Molecular targeting of PCa~evolving specialized pathology~examples of markers and therapy options

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zufus
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   Posted 4/15/2011 6:23 AM (GMT -6)   
Some might find this type of information very enlightening as to what can be tested via pathology via master experts like Dr. Bonkhoff, Bostwick and maybe Oppeheimer and hopefully others, or soon to follow others. Here are some examples of currently known things that Dr. Strum & DR. Bonkhoff have collaborated on and published for patients back in 11/2006.  Way ahead of even the current majority of pathologists.
 
Some of these marker/target PCa issues within a specific patient can be tested for just using specialized immunohistory 'stainings' of the biopsy slides. Others require more of genetic findings that can be tested for, but right that is evolving still as to whom can test for what. Examples:

Molecular targeting of prostate cancer-Marker/ Target Marker Profile-herapeutic Options:

 AR-Androgen receptor  hypersinsitive AR  = ADT3  & AR lowering therapiesBLC-2      Positive  = Taxane, Vitamin E, Aspirin  (found useful)

Chromogranin A (CGA) (stainings)    Positive   RP better than RT &  Intermittent AB, Somatostatin-Analoga, Anit-Angiogenetic drugs* (Thalidomide)COX-2        High expression (2+,3+)= Celecoxib

FAS    High expression (2+,3+)=  Orlistat

HER1 and HER2/neu    >10% = ADT3,  Lapatinib MUC-1    postive       MVA-MUC-1-IL2

PAP           Positive  =Provenge

Somatostatin- receptor   positive =  Somatostatin-Analoga

Occult metatases    disseminated tumor cells  =  systemic therapies

-------------------------------------------------------------------------------------------------------

(*other drugs are now known for this too, not listed I am adding a new one XL-184 perhaps and others are out there)------------------------------------------------------------------

This didn't copy directly the way it was on paper. So the first item is the marker/target, second item to the right is the marker profile (high expression, found positive, etc.), the third item to the right is the therapy options that are currently known to work on patients (generalized).

The AR receptor in our PCa (androgen receptor) is big deal as to how hypersensitive it is, because as the AR receptor influences occur(changes at the molecular level), this can influence how fast you become refractive in the disease...which accounts for how fast one may fail on casodex and other therapies. This helps us to understand some (I am just a layperson, duh!), why some patients can go on certain drugs much longer than others..especially for this AR testable issue. This can be done just by using specialized pathology staining methods for this particular analysis.

Another one above is Chromogranin A (CGA) another staining testing available and the findings are that those found with this can do 'intermittent AB' (intermittent androgen blockage)...thus intermittent casodex or Lupron type drugs. Weirder yet, the findings suggest RP is better than RT (according to Dr. Strum/Dr. Bonkhoff as collaboraters)..on this marker testings if found 'positive'.

Another above is a marker called PAP, not to be confused with the oncology PAP old testing analysis (which is useful still in findings for possible mets). Those with positive findings in this analysis are better suited for Provenge, which is a new vaccine therapy.

This information is not widely known by even pathologists, at this time. As with anything in PCa, it takes alot of time to evolve into mainstream and to get others on the same page. This is going to get bigger and bigger, the Paact Newsletter has current article on Molecular Pathology by Dr. Chinn (fyi). See it within their website on line newsletters (tab) www.paactusa.org  (newsletters), similar discussion.

Novel approaches for AR issues that are evolving right now, test in vitro and found non cytotoxic, but unknown on molecular signaling effects are:  rapamycin (mTor inhibitor), celastrol and gedunin.  You might want to remember those names, they may become more significant in assisting the Androgen receptor issues. (published in Dr. Rubin's  thing in Modern Pathology 2008 issue, page 8).  cool   

 

 

 

Post Edited (zufus) : 4/15/2011 5:31:00 AM (GMT-6)


Purgatory
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Total Posts : 25393
   Posted 4/15/2011 8:42 AM (GMT -6)   
Some powerful info there, zufus, wish you had a way to translate it down a notch, to make it easier to understand
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 margin
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, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

zufus
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   Posted 4/15/2011 11:20 AM (GMT -6)   
It is not simple stuff and I am blown away on alot of it, but let me add some, maybe easier info on the AR (androgen receptor) because we all have them on our PCa cells, how they appear when stained in pathology makes a difference in HT control.

AR mediates cell proliferation (further growth I would translate) and plays a pivotal role in tumor growth and progression of PCa. The prognostic and predictive significance of one's AR status in within the tissue and can be tested via staining methods. Example:
Staining intensity (high/low)
AR distribution (homogeneity vs. heterogeneity)
Proliferation activity (determined by marker M1B-1)

Recent studies found high level AR expression (3+) was found to correlate with clinical stage: lymph node status, extracapsular extension, seminal vesicle invasion and Gleason score. (I have no idea how they measure to get the 3+ but it has to do with homogeneity of the cells seen under scope)

AR cells seen under the microscope that are homogeneous (more together and not widely dispersed predicts good response to HT therapy like casodex) if they are seen more widely dispersed it is harder to control and more towards earlier resistance to therapy (huge clue for onoc-docs...guys like Dr. Strum using this kind of information and have done so for a few years). This kind of information all patients could find useful from easy Pathology staining...this will become a more standardized testing with more education in PCa is my assessment. It can be done right now by Bostwick, Oppenheimer, UroCor, Bonkhoff and some others. This is simply staining, not a gene analysis thing. Instead the docs just prescribe casodex, Lupron etc., willy nilly and just see how long it works...usually works in almost everyone...how long is a huge variable and another would be what else would workor work as well or better (without looking a the profits side of protocols)?????
Dx-2002 total urinary blockage from PCa emergency room, bPsa 46.6,
12/12 biopsies all 80-95% vol., Gleasons found 7,8,9's, scans appeared clear, ADT3 prior to Neutron & Photon radiations, DES since 2004-5.

John T
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   Posted 4/15/2011 11:42 AM (GMT -6)   
Zufus,
Do you know if these can be done with bopsy slides? I know there are many path tests for staging cancers that need quite a bit of tissue in order to perform, and biopsy samples can't provide enough tissue. I'm all for any markers that will improvement outcome.
When my wife had breast cancer she had two courses of Chemo before surgery. The removed tumor was sent to a small private lab in Huntington Beach where they ran tests on 24 different Chemo drugs and monitored tumor reaction. The two Chemo drugs she took were on the low end of effectiveness and one rarely used drug showed remarkable effectiveness and she went through a 3rd course using this drug. This kind of testing needs a large amount of tumor tissue, much more than a biopsy could provide.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 4/15/2011 11:49 AM (GMT -6)   
Yeah from what I have heard and so far comprehend this can be done with your existing pathology slides, but only a few wise guy patho-docs can do this. But it is worth considering, especially on high risk scenarios this info could help a wise onco-doc as to drug therapies, Dr. Strum has used such info before in his strategies I have heard. Since you are a cutting edge wise PCa patient (combidex and Scholz), you gather the importance already, maybe contact Bostwick, UroCor or Oppenheimer or Bonkhoff and ask about stainings for AR receptor testings. I think they all do this, how much???? Probably  $300-500 is my guess just for the one test, insurance might cover it.

Now depending upon where one is in their PCa journey, the AR receptors can change and become even more prolific over time, so then maybe rebiopsied tissue would be reviewed to see how the AR expression would be up to date.
-----------------------------------------------------------------------------------
 
Someone posted at yananow about DNA testings, but this is for your normal body cells DNA and probably doesn't tell much about your PCa...is my guess...but it is on sale (LOL) right now for  $99 vs. $400-500 normal charge.  I am saying look into what are they actually selling you??????????  http://www.23andme.com/user/signup/    Might not have a dam thing about PCa within this testing thing....caveat emptor!

Post Edited (zufus) : 4/15/2011 10:58:53 AM (GMT-6)


Purgatory
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Date Joined Oct 2008
Total Posts : 25393
   Posted 4/15/2011 12:04 PM (GMT -6)   
thanks, that helped
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 margin
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, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 4/15/2011 12:11 PM (GMT -6)   
Purg- I am one whom prefers very lay persons words too, most docs do not write anything in that form (lol). Have you tried reading medical Abstracts...those are a blast...always such definitive findings (LOL)...every layperson knows what the summary adds up to. (LOL) Let alone the terminology in those.

If I can boil it down and not lose the message or the messenger will try to do so. Naturally you hate posting anything found wrong or controversial, but it can happen...we try the best we can as layees.  rolleyes

Purgatory
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Date Joined Oct 2008
Total Posts : 25393
   Posted 4/15/2011 12:17 PM (GMT -6)   
zufus, my experience is with 30 years of reading lengthy and complex legal and business agreements, where little words like "or" or "if" or "and" can make or break a deal. When I read the medical abstracts you are talking about, it might as well be written in Chinese. Sometimes my wife/nurse can interpret, sometimes not. At least my beloved uro will take the time to translate things at my level until he is sure I understand. Your info is great, though.
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 margin
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, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

Fairwind
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   Posted 4/15/2011 12:19 PM (GMT -6)   
But in the final analysis, does all this study, work and research appreciably extend PC victims lives?? What I'm trying to say is does any of this make any real difference?? Or does it just make for interesting reading?

Ten years ago, 32,000 men a year died from PC. That number remains the same today...

If Bonkhoff, Bostwick, Strum and maybe Oppeheimer were making startling discoveries, why doesn't the rest of the industry follow their lead?? Yes, their work is interesting but is it important? What about the 32,000 who died? Are they all just ignorant clods treated by equally ignorant doctors who could have been saved had they only made a better treatment choice, made the right phone call??

Sorry, but I take exception to those who say unless Bonkhoff or Bostwick read your slides you are doomed to receiving less than effective treatment..4200 new cases of PC are diagnosed every week in the U.S. Imagine what would happen if everybody sent their slides to Bonkhoff? That's quite a work load..
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

zufus
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Date Joined Dec 2008
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   Posted 4/15/2011 12:29 PM (GMT -6)   
Fairwind- welcome to PCa...some are pioneers...now with your thinking John T would have not found his PCa and/or where it was located...because all our experts were wrong over here(did you notice??) and he went to many places. Your goal if you fail cure...is maybe to live as long as possible. Clue: Howard Hansen and some others lived 17 yrs. with various protocols....likely if they went conservative protocols...could have been maybe 5-10 yrs.???? Dr. Fred Lee....how dumb of him to go outside normal treatments...and be alive at year 29+ with uncureable PCa.

We are looking for answers and optimistically trying...myself I am willing to go way outside the box for anything that appears to work or extend life or quality of life. Medical system in general are like the titanic....until someone fixes the rudder...the course remains as stupid as ever to the icebergs. Notice cancer has been on the burner for 40-50 yrs. of research....finally we are seeing some results and even cures. Stay tuned...the next 10 years will make the last 40 look ridiculous.
Dx-2002 total urinary blockage from PCa emergency room, bPsa 46.6,
12/12 biopsies all 80-95% vol., Gleasons found 7,8,9's, scans appeared clear, ADT3 prior to Neutron & Photon radiations, DES since 2004-5.

ralfinaz
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   Posted 4/15/2011 12:57 PM (GMT -6)   
Fairwind said...
But in the final analysis, does all this study, work and research appreciably extend PC victims lives?? What I'm trying to say is does any of this make any real difference?? Or does it just make for interesting reading?

Ten years ago, 32,000 men a year died from PC. That number remains the same today...


Not quite Fairwind. There has been a 40% reduction in PCa mortality (never fully explained) since the mid 90s. If what you say is true:

2,000.000 men diagnosed in the last ten years.

320,000 men dead from PCa

So why are we constantly told that "only" 3% of men die of PCa?
Why are all these over diagnosed and over treated men dying from a disease that is indolent and never progress?

Lately we hear:

PSA should not be used by men 75 or older.

These last days we heard that 70 years old should not get tested as often while men in their 50s should be tested more, but that testing could be harmful and treatments do not show a benefit.

The debate about the benefit or harm of testing has resulted in less men getting the test. In time more men will die more often...

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!
www.pcainaz.org/phpBB304

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/15/2011 1:02 PM (GMT -6)   
Ralph, excellent post, you read my mind and heart on that one. I agree 100%.
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 margin
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, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

Fairwind
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Date Joined Jul 2010
Total Posts : 3892
   Posted 4/15/2011 1:18 PM (GMT -6)   
"the next 10 years will make the last 40 look ridiculous."

Only if you have a lot of time and money...They rest of us will have to put up with Kaiser and United health Care...

It's impossible to say whether a journeyman oncologist could have eventually diagnosed JohnT's case..His is very unusual, he realized that at the beginning and took extraordinary steps to finally achieve an accurate diagnosis. But saying it would never have happened otherwise is an assumption..Nobody knows that...But in 90% of the PC , the diagnosis and treatment is pretty straight-forward as are the eventual outcomes. The 10% whose cancer does not follow the rules are indeed well advised to seek out specialists who treat these cases using tools and methods outside the mainstream with some degree of success. But this does not mean their treatments are successful for everybody, and writing books about the successful cases while ignoring the cases that were not so successful is poor medicine. But it is good business, And they are all businessmen as well as doctors.. Successful doctors are all experts at telling us what we want to hear...We treat them like Gods but they are men who would all be unemployed if a true cure for cancer were ever found.

zufus
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   Posted 4/15/2011 2:57 PM (GMT -6)   
No John's case in missed biopsies is not that unusual happens to many later then found PCa patients...Dr. Strum was touting Combidex scan 8+ years ago when nobody else heard of it (pioneer...Tiger Blood...Winning-LOL). John should tell his own story... I get your point and understand it and not saying you are wrong, but not gonna stop looking at everything.

Other Pioneer events in PCa: Cryo therapy invention (still useful) many laughed surely, HIFU many might laugh (still useful), DaVinci robot in USA 2002 (less than 10 years ago Domo Arigato (lol)...and now is the MainStream method for PCa removal it appears). Now cyberknife radiations and other radiation breakthroughs.

Pioneering(history) drugs: 1940's DES, 1980's casodex into the USA and Lupron et al LHRH, x. Ketoconazole( around 1982) used in USA (founded in Canada by pioneer idiot whom tried it on PCa..LOL-1970's), Degarelix 2009 or so, Abiraterone 2011 trials, MDV3100 2011 trials, Provenge 2011 (first PCa vaccine in the USA), Jevtana 2011 trials. Other stuff: zometa, fosamax, flomax, avodart, leukine, estradiol patches, taxanes and plenty more. Ten years ago Ralph can tell you exactly what patients choices were then and how much less information was known about...I have seen the information pool go hugely expanded since 2002 and more options and better protocols for patients and wiser patients and doctors.

Coming soon it appears: ARN-509 (like MDV3100 'super casodex), Tasquinimod (Europe), XL-184, (for bones)=Denosumab and toremifene. Plenty others I missed right now.

Now how many uro-docs are going to be right on top of the newest drugs, let alone the oldest ones? Pioneers.....may be your only hope is the message so just cause it isn't all mainstream today, doesn't mean jack.

Post Edited (zufus) : 4/15/2011 2:01:28 PM (GMT-6)


John T
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   Posted 4/15/2011 4:50 PM (GMT -6)   
Ralph,
The 3 -4% number is number of deaths from PC compared to deaths from all causes for men. The death rate for those Dxed with PC is about 12%.
(2.2million Dxed and 270k deaths in a 10 year period. Which means that 88% of all PC patients die from something else.
Fairwind,
A journyman would never had discovered my PC. I went to 6 urologists, all specializing in PC, over a 10 year period. Doctors from UCLA, UCSF and UC Irvine all confirmed a DX of BPH. Even when I was finally DXed with a <5% G6, that DX was completely wrong and the surgical recommendation would have ended in disaster in my case. When I saw Scholz and Bahn for a 2nd opinion, they knew exactly where to look. There are only two places where a tumor can create PSA in the quantity I had, the transition zone or the lymphnodes, and there was only one thing that could have created the pattern of my 10 year psa history, PC! What is completely obvious to some doctors didn't even registure with 6 others. My case is unusual, but I would have never known if I had not gotten a 2nd opinion and more testing. I wonder how many cases of failed treatment are due to improper staging, and how many others just got lucky in their treatments. We know from surgical results that about 25% of PC is under staged and about 20% is over staged. We also know that 25% -30% fail primary treatment. There is something wrong with a picture that has a 45% margin of error going into a life changing procedure. I'm a true believer in getting as much information as you can get BEFORE making a treatment decision. Because of the additional information I received I knew that surgery would have resulted in loss of both nerves as well as a high probability of incontinence and positive margin. I also knew that I had only a 4% chance of the cancer escaping, eliminating full body radiation and a long course of HT. Information about your PC status is critical and getting a doctor that knows how to obtain and use that information is even more critical. In 10 years no one ever mentioned color doppler, Combidex, PAP and PCA3 as additional tests I could have in order to get a better handle on what was occurring. Every one of these was an important piece of data that painted a fairly accurrate picture of my status that I didn't have before. If I had known more about tumor markers then, I would have requested them. I think that spending a few thousand dollars more up front to gain a more accurate understanding of your staging is well worth it. If primary treatments had a 95% rate of success I would agree with your point of view, but they are currently not even close. We could take all the money spent on bone and CT scans for low risk patients, and put them into better testing that provides valuable information, and save a few grand in the process. This could also reduce unnecessary treatments or provide alternative primary treatments with a greater success ratio.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/15/2011 4:55 PM (GMT -6)   
Then the 12% death rate from PC should be the one advertised here, not the single digit number. You are talking about one out eight men dying from PC if dx. That's a pretty high rate. Though with my former rare cancers, the death rate was a full 50% from the few cases they had to study.
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 margin
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, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

ralfinaz
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Date Joined Jan 2011
Total Posts : 735
   Posted 4/16/2011 8:57 AM (GMT -6)   
John T,
When mentioning PCa deaths, it seems that they always include the "only" 3% die of the disease. Unintentionally, Fairwind said that PCa mortality has not changed in the last 10 years and we know that is not correct (at least not here in the USA). There is a tendency to ignore the significance of PCa before the PSA era. That natural history of untreated PCa has been ignored and PCa mortality can be very high when the disease develops undetected. As we always hear about how PCa is an old man disease we need to know the following:
Deaths from PCa in the USA by age groups:

35 to 44: 24

44 to 55: 395

55 to 64: 2154

Total: 2573 men

Seven men die every day before the age of retirement and that is way too many in my view.
Those men represent 9% of those that died here of PCa in 2005 under the age
of 64.

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!
www.pcainaz.org/phpBB304

John T
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Date Joined Nov 2008
Total Posts : 4268
   Posted 4/16/2011 9:21 AM (GMT -6)   
Ralph,
Sorry if I gave the impression that I was minimizing PC deaths. I was only putting it into perspective. When we have a disease we tend to focus on that disease, and that is only natural. Some men on being Dxed are naturally fearful and medical and government policy makers tend to focus on numbers, not individuals. 88% of those of us Dxed will survive, and the majority of the others will have 10-15 years.
Our lifetime risk of dieing from PC is 3-4%. I was in an envornment that the 6 month death rate for my unit was 12% and serously injured was 120%. I'll take PC anyday. Everything has to be put into the perspective you are dealing with.
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

ralfinaz
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Date Joined Jan 2011
Total Posts : 735
   Posted 4/16/2011 9:53 AM (GMT -6)   
John T,
You did not give the impression of minimizing PCa deaths, More influential "experts" do. And they do it often and without regard of what the impact of this disease has in our society. The result has been that less men are getting tested and we know where that leads to...Yes, for now let's tell those seven men who are dying every day before retirement not to worry, help is coming...

RalphV

Post Edited (ralfinaz) : 4/17/2011 12:29:51 PM (GMT-6)

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