There is not "a one size fits everyone" in PC. I'll keep harping the point until I'm blue.
"You have to tailer the treatment to the biological aspects of your individual cancer" In some cases AS is the absolute best treatment when an individual's stats are low. In some cases surgery is the best treatment and in others radiation will have a very significant advantage. In high risk cases a combination therapy inculding HT offers the best chance of survival. Those that advocate "one best treatment" for all are not doing anyone a service. As soon as we realize that all cancers are not the same and that some are indolant and others are very agressive and dangerous we can reduce the amount of both over treatment and under treatment for those that have this disease.
Dr Strum gives the best advice for those wishing the most favorable outcome:
1. Know the biology of your cancer
2. Fit the treatment to your cancer's biology.
3. Choose the BEST artist to perform that treatment.
This is a simple, but powerful strategy in dealing with this disease.
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.