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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Hi wjohn,

And welcome to the board! None of us wanted a reason to be here, but it is a fine group!

You have already had some excellent responses, and I'll add some more thoughts.

As you are likely to know by now, your PSA is reasonably low, even at 7, and your Gleason score at 6 is a low-risk characteristic. (Was it done by an expert pathologist specializing in PC, or are those figures based on a review by an expert?) One point of concern is that rise from 4.75 to 7.0. Would you mind telling us the dates of those tests? The reason is that we now know that a rise of more than 2.0 in the year before diagnosis (or a PSA velocity (PSAV of more than 2.0 based on more closely spaced dates), [I][U]in men diagnosed with prostate cancer[/U][/I] (does not apply to others where the PSA is responding partly to growth and or partly to infection that drives the PSAV to exceed 2.0), indicates likely higher risk than would be expected based on the usual major characteristics (Gleason score, PSA level, and stage) :confused:. However, even if the PSAV exceeds 2.0 in the year prior to diagnosis, some such men will still not be at higher risk; it's a statistical thing. (Dr. Anthony D'Amico and team, 2004, 2005) Also, if your clinical stage is 1 or 2, the increase in risk is miniscule. Would you mind telling us the stage? Depending on the answers and several other characteristics, it is possible you might still be a low or very low risk patient, eligible for active surveillance. (The other characteristics usually considered important include the percent of biopsy cores with cancer, the PSA density and perhaps similar factors, including such factors as "vascularity" (blood supply) and location of the tumor if you want to be very thorough. (Age is a consideration, but not a major factor in this, even at age 50, per some leading experts, but with some controversy.)

I would like to cushion that information about possible higher risk due to the PSAV with key facts you need to know regarding your outstanding chance to survive prostate cancer. Thanks to excellent success in screening and early detection, coupled with major advances in treatment and supportive tactics, prostate cancer patients are head and shoulders above patients with other types of cancer, possibly with the exception of squamous cell skin cancer, which also has extremely high survival. In fact, the 2009 Statistical Abstract of the United States, Library Edition, Table 173, shows that survival five years after diagnosis for white males for prostate cancer is 99.4%, with the percentage for black men just a few points behind! :D That means that virtually all of us have at least five years, even high risk patients. And those high risk prostate cancer patients do exceptionally well, with survival of 95% at the ten year point! :D (Long-Term Survival Rates of Prostate Cancer in the Prostate-Specific Antigen Screening Era", J Con Onc, January 2005). Moreover, you can tell from the trend data in the abstract that survival for us is steadily improving. :cool: But we already can demonstrate ten year survival for high risk patients that is superior to five year survival for all other major types of cancer! With what appears to be a low risk case, you have an excellent chance of being cured altogether. :cool:

Mickey and John T already posted favorably about IMRT, which would include TOMO therapy. I would like to join their choir. At last year's National Conference on Prostate Cancer, Dr. John Blasko, a highly respected pioneer of seed therapy from Seattle, gave us a talk on the results of an expert panel's review of various therapies, looking at both effectiveness in controlling cancer and side effects. The bottom line was that radiation stood up very well for all risk-levels of cancer, with greater effectiveness demonstrated long-term as well as competitive if not superior side effect profiles. (For instance, Dr. Michael Dattoli has published some quite favorable long-term results (average followup 14 years as I recall it) for his combination of seeds and IMRT for intermediate and high risk patients.)

That said, despite reviewing many studies on all kinds of therapy, the panel concluded there was not enough data to reach any firm conclusions about conclusive superiority of specific therapies for specific risk levels and circumstances, which is a point that viperfred made in his post. (Another key point is that the quality of the doctor probably matters more than the kind of therapy in most instances.) I've looked for that expert panel paper to be published, but it has not been published yet. In the meantime, Dr. Peter Grimm, DO, and his Prostate Cancer Treatment Center have published an informal but thorough paper about it among a number of helpful items on Prostate Cancer, including the key tables of comparative results. Their article is headed “Prostate Cancer Results Study Group”. It is wonderful that this preliminary paper, which has been presented late last year to the oncology medical community's organization (ASCO), is now available!:angel: :D

About the CyberKnife Stereotactic Body Radiotherapy choice that viperfred is mentioning: This looks like a really promising approach, and the ability to complete it in just five sessions makes it highly attractive. There is some good but preliminary evidence that the treatments should have a day of rest in between to minimize the risk of severe late rectal side effects. The one major drawback is that there just is no published information covering average followup of patients for more than nearly three years (think the average is around 34 months in the longest running, Stanford U. - Dr. Christopher King), study. (That makes it too recent to appear in the expert panel study.) That said, results are exciting and this therapy could be a good choice for a person willing to take some risk. Some patients are doing great at five years, and, I haven't heard any reports of any at that point or beyond who are having problems, but we just don't know yet how most men will do.

Take care, and good luck sorting through all this :dizzy: ---> :confused: ---> :cool:,


[QUOTE=njwilliej;4242900]I'm 50 just recently diagnosed with PC. PSA was 4.75 and gleason 6 (3+3). had a recent PSA now at 7.0. I am a diabetic and not happy with the surgery option. Looked at HDR, LDR, Tomo and Proton Therapy. Was leaning toward Proton but the distance was 1hour and 40 minutes each day for 9 weeks. Can get the IMRT TOMO closer to home same duration of 9 weeks. Anyone can share your thoughts on this therapy as I am scheduleing for August 2010. thanks wjohn[/QUOTE]

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