtually 100 percent curable"
 
I have several other 15year studies from them about this to...
 
Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 2/3/2010 1:51 PM (GMT -6)   
In the post Mike mentions "Another recent report clearly states that “approximately 40% of patients aged 65 and older who begin active surveillance will die of other causes before their cancer progresses to require definitive treatment".

That kinda shows how few in their 40's can live out their lives just monitoring their disease. If 40% of those diagnosed at age 64 and up can live without treatment, my bet would be that less than 1% can do it at age 40. Regardless of PSA/Gleason...Thus why the Epstein Criteria absolutely excludes these men from the active surveillance as a first line approach.

It would be pretty much silly for a 41 year old who has Gleason 6, PSA 3.5 with a PSADT of 42 months to consider any lengthy term on AS. Assuming the PSADT does not change, by age 48 he will have G6 PSA 14 ~ far less favorable numbers even if his disease does not morph to a higher Gleason sum. His next 42 month period could include PSA over 25 with likely lymphatic invasion and/or bone mets. Especially when you consider that Epstein suggests he could have been cured at age 41 ~ the math might work for a 64+ guy, but it does not work at all for the younger age groups...

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 2/3/2010 12:13:19 PM (GMT-7)


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 2/3/2010 2:45 PM (GMT -6)   
Hi Tony,
 
While this discussion drifts off a little from the original posting, and crosses into other recent (few weeks ago) discussions on AS, I simply wanted to chime-in but add to your comment....see if you agree.
 
I agree that AS is very unlikely to the appropriate long-term sole treatment for a PC patient in their 40's.  However, someone who discovers very low risk PC in their 40's could employ AS as a "deferal strategy" by adopting the diet, exercise and lifestyle tactics of an AS program (to reduce the rate or even arrest the further development of PC, depending on how aggressively the AS tactics were undertaken) while monitoring progress on curative treatments. 
 
I would think this can be a very practical approach, although I would believe (as a generalization) that the younger one is, the higher the anxiety to "get it out" might run, and that would have to be dealt with.  To this end, I would only refer back (without re-stating) to the prior AS discussions and the importance of dealing with the psychological aspects. 
 
I emphasize my underlined "could" and "can" words in the paragraphs above because a "deferal strategy" wouldn't be for everyone...but not a bad decision for the right circumstances.
 
regards
 

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/3/2010 3:22 PM (GMT -6)   
Casey,
In my example above the safe delay period was likely one doubling cycle. 3-4 years. You don't want to start encouraging men to continue AS with PSA's that started out as 3.5 climbing to 7 in less that 4 years, do you? Especially if he in only 45 at that point...

It's a fine line to draw and it has no definable place to place that line. Personally, I wouldn't do AS in the younger age group if I had that scenario, even with what I know now. But AS can be safely done for an unclear time. But why risk anything? Too many here put too much emphasis on SE's over emphasis on cure.

I agree only to a point with serious considerations...

Tony
Prostate Cancer Forum Co-Moderator


ChrisR
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Date Joined Apr 2008
Total Posts : 831
   Posted 2/3/2010 4:07 PM (GMT -6)   
All this discussion at A/S is only relevent if PSA is a reliable marker for progression.  I don't know the answer to that and I don't think anyone does.  My PSA went up .35 in 4.5 years.  So provided rate remained constant, I would be 90 and have a PSA of 6.5.  I was not willing to bet on that one,  especially when the treatment numbers looked as good as they did from J.H.
 
Keep in mind these are J.H. numbers.  Not every hospital will have the same.  I was Gleason 6 according to J.H. pathologists and also my local guy.  That does not mean they are the only ones that can call a Gleason 6.  It just means if they call you a Gleason 6 and they operate on you and you turn out to be "Gleason 6 organ confined in their eyes" you have an excellent prognosis.  When I found out I was Gleason 6 and read about their stats.  I gambled I would remain Gleason 6 and I went to them because if I did stay Gleason 6 I would expect to fair the same as all their other patients did.
 
I also have read a much larger study that combined many institutions to the total of approx. 11,000 patients of Gleason 6 organ confined PCa. The survival rate after 20 years was 99.97% ,  in other words only 3/100s of the group died from PCa.  Who knows, maybe they were mis-classified and weren't even Gleason 6 to begin with.
 
I'm still scared has heck all the time about this.  Well, except when I am drinking...


Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010

Post Edited (ChrisR) : 2/3/2010 2:36:12 PM (GMT-7)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 2/3/2010 4:12 PM (GMT -6)   
Tony,
You assume that all PC will progress at some point and this is not a correct assumption. Klotz in his studies indicate that approximately 70% of low risk PC did not progress after 7 years, either with psa or Gleason upgrade through biopsy. Mike's post indicating 40% progression is in line with this.
We all agree that any sign of progression needs to be treated and Hopkins data indicates that this can be done with the exact same cure rate as immediate treatment. Data from the UCSF study on AS shows that a group on a regulated diet showed no one in the group having progression. A control group without the diet showed some patients progressing.
This still means that the vast majority of low risk PC will never progress to the point of hurting you.
We know for a fact that 50% of all men aged 50 have PC tumors in their prostate; we also know that nowhere near 50% of these are ever DXed or treated for PC. All the untreated patients should be dieing like flys if your premise held true. And yes, I am very concerned with having severe side affects from a treatment for something that has a very small chance of ever hurting me. The chances are far greater of dieing from a heart attack or another cancer than from a low risk G6. The cure is much worse than the disease.
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 2/3/2010 4:36 PM (GMT -6)   
I respectfully disagree with the interpretation of the Klotz study. The Klotz study states that it did not progress enough in 7 years to cause enough risk in 70% of cases to warrant treatment. But 30% odds of disease progression to the point of intervention is a pretty darn high number for a 40 year old man. The UCSF study is also based on the median age of 64. That's entirely off topic to the question.

The question is "Is PCa more aggressive in younger men?

My answer is no, but define aggressive. A Gleason 6, PSA 6 may not be aggressive enough to warrant treatment in some 64 year old men. But it's certainly aggressive enough to warrant treatment in a 40 year old man. If he wishes to take risks, I don't have a problem with that.

I am in perfect step with all AS guidelines. The man has a greater than 10 and 20 year life expectancy so he is neither low nor very low risk according to the Epstein Criteria and he has an opportunity to nip this is the bud.

Tony
Prostate Cancer Forum Co-Moderator


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/3/2010 4:50 PM (GMT -6)   
If anyone is wondering about the Klotz study, here is the InfoLink article on the study John is referring to:

prostatecancerinfolink.net/2009/11/17/the-sunnybrook-active-surveillance-experience/

The study was performed on men with the median age of 70 years old over a 14 year period. 30% ended up being reclassified for offering treatment. "Risk" in 70 year old men is not the same as risk in 40-49 year old men.

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 2/3/2010 3:01:02 PM (GMT-7)


gold horse
Regular Member


Date Joined Nov 2009
Total Posts : 360
   Posted 2/3/2010 5:54 PM (GMT -6)   
SHU,YOU WILL BE JUST FINE AND WILL SEE MANY ZEROS.
DIAGN=46 YEARS
GLEASON=3+3
FATHER HAD PC,THEN I THEN MY BROTHER STILL HAS TWO BROTHER PC FREE.
MARRIED,TWO CHILDREN.AGE 13 AND 8.
LAPROSCOPY SURGERY 6/2005
PATOLOGY REPORT.
GLEASON=3+3
TUMOR VOLUME=5%
LYMPHOVASCULAR INVASION=NEG
PERINEURAL INVASION=POSI
TUMOR MULTICENTRICITY=NEG
EXTRAPROSTATIC INVASION=NEG
SEMINAL VESICLES BOTH=CLEAN
MARGIN ALL=NEG
PT2ANXMX
DEVELOP SCART TISSUE AND NEEDED A SECOND SURGERY BECAUSE COULD NOT URINATE,
PSA 6/05=0.04,0.04,0.04,6/06,0.04,0.04,0.04,6/07,0.04,0.04,0.04,6/08,0.04,0.04,1/09
0.04,10/09,0.04
 


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 2/4/2010 1:51 PM (GMT -6)   
 
Here's your answer.
 
 
The majority of cases are not aggressive.
 
94% survial after 20 years for the surgery group.  Total patients under 50, 8200.  22% poorly differentiated and 70% moderately.
 
That means 6% died after 20 years in the under 50 group.  Who knows how many were in the poorly differentiated group and who weren't.   I'll take 20+ years for any cancer....
Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3739
   Posted 2/5/2010 2:33 PM (GMT -6)   
Hey Shu,
I don't know if you mentioned it or not already, but how did you get that first PSA? Did you or your PCP suspect something?
(I am wondering if you are me 20 years ago. If yes, then Quick! sell the stock before it crashes and you lose your pension. )
Jeff
DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 6=3+3. Bone and C/T scans neg.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots, See Uro 1/22/10 Trimix unsuccessful.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day
1/11/10 6 months: Still 3 pads but leak is now 320 ml (5 day avg.)
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05.

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