Strategy for beating PC

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John T
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Date Joined Nov 2008
Total Posts : 4188
   Posted 9/22/2010 4:15 PM (GMT -6)   
Dr Strum's best advice for beating PC is is faily simple:
1. Know the biology of your individalu cancer
2. Fit the treatment option to your cancer's biology
3. Find the best artist to perform the treatment.
 
I think that this is excellent advice for anyone hoping to beat this disease and a good strategy to follow. I have a military background and military history is my hobby, So I like to think of fighting PC as fighting a war. As as we were taught, Hope is not a strategy, and you have to have a good strategy to win. It does not guarentee winning, but it results in the probability of a favorable outcome.
Know the biology of your cancer. To me this means knowing how your enemy operates, his tactics and his strengths and weakness. All PC is not alike. There is very slow growing and indolant PC; PC that is growing at a rate that will eventually hurt you given enough time and PC that is very dangerous, and must be delt with in the most timely and severe manner. Also as long as PC is fully contained in the prostate it will not hurt you. Once it escapes, it grows locally in the prostate bed or surrounding tissues, then it goes to the pelvic lymphnodes, then to all the lymphnodes and then to the bones. It feeds on testosorone and insulin. It expresses itself in rising psa and pathological gleason grading, and you can tell a lot by these two metrics. PSA doubling time is usually a good indicator of how fast the cancer is growing and is genetic to the cancer, which means that it doesn't usually change over time.  Multiple psa readings over time will usually give a good indication of how the cancer is behaving.
Multiple scans, color doppler or MRIS can also tell you a lot about your enemy; is he growing and how fast and is he near any critical areas, such as the margin, seminal vessicles, nerves ect. PSA3 can indicate its agressiveness and PAP can indicate if it has escaped the prostate. Only after you have good indications of its agressiveness, growth rate and location can you develop a strategy to defeat it. Going in blind usually results in failure and losses.
Find the treatment option that best fits you cancer's biology. If it is very slow growing and fully contained and not near any critical areas there is no need to attack; you will only suffer losses and be in the same place you sarted. You can watch it for any signs of increasing strength as in this stage it can't harm you. If it is growing to the point that sometime in the future it may become dangerous then you can deal with it. If you don't know the exact location or the size of your enemy your attack may fail. If you can identify it's location, size and strength then you can remove it choosing an option that least damages your own body and eliminates the threat. If it is strong and moving fast you have to hit it hard with all you have before you are overwhelmed. This may include surgery, RT and HT all in combination. Your best chance is the first chance and piecemealing your resources may not be the best strategy.
Choosing the best artist to perform the treatment. You want your most experienced and best general in the fight, not some newcomer. Skill and experience does matter.
 
I see a lot of patients make decisions based upon just one psa, one gleason reading and one doctor's recommendation; most of the time it's just not enough information to base a life changing decision on. As in most things, including fighting a war, you need information, a strategy based upon that information and a good general to implement it.
JohnT
 
 

Fairwind
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Date Joined Jul 2010
Total Posts : 3625
   Posted 9/22/2010 4:42 PM (GMT -6)   
John forgot to mention that wars are VERY profitable for those supplying the arms and supplies. This leads to competition amongst the service and equipment providers which can blow a smokescreen over the battlefield as they try to promote their products!

You as the Commander will have to see through this smoke and choose the tactics most likely to succeed. You will not win every battle..Learn from your mistakes, don't be afraid to fire generals who have proven themselves incompetent, regroup your forces and move on..

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3780
   Posted 9/22/2010 5:42 PM (GMT -6)   
"I think you should hit a tumor with what you believe is your best shot, early and hard."
 
 -- Andy Grove, 1996
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/22/2010 6:07 PM (GMT -6)   
John,

That was a good summary of a great strategy. It should at least be at the foundation at the start of each man's PC journey.

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.

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 9/22/2010 6:11 PM (GMT -6)   
I have a different metaphor for prostate cancer, although I agree that "PCa is hell" would be an apt saying.

I think of prostate cancer as a Casino. You walk in, chose your game. AS? open surgery? Robotic? Seeds? SRT? ADT? Calculate your odds. Place your bet. Collect the consequences of your bet. Cash out? Let it ride? You decide. Nothing is certain.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 9/22/2010 7:38 PM (GMT -6)   
In a Casino you have predetermined odds as an outcome which the player cannot change. It's more like horse racing or sports booking where a good handicapper using the latest information has a distinct advantage.
With PC there is a definate element of luck, but I believe you can significantly tilt the odds in your favor with better information and skilled doctors.

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


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5644
   Posted 9/22/2010 8:08 PM (GMT -6)   
John T, I have heard of the military strategy somewhere before, by someone somewhere, it was a uro or someone connected, im sure he was a doctor. Like you, he was quite articulate, and it was an interesting read. Im sure it was from a PCA book, was impressed by that line of thinking.
age 67 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of Washington Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci, extensive PNI, That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " Francois de la Rochefoucauld, source courtesy of Tatt2

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3625
   Posted 9/22/2010 8:41 PM (GMT -6)   
F8 said...
"I think you should hit a tumor with what you believe is your best shot, early and hard."

-- Andy Grove, 1996


As everyone knows, I was and am a strong proponent of that strategy. From my personal perspective aggressive treatment was / is the correct path. But for a sizable percentage of PC victims, concentrated in the Gleason 6 ranks, treatment that avoids the risk and reality of nasty side effects associated with surgery and radiation can be the best choice because quality of life matters and the younger you are, the more it matters. Today, advanced screening methods and tests are making less aggressive treatment possible for many people..

Having said that, many men like Andy Grove will nevertheless choose aggressive treatment just to be done with it for once and for all regardless of what risk category they are in..

Everyone is different. Everyone has different priorities. All of us want successful treatment..

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 9/23/2010 6:31 AM (GMT -6)   
I like Dr. Strum's wisdom and your approach John, and your journey is a real eye opener for others to witness how all that went down, it helped confirm alot of my prior suspecions. There are other peoples views on PCa that are all over the place such as:

In PCa the rules are....No Rules!
Got PCa....get rid of it asap!
Take your time it isn't going anywhere soon
Hit it hard and fast
Flip a coin, cause that is about how wild it can be
Do x,y,z, and if that fails, then a,b,c!
(more extreme?)- do nothing, darn the torpedos (some people have chosen this also)

Robert Young's quote- 'you are found in a jungle'= Jungle coined word
Aubrey Pilgrim- ' first rule in PCa....is there are no rules'
Lenny H. - 'you have the sword of Damoceles over your head'
Alfred E. Neuman- 'what me worry' (mad magazine-LOL)
Zufus's terminology- crossing over to the twilight zone and living in limbo land
---------------------------------------------------------------------------------------------
Just pointing out the mix we find in dealing with PCa....as you say John it is a war and somebody is going to win or lose, some fight this with everything they got including some of the intangibles, which is noble even in losing the major war. Your best chances are as you mentioned with atleast an educated and an attempt at measureable known variables being deciphered so as to get the best outcomes. The science is not anywhere near exact, it is currently more of an art and in the abstract (play on words.) The low stats patients have the greatest odds is the good news.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4081
   Posted 9/23/2010 6:32 AM (GMT -6)   

JT...excellent post!  I hope every new patient that comes here reads this and heeds the advice.

Tudpock (Jim)


Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 9/10/10. 6 month PSA 1.4, 1 year PSA at 1.0. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643
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