PCa more deadly than previously thought

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kbota
Regular Member


Date Joined Aug 2010
Total Posts : 487
   Posted 6/16/2011 7:34 AM (GMT -6)   
Information to be aware of, but not what we want to hear


www.thirdage.com/news/prostate-cancer-more-deadly-than-previously-thought_06-16-2011
Age 57 at Dx
5/09 PSA 2.26
6/10 PSA 3.07 FPSA 18% DRE +
Biopsy, 7 of 18+, >60%, 4+5=9
7/21/2010 - RRP
Nodes & Ves neg
tumor contained, still 4+5=9
pni ext.
9/3/10 - 0.04 99% continent
10/14/10, 0.04, and lupron #1, 99.9% continent
Total ED, implant on 12/15/10
2/11 - 0.04, HT #2
6/11 - 0. , HT #3

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3739
   Posted 6/16/2011 7:45 AM (GMT -6)   
Great. Another study....

And what about that quote "Men who regularly drink coffee - caffeinated or decaf - are significantly less likely to develop a deadly form of prostate cancer, according to a new study."
I've been drinking grass clippings green tea because that supposedly reduced the chances of developing PCa.

I can only slurp down 400 ml of liquid in the morning or I'll have to pee by 11:00 AM. I can't have a full cup of each. Should I trade off every day? Every week? Should I mix them 50-50. Clearly, a study is needed. smilewinkgrin
Jeff

Post Edited (Worried Guy) : 6/16/2011 6:48:42 AM (GMT-6)


kbota
Regular Member


Date Joined Aug 2010
Total Posts : 487
   Posted 6/16/2011 7:51 AM (GMT -6)   
Uhm,.....is it possible to overdose on green tea? What about pom juice?

The day before my PCa takes me out, I'll beat the devil to it with a mega dose of mega-tea.

Now,...."study that!!!

<snicker>
Age 57 at Dx
5/09 PSA 2.26
6/10 PSA 3.07 FPSA 18% DRE +
Biopsy, 7 of 18+, >60%, 4+5=9
7/21/2010 - RRP
Nodes & Ves neg
tumor contained, still 4+5=9
pni ext.
9/3/10 - 0.04 99% continent
10/14/10, 0.04, and lupron #1, 99.9% continent
Total ED, implant on 12/15/10
2/11 - 0.04, HT #2
6/11 - 0. , HT #3

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 6/16/2011 7:53 AM (GMT -6)   
Thanks kbota,
However it may just be early but these two paragraphs don't quite add up to me.

Experts found that of the 20,181 men with the disease who died between 1997 and 2007, 49 percent of the deaths were attributed to prostate cancer. Some 12 percent of deaths were due to other cancers, 17 percent were due to heart disease, eight percent were due to pneumonia and 13 percent were due to other causes.

and

Prostate cancer is the second most common cancer in men, with 37,000 new cases popping up annually in Britain and more than 10,000 men dying from it every year.

The way I read it is only 20,181 men died in a 10 year stretch but 10k men die from it each year ???????? Dropped a "0" and it should have been 200k men in the first paragraph?
Dave in Durango CO

07-06 PSA 2.5
01-08 PSA 5.5 (Dr never told me)
09-09 PSA 6.5 (age 55)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5
03-01-10 Age 55 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson
03-16-10 Path' G-8 (4+4+5) Bilateral involving 21% of left lobe, 3% of right lobe, SVI, Focal positive margin, pT3b NO MX

All PSA as of 5-03-11 <0.04

kbota
Regular Member


Date Joined Aug 2010
Total Posts : 487
   Posted 6/16/2011 8:02 AM (GMT -6)   
Must have been a slow news day. He he
Age 57 at Dx
5/09 PSA 2.26
6/10 PSA 3.07 FPSA 18% DRE +
Biopsy, 7 of 18+, >60%, 4+5=9
7/21/2010 - RRP
Nodes & Ves neg
tumor contained, still 4+5=9
pni ext.
9/3/10 - 0.04 99% continent
10/14/10, 0.04, and lupron #1, 99.9% continent
Total ED, implant on 12/15/10
2/11 - 0.04, HT #2
6/11 - 0. , HT #3

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3880
   Posted 6/16/2011 8:07 AM (GMT -6)   
No question that advanced cases have greater mortality as it is often not curable, but can be treatable for the long term. Big advantage over most every other type of cancer.

Alarming that in Britain each year 37,000 dx and 10,000 deaths, or a 27% result. In the US each year 186,320 dx and 28,000 deaths, or a 15% result. Hopefully the superior US results will continue to be as good in the future even as we evolve to more of a British style medical system.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy December 6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.
PSA <.1 on 4-7-2011
Second Eligard shot on 4-7-2011

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 6/16/2011 10:11 AM (GMT -6)   
I think this shows the difference in health care systems rather than any thing new about PC. In the US about 21% of those DXed will eventually die vs 49% in the UK. They are either DXeing too late or their treatments are not as effective as ours.
JohnT
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.

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 6/16/2011 10:43 AM (GMT -6)   
One possible explanation (though I don't know this for a fact) is less screening.   If you don't routlinely screen, many people will live their lives without ever knowing they have prostate cancer -- but of those who are diagnosed, a much higher percentage will have advanced disease and die.   If you screen routlinely, you catch a lot of earlier stage cancers -- so more diagnoses, but lower percentage die. 

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 6/16/2011 1:47 PM (GMT -6)   
The press got the numbers wrong, of the 50,000 men in the study about 20,000 died of all causes and of this 9,900 or about 49% died of PC.
The death rate from PC is 9,900 of 50,000, not 20,000, or a more reasonable 20%. The headline was totally wrong and misleading.
JohnT
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.

kbota
Regular Member


Date Joined Aug 2010
Total Posts : 487
   Posted 6/16/2011 3:33 PM (GMT -6)   
Thanks for the correction JohnT.
Age 57 at Dx
5/09 PSA 2.26
6/10 PSA 3.07 FPSA 18% DRE +
Biopsy, 7 of 18+, >60%, 4+5=9
7/21/2010 - RRP
Nodes & Ves neg
tumor contained, still 4+5=9
pni ext.
9/3/10 - 0.04 99% continent
10/14/10, 0.04, and lupron #1, 99.9% continent
Total ED, implant on 12/15/10
2/11 - 0.04, HT #2
6/11 - 0. , HT #3

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 6/16/2011 4:17 PM (GMT -6)   
The mortality of prostate cancer in that study was 49%

From another source, same study:

"Researchers from King's College London looked at 50, 066 men with prostate cancer in the Thames Cancer Registry between 1997 and 2007.
Of this group, 20,181 died during the 10 years. And, of these deaths, 49 per cent were recorded as being due to the cancer itself. According to the study twelve per cent of deaths were caused by other cancers, 17 per cent from heart disease, 8 per cent were from pneumonia and 13 per cent were due to other causes."

The problem in the UK as in other countries in the EU, is that the use of the PSA test is very low and men are diagnosed with more advanced stages of the disease and die more often of the disease. This is during the PSA era, but since the disease is not diagnosed early the disease can progress silently. This is precisely the point I was making in another thread. Given enough time prostate cancer can progress and kill men...it can be more lethal than advertised...

Source: http://tinyurl.com/4ybmrtw

RalphV
Phoenix, Arizona
Disclaimer: I am a long-term prostate cancer survivor. My comments are not intended as medical advice. The intent is to provide information. Seek direct recommendations from your medical team.
Surviving prostate cancer since 1992 at age 58. RP; Orchiectomy; GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall; Stage T4; Last PSA September, 2010: <0.1 ng/m

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/16/2011 4:55 PM (GMT -6)   
Ralph,

You said:

This is precisely the point I was making in another thread. Given enough time prostate cancer can progress and kill men...it can be more lethal than advertised...

I have always believed this. I don't think people should always be told that an "entry level" G6 is harmless and unlikely that it's not likely to progress. While this may be true often, certainly not true all the time. That's why I like my new oncologist persepctive, of not treating just a number, but treating the patient's particular case.

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 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, 6/11 5.8
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

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/16/2011 5:26 PM (GMT -6)   
Purgatory said...
 I don't think people should always be told that an "entry level" G6 is harmless....
 
Are men always told that G6 is harmless?   WOW, that's dangerous!!  Run as fast as you can away from anyone who says that...although I've never seen anyone, anywhere say that.   In other words, anyone who would say this probably doesn't know **** about PC.
 
There are many G6's which may be harmless, but it depends on other important factors such as a small number of biopsy cores positive, low percentage of cancer in the positive cores, and other stringent criteria.  This is how G6 men eligible and not eligible for AS are weeded out.
 
 
 
 
A much more interesting statistic with a revealing perspective, I think, comes from the US where the rate of death from heart disease is 20X the rate of prostate cancer death.  (LINK)  The good news is that one can reduce their probability of death from heart disease, and reduce their probability from prostate cancer, through exercise (LINK)...a two-for-one winner!
 
 

Post Edited (Casey59) : 6/16/2011 4:33:00 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/16/2011 5:55 PM (GMT -6)   
Casey,

Since you want to be technical, change my word from "always" to "often", and I meant it in the context of advice given right here on HW. I have never heard any of my doctors downplay a G6.

david
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, 6/11 5.8
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

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 6/16/2011 7:01 PM (GMT -6)   
Ralph,
This 49% is misleading: There is no way that 49% of men die of PC.

20,181 deaths of which 49% were PC = 9888 deaths due to PC.
9888/ 50,066 that were Dxed = 19.5% death rate, which is realistic.

The way this is stated everyone believes 49% of those Dxed died of PC, when it is in fact 19.7%
JohnT
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 6/16/2011 7:04 PM (GMT -6)   
Sure makes a big difference in that number, John. The one way is almost 1 out of 5 men dying, as opposed to almost 1 out of 2. The higher number of those dying doesn't seem to fit into the relationship between men being diagnosed, as to those dying, as you stated.
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, 6/11 5.8
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

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 6/16/2011 8:02 PM (GMT -6)   
John T said...
The press got the numbers wrong, of the 50,000 men in the study about 20,000 died of all causes and of this 9,900 or about 49% died of PC.
The death rate from PC is 9,900 of 50,000, not 20,000, or a more reasonable 20%. The headline was totally wrong and misleading.
JohnT


I guess then John, that means that so far as prostate cancer is concerned, there is no advantage to the more expensive private health system. devil
Bill

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/16/2011 8:12 PM (GMT -6)   
BillyMac said...
John T said...
The press got the numbers wrong, of the 50,000 men in the study about 20,000 died of all causes and of this 9,900 or about 49% died of PC.
The death rate from PC is 9,900 of 50,000, not 20,000, or a more reasonable 20%. The headline was totally wrong and misleading.
JohnT


I guess then John, that means that so far as prostate cancer is concerned, there is no advantage to the more expensive private health system. devil
Bill
 
 
Quite the contrary...
 
This is still a significantly higher percentage of patients diagnosed with and dying of prostate cancer in the UK today than in the USA today … but it is nowhere near the 49% mortality previously reported.
 
Those that reported 49% PC mortality are busy wiping the egg off their face. 

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 6/16/2011 9:31 PM (GMT -6)   
If we look at numbers that we can trust.
There are 27,000 PC deaths each year and 230,000 new PC cases. This equates to 11.7% of deaths to all men Dxed. This ratio will decrease as the population gets older and more men are Dxed with PC and also because of increased screening the number of men Dxed will increase. The number of deaths will decrease slighly or remain constant. (This has been the 5 year trend). Also new treatments will reduce the death rate; so I can see it going to below 10%.
Billy Mac, using these numbers the US would have 50% the death rate of the UK. I personnally think the private system delivers superior results, but I don't think the added benefits justify the total costs of our system compared to others.
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.

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 6/16/2011 10:34 PM (GMT -6)   
JohnT,
In round numbers the study selected 50,000 men from a registry. Of those 20,000 died.
A further breakdown noted that 49% of the dead died of PCa and 51% of other causes.
The cohort selected were the 20,000 men that died and not the other 30,000.
The other 30,000 still living with prostate cancer do not enter in the calculation. If they did, then why not include the 370,000 diagnosed with PCa between 1997 and 2007? Then the mortality would be 2.7%.

The authors of the study made the following comments:
Professor Henrik Moller, study author from King's College London and head of analysis and research at the NCIN, said: "Our data show that a high proportion of men with prostate cancer die from the cancer."

Simon Chowdhury, study author and consultant oncologist at Guy's and St Thomas' NHS Foundation Trust, said: "This confirms that prostate cancer is a major cause of morbidity and mortality for a large number of men and the importance of ongoing and future research into this area."

Professor Malcolm Mason, a UK prostate cancer expert, said: "This is an extremely important study, which highlights that prostate cancer is not a trivial disease for large numbers of men in the UK who suffer from it. It is important for specialists, and for healthcare planners to realise that, particularly for men with advanced prostate cancer, their disease poses a significant threat to their health and their life, and the old notion that 'most men die with it, not of it' is simply not true for men with advanced disease.
"However, since 1997, many more men are being diagnosed at a much earlier stage, and for these men the outlook is excellent, even without any treatment. This is why the notion of the 'tiger and the *****cat' is a helpful way of understanding the contradictions. Many of the men in this study had the 'tiger' form of the disease, and a significant number died of it. In Europe today, most men who are diagnosed have the '*****cat' form, and will have an excellent outlook. There have also been a number of important advances in treatment over this timeframe, so it is possible that not all of the men in this study who died of prostate cancer, would die of it today with modern treatment."

Unfortunately in the UK they are still not using PSA as it is considered a non-specific cancer marker and men continue to be diagnosed with more advanced disease and die more often. In spite of them above saying that now men are diagnosed with earlier stages, if that were the case, why the PCa mortality rate in the UK in 1997 was 32.6/100K and in 2007 was 33.9%. In the absence of some method of early detection and effectively timed treatment, PCa can have a high death rate.

RalphV
Phoenix, Arizona
Disclaimer: I am a long-term prostate cancer survivor. My comments are not intended as medical advice. The intent is to provide information. Seek direct recommendations from your medical team.
Surviving prostate cancer since 1992 at age 58. RP; Orchiectomy; GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall; Stage T4; Last PSA September, 2010: <0.1 ng/m

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 6/16/2011 11:49 PM (GMT -6)   
Ralph,
If what you are saying is if PC is detected by symptoms and not any type of screening it means that the PC is high grade and is or close to matatistis at DX. Given these parameters I could see that a high % of men in these cases would eventually die of PC. The fault of this study is that we have to wait for all the men to die to get an accurate number. The men with the most serious cancers are certaintly going to die first and radically skew the numbers. There may be zero deaths in the 30,000 that are still living. To assume that 50% of all men DXed with pc are going to die from it just doen't meet the smell test. I think the 11% number is pretty accurate and reflects what is happening in the US today. No doubt the UKs numbers are higher, but not anywhere close to 50%.
Even with high risk cancer we know that most treatments have a 50-65% cure rate with conventional treatments and many will live for 10-15 years after primary failure. There is just no way I can back into a 49% death rate unless it starts with patients that are already systemic at DX. The numbers just don't jive with everything we know.
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.

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2217
   Posted 6/17/2011 12:09 AM (GMT -6)   
As a Brit I think that the problem in the UK may be that there is far less screening than in the US, thus the PCa gets detected by guys going to the doc when they have symptoms, rather than becasue they want a routine PSA test. By the time you can notice symptoms the PCa is likely to be more advanced, and thus harder to treat effectively.

(Yes there is a National Health Service in the UK, but it may be the case that the emphasis has been far too much about trying to cure sick people rather than prevent them getting ill in the first place. The UK is not the only country where there is a lack of prevention.)

Alf

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 6/17/2011 9:40 AM (GMT -6)   
Casey,
I see that you are fast at criticizing (pelting them with eggs) the authors of the study for trying to caution men in the UK of the high PCa mortality there. In a country in which almost a third of those diagnosed die of PCa, their little study will be lost in the bureaucracy on the NHS in a flash. The fact remains that PCa can develop without symptoms to an advanced stage where treatments are more difficult and death from the disease more possible.

Do we believe that men are born with GS 8 to 10? Or do we believe that the carcinogenic process, however variable goes from pre-cancerous to aggressive cancerous in a step-wise manner?

For a cancer to metastasize it has to acquire the potential to survive outside the prostate gland, invade local and distant tissues and grow. Few cancerous cells have that potential, but when they do they have a higher propensity to kill. That is the case with PCa. It goes from well-differentiated to poorly-differentiated and in doing so becomes metastatic with an affinity for bone tissue.

JohnT,
The study was set to investigate cause of death in a cohort of men that died of PCa. Will the other 30,000 men die of the same rate? It depends on the stage of diagnosis, treatments etc. The point these authors are trying to make is that PCa has a high potential to kill when diagnosed late. They say so in their comments. They try to dispel the notion that prostate cancer is a “good” cancer and few die from it as it is happening in the UK these days...sad situation

RalphV
Phoenix, Arizona
Disclaimer: I am a long-term prostate cancer survivor. My comments are not intended as medical advice. The intent is to provide information. Seek direct recommendations from your medical team.
Surviving prostate cancer since 1992 at age 58. RP; Orchiectomy; GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall; Stage T4; Last PSA September, 2010: <0.1 ng/m

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/17/2011 10:36 AM (GMT -6)   
ralfinaz said...
Casey,
I see that you are fast at criticizing (pelting them with eggs) the authors of the study for trying to caution men in the UK of the high PCa mortality there.
 
No…but quick to call-out bad misinformation.
 
To remain relevant, we need to remain credible…and misinformation is damaging to one’s credibility.
 
[The egg-in-face published criticism came from the link I provided in the prior posting.]

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 6/17/2011 11:42 AM (GMT -6)   
Casey,
That is misinformation "in your mind". We are talking about PCa in the UK and not here. Data from the US is not relevant to the study because here the use of PSA testing is higher and PCa is identified earlier AND treated more often.

To be credible on has to provide reliable sources and it seems to me that you are short on doing that. Look, you seem to mixing the present situation here with what is happening in the place of origin of the study. I guess that doesn't qualify as misinformation...

RalphV
Phoenix, Arizona
Disclaimer: I am a long-term prostate cancer survivor. My comments are not intended as medical advice. The intent is to provide information. Seek direct recommendations from your medical team.
Surviving prostate cancer since 1992 at age 58. RP; Orchiectomy; GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall; Stage T4; Last PSA September, 2010: <0.1 ng/m
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