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Cancer: Prostate Message Board


Cancer: Prostate Board Index


[COLOR="DarkGreen"]Hi Bob,

I'm responding to your post #17 regarding 04chris's case with a different viewpoint. You wrote in part:[/COLOR]

[QUOTE=harpman;4707580]Jim
I suggested to 04chris that he stop the supplements until he has a consultation and the doctor ascertains what his present condition is. I'm going on the assumption that if your prostate cancer is curable you don't really want to delay treatment to slow down you PSA doubling time whatever it is as. If you spend enough time slowing PSA doubling time down you will lose your chance for a cure. Patients who have a failed RP are usually directed to some form of radiation therapy and/or hormone therapy immediately upon the failure becoming evident. I agree with Johnt1 that the best course is to seek treatment.

Bob[/QUOTE]

[COLOR="darkgreen"]In general, I see your point, but 04chris's PSA is now hovering around 8, which is well past the point when salvage RT is ideal for a recurrence. As I understand it, the ideal time for RT is when the PSA has not exceeded 1.0, with some evidence that the lower it is, the better, though I suspect that waiting until it at least exceeds 0.2 is okay, as that is the commonly recognized threshold for a clinically significant recurrence.

On the other hand, with the new Feraheme scan at Sand Lake Imaging that can pinpoint cancer as small as 3mm in specific, well-located lymph nodes, that concept may be changing, with some men having mets in just a few nodes or bone sites now having a late shot at a cure. However, I doubt that even this new development would significantly affect the following approach.

There is a strong movement among some major prostate cancer experts to try to avoid treatment for recurrences that are mild, and they have done enough research to get a pretty good handle on what is mild and what is not. One of the leading centers in this is the famed James Buchan Brady Urological Institute at Johns Hopkins, home for some of the best prostate cancer surgeons and researchers. I think you will be encouraged at the advance in the state-of-the-art for assessing recurrences after surgery if you look at their key publications. In essence, they have discovered that you can look at just three factors and get an excellent handle on whether most recurrences are mild - many are - or serious. They look at PSA doubling time after recurrence, whether the recurring patient's PSA hit 0.2 within or after three years from surgery, and whether the Gleason score for the pathology result from surgery was less than 8 or 8 and higher. Here's the citation for the initial study that excited doctors and the recurrence community:

JAMA. 2005 Jul 27;294(4):433-9.
Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy.
Freedland SJ, Humphreys EB, Mangold LA, Eisenberger M, Dorey FJ, Walsh PC, Partin AW.

If you search for it in www.pubmed.gov, you will also find a free link to the complete paper. PubMed also gives leads to a number of related and more recent articles. Dr. Freedland moved in the past couple of years from Johns Hopkins to Duke, and I believe he is continuing this line of research with both his old and new associates.

I don't want to "spoil the movie" for you by spelling it all out, but, if a man has a recurrence with a PSA doubling time greater than 15 months, had the recurrence more than three years after his surgery, and had a pathological Gleason score less than 8, the chances are very strong that his recurrence is mild. When those three stars don't all align so nicely, the cancer is more aggressive, but still fairly mild for many of the combinations. I'm hoping you will take a look at the research and let us know what you think about it.

Fortunately, 04chris has been rather successful in controlling that PSA doubling time, which is by far the most important factor in the Freedland approach. He describes that in his past posts.

Take care,

Jim :wave:
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