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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Re: Change of life
May 23, 2010
[COLOR="DarkGreen"]Hi JAYK,

I would like to join White Lightning in welcoming you to the board! Yes, all of us would rather not have a reason to have joined, but we are a good group.

I'll add some thoughts in green to your post #3 in the thread, building on White Lightning's helpful comments.[/COLOR]

[QUOTE=jkillesr;4251283]White Lighting

Thank you for the advice, I've already made up my mind, I guess I'm just searching for someone to tell me it's the right decision.

[COLOR="darkgreen"]I generally try to stand back a bit when I read a comment like yours, but in this case I think you need to kick the tires hard again and give that motor another look before you fully commit to surgery. Okay, this is prostate cancer and not buying a used car, but some of the principles are similar regarding risk taking. By the way, I too selected surgery and called Johns Hopkins to set up an appointment for my challenging case. They rejected me, but my initial feeling of dismay and rejection :confused:turned in time into gratitude. It's so important to match the therapy to your circumstances, as well as your preferences. Surgery may still turn out to be the option you like best, but there are some more key bases to touch.[/COLOR]

After hearing the pros and cons of Radiation treatment from a the Radiation Oncologist, it confirmed my already preconceived idea that it could work for me but I don't think I would ever feel it was the right decision.

From the moment I was diagnosed with Prostate Cancer, there's only one thing I've have wanted and that is to remove it, and thats not even my worse fear, it's life there after.

[COLOR="darkgreen"]There are a couple of facts I thought you might want to know, but I'd like you to know first I've wrestled a bit whether to tell you; I don't want to discourage you, and belief and confidence do play a role in success, I think. I've decided to pass this on because the second part of your sentence shows there's actually something you want more than to "remove it," and removing it may compromise "life there after." Okay, stop reading here if you wish, but here are the facts. I'll follow the discouraging facts with some very welcome information that cushions the impact.

In studies done on good, low-risk surgery candidates (probably Gleason 6s, PSAs <10, stage 1 and 2a), substantial percentages [I][U]already had prostate PSA cells, thought to indicate prostate cancer, in their circulating blood and bones![/U][/I] :confused: In one study of patients with clinically localized prostate cancer just prior to planned surgery, 57% - [I]more than half[/I] - had PSA in bones when one side of the body was checked, and 74% - [I]virtually three quarters[/I] - had PC cells already in the bones if both sides of the body were checked! :eek: :dizzy: :( (Source: Melchior, 1997, Journal of Clinical Cancer Research, p. 7 of 8; you can check the abstract at, a site we can use on this board because it is Government sponsored, and there is a link to a free copy.) Therefore, while researchers aren't sure that all PSA in bones is due to cancer, they are leaning strongly that way; it's more likely than not that [I]you[/I] already have some PC cells in your bones! :( Moreover, this study and others have found a lower but substantial percentage of patients had circulating tumor cells in the peripheral blood (meaning not just in the prostate but rather circulating throughout the body) of low-risk prostate cancer patients. :confused:

So where's the good news? Here it is: despite these facts, the proportion of patients with prostate cancer who have recurrences is "by far" below the proportion who have PSA in their bones! As the authors put it, "We speculate that dissemination of prostate cells to the bone marrow in patients with prostate cancer occurs frequently, but that in most cases, especially with curable tumors, the cells do not survive...." :D :cool: There is still uncertainty as I understand it, but the question appears to hinge on whether the cancer is "curable."


Okay, now lets look at the odds that your cancer is still within the range of surgery (basically not extending beyond the capsule or seminal vessicles). You probably know about the Partin Tables, but I'm not getting a sense that you have taken the odds into your calculation. Am I wrong? My copy of the Primer has the Partin Tables as of 2001. I think there has been an update, but the new figures are likely very close to the 2001 figures. Let's look at figures for a case like yours: a PSA in the 4.1 to 6 ng/ml range, T2a (could be T2b or T3 based on what you have posted, do you know?), and a Gleason of 3+4=7. The table says there is a 46% chance that the prostatec capsule has been penetrated (but small chances of seminal vesicle or lymph node mets). But if the stage is notched up to T2b, the chance of penetration increases to 51%, slightly better than a coin flip. [I][U][B]If the capsule is penetrated, then surgery is not going to get it all![/B][/U][/I]

However, brachytherapy is able to deliver a powerful dose to the prostate itself and can also, in the hands of talented doctors, give a strong dose to the key millimeters just beyond the prostate. That's critical, because, for prostate cancer caught early, it's extremely likely that cancer that has spread beyond the capsule is still within those crucial few millimeters that can be adequately dosed by seeds placed around the capsule.

You may want to do some additional staging to gauge what you are up against. The Gleason scoring should be done by a pathologist with special experience and skill in prostate cancer, not just by a general pathologist, because quite often general pathologists somewhat underestimate (and sometimes overestimate) the grades of the disease. it's common to get a second and expert pathology opinion. (On the other hand, your biopsy report provided the kind of detail that is needed; your pathologist may have been an expert, but check whether he's a generalist (doing children, adults, men, women, dogs, cats, you get the idea ;) .)

You may want to get a repeat PSA, to help gauge the PSA velocity, a very useful piece of information, and along with it a PAP test (prostatic acid phosphatase), which is quite useful in predicting metastases and the success of both surgery and radiation. (The Primer gives some of the key data about that.)


Will I be one of the ones that fall into the low percentage group and loose all bodily functions?

[COLOR="darkgreen"]Do you have urinary trouble now? If so, that's a consideration against radiation, but that consideration is just one, with others, including cancer control and cure, being primary.

By the way, a single course of triple hormonal blockade for thirteen months with mild drug maintenance has had stunning success, with recovery from side effects within a few months and long-term cancer control, but it is quite unconventional. (Longer term intermittent triple blockade has been the only therapy I've used.) I can provide leads and more information if you wish.[/COLOR]

Do I prepare for the worst and hope for the best, how do you prepare your state of mind not knowing the outcome?

I will soon have an appointment with the Surgeon, from what I learned so far he is well experienced in robotic radical prostatectomy and will be using the most up to date machine in a teaching Hospital. Are there any other bases I need to cover?

[COLOR="darkgreen"]There's a good, but far from certain, chance that he could cure you, in your particular case circumstances, with minimal side effects.

You could go an extra mile and get an endo-rectal MRI with spectroscopy from a center of excellence like UCSF or Memorial Sloan Kettering. You could get a color Doppler ultrasound biopsy to determine blood vessel support of the tumor (vascularity), size, location, etc. You could go to Belgium to get a Combidex scan to determine spread to any lymph nodes throughout the body.[/COLOR]


[COLOR="darkgreen"]Good luck to you, and take care,

Jim [/COLOR]

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