Another article on delaying PC treatments?

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Purgatory
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Date Joined Oct 2008
Total Posts : 25380
   Posted 4/26/2011 9:26 PM (GMT -6)   
 
I am not endorsing the sentiments of this article, just passing it on for thoughts.  Seems like the same old hash to me

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 4/27/2011 12:30 AM (GMT -6)   
Good article, I,ve been wondering especially after so many people getting treatment, post primary, if maybe thats the bulk of over treatment right there. The SRT rate really bothers me, as does HT, being done so early because I have serious concerns about, not the need so much, as to the timing of the need. I am not bashing the medical community here and if I am, I am bashing every major institution in our civilization from churches to banks to auto shops to ad nauseum. Because, IMO, the civilization we live in today is all about the money in pretty much every arena of our lives. It drives everything. I remember a time when this was not the case and it was not that long ago.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

Steve n Dallas
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Date Joined Mar 2008
Total Posts : 4829
   Posted 4/27/2011 3:25 AM (GMT -6)   
"Each year, 157 out of 100,000 men are diagnosed with prostate cancer in the U.S. Of these, 25 - or about 1 in 6 - will die from the disease, according to the National Cancer Institute. The average age of diagnosis is 67 years and the average age of death from prostate cancer is 80."
 
So many questions still need to be answered... Like who falls into the 25 out of 100,000 will die catagory.
 
My diagnosis was at age 53. The possibility that I might die in 13 years is why I had surgery.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/27/2011 4:55 AM (GMT -6)   
logo- almost sounded like the words I would say...(LOL)...this is why independent auto shops can do better than dealerships in some cases....(LOL)

reachout
Veteran Member


Date Joined May 2009
Total Posts : 725
   Posted 4/27/2011 6:11 AM (GMT -6)   
The article says:

"The underlying problem is that we're over-treating prostate cancer because we don't have a perfect method of identifying those people that will never be harmed by their cancer," said Dr. H. Ballentine Carter, professor of urology and oncology at Johns Hopkins University School of Medicine in Baltimore, Maryland.

OK, I get that. Then it says:

The researchers followed more than 650 men, averaging 66 years old, who had been diagnosed with very low-risk prostate cancer. They followed the men for as long as 15 years. At the end of the study, about 400 of the participants had had no treatment for their cancers, and about 250 did.

Wait a minute. If we can't identify those who will never be harmed by the cancer, how can we conclude anything from a study where we selected those with low risk cancers?

John T
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Date Joined Nov 2008
Total Posts : 4223
   Posted 4/27/2011 9:58 AM (GMT -6)   
Reachout,
I don't understand your question. We can select from gleason, DRE, psa and tumor volume those who will definately be harmed by PC. These are always recommended for treatment. There is a group of patients with low risk stats in which some pc will continue to grow and some that will remain stable or grow slow slowly to never cause harm. Currently the only way to identify the harmless from the not harmless in this low risk group is to watch it over time. By watching it for a number of years we can conclude that 30% of these patients have PC that is growing faster, and therefore should be treated.
Initially we can divide patients into two groups according to their staging. One group needs treatment and the other group with low risk stats only 30% will ever need treatment; but we have no way to identify those 30% except by monitoring over time.
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.

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 225
   Posted 4/27/2011 11:07 AM (GMT -6)   
John T,

The challenge for us individual is that we were faced with choosing between two evils: immediate treatment (radiation or surgery) and face the risks of side effects, or AS and a chance that cancer might escape and be too late (even though statistics indicated otherwise but we did not trust statistical uncertainty). Most of us chose the devil we knew: treatment.

Another thought:

If health care and insurance policies dictate AS for low risk cases or we pay out of pocket, I am sure there will be more AS. However, in the US, that is a big if. :)

Cheers.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4149
   Posted 4/27/2011 11:25 AM (GMT -6)   
Newporter, you raise an important issue in your last sentence.  My prediction is that this WILL be the case at some point in time.  What many are saying now is that doctors and patients do not have the discipline to use AS even if it is likely the most appropriate treatment.  I'm not saying that is right or wrong for purposes of this discussion, I'm just saying this is a premise that is gaining traction.  With more traction and with the increasing pressure to reduce health care costs in the USA, I can see a time that medicare and the insurance companies will have some very specific guidelines as to when they will pay for PCa treatment.  Just as insurance won't pay for a leg amputation for an early stage squamous cell skin cancer on an ankle, the time may come when it won't pay for a prostate amputation/zapping for an early stage prostate cancer.
 
Time will tell but this will be interesting to watch over the next few years.
 
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 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3740
   Posted 4/27/2011 12:13 PM (GMT -6)   
"Because, IMO, the civilization we live in today is all about the money in pretty much every arena of our lives. It drives everything. I remember a time when this was not the case and it was not that long ago." (Logo)

Right on, Brother, right on....The only drugs or treatments they are interested in are the ones they can get a PATENT on...
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

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/27/2011 1:47 PM (GMT -6)   
I am glad this little article generated such good dialoge.
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

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 4/27/2011 4:09 PM (GMT -6)   
Right on wit da right on!! Thank you for it purgatory.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/27/2011 7:32 PM (GMT -6)   
as the article states, "for older men"...
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX
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