NEW BOOK: Invasion of the Prostate Snatchers

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Jefnef
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Date Joined May 2007
Total Posts : 42
   Posted 9/1/2010 2:16 PM (GMT -6)   
The book, written tag-team style, is a provocative and frank look at the bewildering world of prostate cancer, from the current state of the multibillion-dollar industry to the range of available treatments.

about 200,000 cases of prostate cancer are diagnosed each year in the United States, and the authors say nearly all of them are overtreated. Most men, they persuasively argue, would be better served having their cancer managed as a chronic condition.


Here's the link for the review from the New York Times:
http://well.blogs.nytimes.com/2010/08/30/a-rush-to-operating-rooms-that-alters-mens-lives/?src=me&ref=health

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 9/1/2010 2:22 PM (GMT -6)   
Late to the game Jeff. There are three or four threads floating around about this book with multiple discussions.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Ed C. (Old67)
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Date Joined Jan 2009
Total Posts : 2458
   Posted 9/1/2010 9:08 PM (GMT -6)   
I read the book Jeff. It is interesting read but I don't think any of us will follow what the author did.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

Fairwind
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Date Joined Jul 2010
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   Posted 9/6/2010 12:57 PM (GMT -6)   
I have read the book from cover to cover and have come away with these feelings..The book promotes "Watchful Waiting" as a reasonable treatment option for an unspecified percentage of men who have a higher than normal PSA reading..It seems to promote the theory that most PC is the low-risk, slow growing variety and rushing into aggressive treatment is simply not recommended or necessary..It then goes on to promote HT as the best choice for almost ALL PC treatment.. It even downplays the role of biopsies, instead promoting equally invasive, risky and expensive scanning methods to determine just how aggressive and how advanced a particular cancer is..Biopsies and surgery are viewed as completely unnecessary horrors that men should strive to avoid...But if a biopsy is unavoidable, it should be performed in conjunction with a color doppler ultrasound so that only 6 cores, instead of the standard 12 cores need be taken. They leave the reader feeling that this difference is HUGE when in actuality it is insignificant...Nowhere in the book (or any book) is COST ever mentioned or the need to travel to far away clinics and treatment centers to have these procedures performed...

As you can see, I was not overly impressed with the bulk of the book. I feel it was written in a spectacular and controversial fashion so it would sell a lot of books and maintain author Blum's lifestyle. I WAS impressed with the treasure-trove of information found in the last chapter of the book, 24, and the following appendix.. These last pages were worth the price of the book as they are free from the anecdotal cheer-leading sessions found in the rest of the book or at least the sections written by Blum..

Casey59
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Date Joined Sep 2009
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   Posted 9/6/2010 2:48 PM (GMT -6)   
Sorry Fairwind, you lost me...after you seemed to question "the theory that most PC is the low-risk, slow growing variety and rushing into aggressive treatment is simply not recommended or necessary"...then I stopped reading...
 
Most PC is low-risk & slow growing.  Did you not know that?  Not all PC, but most PC is low-risk and slow growing.
 
Rush into aggressive treatment?  Definitely not recommended for the vast majority of PC patients.
 
Sorry, I tuned out pretty quickly after that sentence of yours...

John T
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Date Joined Nov 2008
Total Posts : 4237
   Posted 9/6/2010 3:17 PM (GMT -6)   
Fairwind,
Since when is a scan more invasive than a 12 core biopsy? Is the difference really insignificant? Many of us think the difference is very significant.
I think you are putting your own personal views into a lot of ideas mentioned in the book.
HT is presented as another option to treat localized PC as is well demonstrated by all the work Liebowitsz had done over the last 20 years. In most cases only a single 13 month period on HT was necessary and all effects disappeared within 18 months. I personally would not do this, but it is another viable option with the benefit of no permanant side affects and leaving all other treatment options open in the future. For men wanting to avoid the risk of all permenant this is a viable option.
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


Fairwind
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   Posted 9/6/2010 3:30 PM (GMT -6)   
I could be wrong here, but from my reading, when taking a wide, random sample of first time biopsies, 75% come back negative, 25% come back positive, and in that positive group, over 50% are Gleason 7 or higher...

Men who have been diagnosed with PC at Gleason 7 and up seldom stay with "watchful waiting" very long..But Dr. Scholz is right about this..With 75% of the first time biopsies coming back negative, far to many biopsies are being performed. There are genetic urine tests on the horizon that can determine if indeed cancer is the cause of the high PSA reading and eliminate most of the unnecessary negative biopsies being performed today...

At my treatment center, TUCC in Denver, my U-doc told me that their positive biopsy rate was 50%, a fact he was proud of. At the time, that information meant nothing to me...But what it means is they are going to great lengths to avoid unnecessary biopsies..

Hear is a fact that Blum & Scholz never mention in their book. At the ten year mark, 90% of the men with diagnosed metastasized PC are no longer with us. By focusing on the 10% who manage to survive, they paint a very lopsided picture...

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 9/6/2010 4:32 PM (GMT -6)   
All due respect, Fairwind, but the greatest number of biopsies result in Gleason 3+3, with a decreasing frequency as the Gleason scores go up. Furthermore, despite already being the largest group, the Gleason 3+3 is growing more than the others...more and more men are finding early signs of PC earlier and earlier. Again, your first sentence in your last posting was a non-starter...

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/6/2010 5:16 PM (GMT -6)   
Casey, can't our brother Fairwind have his own personal views and slant on this book, without your commentary on his opinion. I think he brought out some good points. Your last sentence in your post above, at best, is very condenscending, don't you think?

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Fairwind
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Date Joined Jul 2010
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   Posted 9/6/2010 5:35 PM (GMT -6)   
"Since when is a scan more invasive than a 12 core biopsy? Is the difference really insignificant? Many of us think the difference is very significant." <John T>

The color doppler ultrasound probe is just as invasive as the standard ultrasound probe..Taking 12 samples is not that much worse than taking 6...

Have you read the procedure for the SMRI?? They shove an inflatable probe up your butt, strap you down on the table so you can't move and run you into the MRI machine for 20 minutes or more, probe inflated, and charge you $4500 for information of dubious value..Non invasive??

So I guess it just boils down to how much time and money you have and whether you require an out-of-state expert to tell you you have or do not have cancer..

I'm not looking to get into a big argument with anyone, it's just my opinion...I'll try to look up and source my Gleason score percentage statement as a percentage of total biopsies performed and post it back here, referenced..

Okay, here it is, everything you want to know about Gleason grading..

http://www.prostate-cancer.org/education/staging/Dowd_GleasonScore.html

150,000 biopsies graded this way..

2% Gleason grades 2-5,
48% Gleason 6
50% Gleason 7, 8. 9

That means every year, 4000 men (the 2% group) can safely ignore their cancers, do nothing and safely achieve 100% positive outcomes. Many in the Gleason 6 group can do the same, but must be a little more watchful..

For those of us in the 50% aggressive cancer group, taking advise from those in the "Lets just keep an eye on it" group might not be sound advice. My reading of this book found it dangerously slanted towards the smaller percentage who can take this course of action..I don't think anyone should make any treatment decisions based on this one book...

Post Edited (Fairwind) : 9/8/2010 8:46:13 PM (GMT-6)


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 9/6/2010 6:23 PM (GMT -6)   
Fairwind, I owe you an apology for having misread your posting.

In current biopsy results, about 50% are Gleason 6 or less. Of course, that leaves about 50% for everything else, which includes, Gleason 7, Gleason 8, Gleason 9 and Gleason 10. The way you wrote it was "50% are Gleason 7 or higher."

So, you were right. What you may not also know is (and perhaps this adds value to your understanding) that of all the Gleason scores of current biopsy results, Gleason 6 occurs most frequently.

Sorry for my misreading...
 
 
 
------------------------------
edit:  You I must have been typing at the same time as your edit, above, but I see that you also got the same result.  Thanks!  But to your last paragraph in your 5:19pm edit above, keep in mind that "one size does not fit all."

Post Edited (Casey59) : 9/6/2010 5:27:03 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/6/2010 6:36 PM (GMT -6)   
fairwind, that was a great reply from you, not that I thought you owed any further explanation to your personal opinion.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 9/6/2010 6:57 PM (GMT -6)   
Fairwind said...
My reading of this book found it dangerously slanted towards the smaller percentage who can take this course of action..I don't think anyone should make any treatment decisions based on this one book...
 
 
I couldn't agree more with your last sentence....no one "should make any treatment decisions based on this one book."
 
What this book will do (we who have been aggressively treated should hope) is to help reduce overtreatment of those patients who fall on the side of not needing agressive treatment.  This may not have been YOU, but whatever knowledge you have of your experience may be beneficial to someone else who was "luckier" than you to have a better differentiated version of PC (one with lower Gleason).
 
best wishes...

Tudpock18
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Date Joined Sep 2008
Total Posts : 4183
   Posted 9/6/2010 7:01 PM (GMT -6)   

The data on Gleason grading is from 1994-1998...does anyone have any more current data?

Tudpock (Jim)


Age 62, Gleason 3 + 4 = 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 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

John T
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Date Joined Nov 2008
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   Posted 9/6/2010 7:18 PM (GMT -6)   
Fairwind,
I think I have more experience in biopsies than 99.99% of all patients. The CDU is used to eliminate the need for biopsy, and only if something is seen that a biopsy taken; 3 to 6 samples at most. From Numerous experiences I can testify that a 12 core biopsy is much worse than a 6 core biopsy and a 24 core is a real killer. The use of CDU in AS is to avoid annual biopsies.
I did read the part about the MRIS, in fact I experienced it. Although uncomfortable, it was better than a biospy.
I don't know of anyone who recommends that a Gleason 7 and above being on AS, except when life expectance is way less than 10 years. The purpose of AS is to identify any Gleason above 6 and treat it.
Matastasis is something that occurs after years; it is when the PC goes to the lymphnodes or the bones and starts growing. Before that, it is in the locally advanced stage. It can take years to get to matastatis and HT can slow this to decades. Gleason 6 cancers rarely get to matastasis even though they can get to locally advanced. This is why that even with reoccurrances gleason 6 cancers rarely lead to death. Once pc gets to matastisis it can usually be controlled for about 10 years, depending on the type and agressiveness.
In order to fight PC effectively you have to 1st understand how it works. You also have to understand what your individual cancer is doing and tailor the treatment to match the cancer. This is what I got from the book. You clearly got something else.
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


cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 9/6/2010 7:36 PM (GMT -6)   
The CDU is used to eliminate the need for biopsy, and only if something is seen that a biopsy taken; 3 to 6 samples at most.

Why is this so hard for people to accept.........I fail to understand!!! Do you want more punishment than necessary?

Fairwind
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   Posted 9/6/2010 11:04 PM (GMT -6)   
Amen Gentlemen.. We all have made the points we set out to make, a healthy and spirited discussion..

As always, best wishes to all....

An38
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Date Joined Mar 2010
Total Posts : 1149
   Posted 9/7/2010 1:31 AM (GMT -6)   
I am also not sure what avoiding biopsies is all about. If you have cancer, a positive biopsy is the only thing that will definately diagnose it.

It's one thing using a CDU to guide the biopsy needle, its another thing completely to rely on them to such an extent that you don't do a biopsy at all. And we have discussed in other threads how there is no published peer reviewed data backing the accuracy of the CDU even with Dr Lee and Bahn.

If the pain is such an issue don't let it stop you, consult an anesthesiologist and find a pain managment solution. My husband did and there was no pain at all, a 0/10, the only thing he noticed was rust coloured ejaculate.

He had an MRIS and it was the most uncomfortable thing he had in his entire journey with the exception of the bowel movement 4 days after surgery.

An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)

Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4. Neg margins, seminal vesicles, extraprostatic extension. Multifocal, with involvement in the peripheral, apex, fibro-muscular and transitional zones.

An38
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Date Joined Mar 2010
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   Posted 9/7/2010 1:48 AM (GMT -6)   
Tudpock18 said...

The data on Gleason grading is from 1994-1998...does anyone have any more current data?

Tudpock (Jim)


Since ISUP 2005 the Gleason grading has moved so that there are significantly larger numbers of cases which are diagnosed as Gleason 7 that would have previously been diagnosed as Gleason 6.
See section 7, the incidence of Gleason 7 cancer is now 68% or 39% in two different studies with the latter number being found in a clinical environment with a higher number of low risk cases were likely.  
In addition the Sloan Kettering Nonograms show that only about 30% of small Gleason 6 cancers are slow growing or indolent (defined as cancers not requiring treatment). Even if we ignore the ISUP 2005 upward migration this means that out of 150000 cases:
- 2% would be Gleason 2-5  (3000 cases) and
- 30% of Gleason 6 cases (21600 cases) would be indolent/slow growing.
- The rest (125,400 cases) would have cancer that will require treatment if the expected life expectancy and/or the health of the individual warrant it.
The ideal situation of course would be to identify the relatively small percentage of people who have indolent cancer and not treat them. The danger of course is that our current screening techniques do not allow for accurate identification of these individuals.
An

 

Post Edited (An38) : 9/7/2010 1:48:53 AM (GMT-6)


Fairwind
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   Posted 9/7/2010 11:32 AM (GMT -6)   
Thank you An for posting that. It was that ISUP change in Gleason scoring and the dramatic increase in G-7 tumors that prompted me to criticize Blum's book to begin with. The 68% figure stuck in my feeble mind but not the change in Gleason scoring..I could not remember where I had read about it. Today, I believe, Gleason 7 is the most prevalent type of PC diagnosed..

An important consideration when making treatment decisions that is often overlooked is the AGE of the patient..Once you are over 65, the Grim Reaper really starts going to work on your age group..My high school class recently held its 50th reunion. about half of the original class is already gone, as insurance company tables predicted they would be...Doctors are very much aware of this when laying out treatment plans for PC patients. It becomes a race to the finish line as to what gets written in the "cause of death" box....

Here is an open question..How do you post a direct link into a reply?
Age 68.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA age 66 9.0 DRE "normal", 2ed biopsy, negative, BPH, Proscar
PSA at age 67 4.5 DRE "normal"
PSA at age 68 7.0 third biopsy positive, 4 out of 12, G6,7, 9
RRP performed Sept 3 2010

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/7/2010 11:59 AM (GMT -6)   
Normally you can "cut and paste" it without too much hassle, that's how I generally do it.

And, yes, the patient's age and existing medical history have to be factored into any treatment planning.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Tudpock18
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Date Joined Sep 2008
Total Posts : 4183
   Posted 9/8/2010 3:35 PM (GMT -6)   
I know I'm late to the party on this one...I just finished reading this book and I must admit that I have a much more favorable impression than did Fairwind.  I did find Blum's sections interesting but a bit off-putting given that I think he is a bit off center in his beliefs and it is unlikely that many of us (including me) would choose to follow his path.  But, Dr. Scholz' chapters are certainly worth the price of admission IMHO.  He makes a good case for AS in certain situations, he tells it like it is re side effects of treatment, he makes a good case for inclusion of quality of life as an important consideration in the treatment decision and he provides interesting perspective on dietary issues.  And, speaking of the AS option, his personal perspective is that we will see more progress on PCa treatment in the next 5 years than we have in the past 20...providing another incentive for those who can wait.
 
I don't want anyone to think I am a "urologist-hater" (I'm still living down my "...smarter than a fifth grader" thread) but Dr. Scholz also makes a compelling case for seeing a prostate oncologist to manage PCa rather than a urologist.  He also makes the case for color doppler should anyone be interested.
 
I will definitely be adding this book to my recommended reading list for new patients along with the Walsh and Strum books.
 
Tudpock (Jim)
 
P.S.  Reading this won't make you quite as smart as JohnT but will get you in the same county...
Age 62, Gleason 3 + 4 = 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 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 225
   Posted 9/8/2010 7:52 PM (GMT -6)   
This is my first post and I want to support what Fairwind said. I read all his recent posts and he made a lot of sense to me.

Being newly diagnosed and treated, and went through extensive research (I am a research physicist/engineer) before arriving at my decision to do RRP, I agree strongly with Fairwind's observations. It is one thing to write to advice others when one does not have prostate cancer (I assumed the authors did not have prostate cancer), it is another to try to decide whether to gamble your own life to wait or to treat. One thing I came to appreciate was that no one could predict with great certainty whether my cancer was slow or fast growing even with all the diagnostics tools (DRE, CDU, MRI, CT, Bone scan and molecular analysis, etc.) What I came to appreciate the most was that once the cancer got out of the prostate, even if is is microscopic, the game was over. That became the most important factor in my decision to take it out ASAP and I didn't care that my urologist told me that I was a good candidate for AS!

My post Op pathology report gave me a peak at what my case could have been if I waited: Tertiary Gleason grade 4 and Perineural Invasion, meaning my cancer was probably turning bad quickly. I do not know if I caught it early enough and only time will tell. However, I am sure the outcome will be worst if I waited.

The other thing I learned was that picking a good and experienced surgeon meant everything. I cannot say enough good thing about my surgeon and the outcome: No pain, no positive margins, no incontinence, partial potency from day 1 and back to work in a week, for a 65 year old!
Age 65 Dx; 3/10 PSA 10.7, 6/10 biopsy positive Adenocarcinoma, Gleason 3+3 & several atypia; Clinical stage T2; 7/10 CT, Bone Scan, MRI all negative

8-23-10 RRP; Pathology Stage: Negative margins, Lymph nodes, Seminal Vesicle; multiple Adenocarcinoma sites Gleason 3+3 with tertiary Gleason grade 4. AJCC Stage: pT2,N0,Mx,R0

Catheter out 8-30-10 full continent partial potency day 1, great surgeon!

Red Nighthawk
Regular Member


Date Joined Oct 2009
Total Posts : 289
   Posted 9/8/2010 8:10 PM (GMT -6)   
Hey Newporter, good post and welcome to the board. Good luck with your recovery and I hope you stick around.

Are you a Newporter from roe-di-lan?
Age: 63
Pre-op PSA: 4.1
Post-op pathology:
Gleason grade: 3+4=7, present in both lobes, at least 1.1 cm, and occupying less than 5% of prostate by volume. pT2c NX MX
No lymphatic/vascular invasion present.
Seminal vesicles and extraprostatic soft tissue free of tumor.
Inked margins are free of tumor.
High grade prostatic intraepithelial neoplasia is present
Robotic RP: Sept. 15th, 2009 1 3

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4183
   Posted 9/8/2010 8:13 PM (GMT -6)   
Hello Newporter and welcome to the forum...sorry you have to be here but glad you joined us and I'm glad you are doing so well.  I certainly agree with you about picking an experienced practitioner as that can make a huge difference in outcome.
 
Actually, I am surprised that your urologist told you were a good AS candidate.  Even at age 65, unless you have other major health problems, with a PSA over 10 and 6/10 samples positive you certainly do not meet the Hopkins criteria for AS.
 
Finally and FYI, actually one of the authors of the book DOES have prostate cancer so he speaks from that perspective.  The other author is a fairly well known prostate oncologist who has specialized for many in the treatment of men with prostate cancer.
 
Tudpock (Jim)
Age 62, Gleason 3 + 4 = 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 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!
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