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Cancer: Prostate Message Board


Cancer: Prostate Board Index


[COLOR="DarkGreen"]Hi hulk,

I'd like to extend my own welcome to the Board, though I'm sorry you had the need to join us! :wave:

I'll respond to your first and third posts with some thoughts in green.[/COLOR]

[QUOTE=hulk1989;4702604]I was just diagnosed with prostate cancer. Looking for information on treatments. My PSA is 18, Biopsy showed 4 of 12 cores positive with a gleason score of 4+3=7 with perineural invasion present.[/QUOTE]

[COLOR="darkgreen"]I'll give you the unfavorable news first. You have probably already realized that your case is aggressive, as mentioned also by harpman. Prostate cancer cases are conventionally divided into three risk groups, low-, intermediate-, and high risk, depending on your PSA, Gleason score and stage. You have not indicated your stage, but both the PSA level and Gleason score would indicate higher risk. There are other factors that can also be considered; 4 of 12 cores positive, 33% of the total cores, is just below the higher risk threshold. I'm thinking your PSA probably rose by more than 2.0 in the past year, which would be an independent predictor of higher risk.

Now here's the good news. Prostate cancer screening, case evaluation, decision making, treatment and treatment support have all improved greatly in the past several decades, with major improvement each decade. Moreover, research has demonstrated that even high-risk prostate cancer patients enjoy a 95% survival at the ten year mark, and that statistic was from a number of years ago; survival is almost certainly higher today.

I'm in that group, and I share some similar case characteristics with you: baseline PSA in December 1999 113.6; stage 3 with suspected seminal vesicle invasion; Gleason 4+3=7, determined by an expert pathologist; all cores positive, most 100% cancer; and perineural invasion. Yet I'm doing very well in my twelfth year as a survivor. In fact, I'm now on vacation from the heavy-duty drugs in my triple androgen deprivation therapy (hormonal therapy) approach, and my quality of life is just as good as it was before I was diagnosed, except that I'm feeling some of the effects of age.

In your third post you wrote:[/COLOR]

[QUOTE]Harpman
Thank you for the response to my post. I have been to 2 different Urologists and they have both suggested surgery which concerns me conidering the possible side effects involved. As for the proton beam therapy how many treatments did it require for your treatment? Is it a daily thing? When searching for proton treatment centers the closest one to my area is in Oklahoma City, have you heard anything about this center? The main ones that seem to come up on message boards are Loma Linda, Johns Hopkins, and the center in Florida. [/QUOTE]

[COLOR="darkgreen"]In view of your case characteristics, I'm disappointed but not shocked that two urologists suggested surgery. I'm a now savvy layman with no enrolled medical education under my belt, but it does not take a genius to figure out that surgery for you would be a long shot for success with a strong probability of those side effects you are concerned about. There is a key table that is almost universally used to gauge the likelihood that surgery will cure prostate cancer. It's known as the Partin Table. You can find it published numerous places, but the one I use is from the original 2002 edition of a book you should get: "A Primer on Prostate Cancer -- The Empowered Patient's Guide", by Dr. Stephen B. Strum, MD, and Donna Pogliano, wife of a PC survivor. (The 2005 revised edition is quite similar but has a few more items covered.)

The Partin Table looks at just three factors: your PSA (18 for you); your stage (I'm going to assume it's T2a; if it's stage 3, they would have been irresponsible to recommend surgery - run for the door and don't wait to pick up your hat); and your Gleason (4+3=7 for you). Here's what the Partin Table (2001 version, but not that far from the more up-to-date version) says for a case like yours:

Chance that the cancer is confined within the thin rind of the prostate, which is known as the capsule: 14% for stage T2a (27% for stage T1c, 9% for stage T2b, and 7% for stage T2c. That's not good.

Chance that the cancer has already gone not only into the thin rind surrounding the prostate but has actually penetrated beyond it: 55% for stage T2a (51% for T1c, 50% for T2b, and 43% for T2c). That means there's a better than even chance that the cancer has probably escaped the range where it can be cured by surgery.

Chance that the cancer is already in the seminal vesicles: ranges from 11% to 13% for the various stages. In other words, it's likely the cancer has not yet gotten that far.

Chance that the cancer is already in the lymph nodes: 18% for stage T2a (10% for T1c, 27% for T2b, and 38% for T2c). You would like the odds to be better, but that is not too bad.

Prostate cancer is quite curable by radiation even when it is beyond the prostate and thus beyond the reach of a reliable cure with surgery. Surgeons often think with obsolete radiation statistics (back when an inadequately low dose of radiation was given), and, to be blunt, are not aware that patients like you have a better shot at a cure with radiation.

Harpman is a strong fan of proton therapy, but please look at some recent threads on the board about proton therapy which paint a picture that is not so bright. It has worked for many men, but it works better with lower risk cases (as do all therapies), and, while it justly has a pretty good side effect profile, proton therapy is NOT free of side effects for many men. Research has thoroughly established that.

In my own opinion, neither cryosurgery nor HIFU would be suitable for a case like yours. I'm thinking that radioactive seeds ("brachytherapy"), or a combination of seeds and some kind of external beam therapy would probably give you your best shot. That external beam therapy would probably be IMRT or CyberKnife SBRT. The radiation doctor would most likely want you on hormonal therapy for a period to sensitize the cells to the radiation and also help kill cancer.

There are lifestyle tactics that can be very helpful, as well as mild medications. If you are not on a statin drug, now would be the time to very seriously consider starting a statin; there have been two threads this week about statins and cholesterol as related to prostate cancer.

A lot of lower-risk prostate cancer patients can get away with relying blindly on their doctors and not empowering themselves. I'm convinced that's not the case for us higher-risk patients. Two other books that are outstanding for empowerment (and optimism) are: "Beating Prostate Cancer: Hormonal Therapy & Diet," Dr. Charles "Snuffy" Myers, MD, and "Invasion of the Prostate Snatchers," by Ralph Blum and Mark Scholz, MD. A small investment in the three books will likely pay you huge dividends. There are some fine free resources as well. For instance, the Prostate Cancer Research Institute, PCRI, a non-profit organization, publishes many helpful articles.

One thing the books (and PCRI) stress is the critical importance of an accurate Gleason score. Frequently Gleasons are inadequately analyzed by general medical oncologists. If the original was not done by a pathologist who specializes in prostate cancer, you need to get a second opinion.

I hope this helps.

Good luck and take care,

Jim :wave: [/COLOR]





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