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Cancer: Prostate Message Board


Cancer: Prostate Board Index


Hello jupaul,
I could not agree with you more - the decision making process with prostate cancer is overwhelming. I was quite frustrated with there not being a clinical way to approach the decision making process. Allen was a great help to me and he is responsible for having the Prostate Cancer Decision Tool tacked to the top of this board. I hope you will take time to read it if you haven't already.

My point about the Procepia is that (again, I haven't researched this) by taking the Procepia, you may have suppressed the actual progression of your PSA. In other words, you could have had PSA scores over the last 10 years that were in the 2-3 range because of taking Procepia while the actual PSA might be double that - 4-6, which as you can imagine would be of alarm. On the other hand, if your doctor knew or understood the affect of Procepia on PSA, then he or she could counsel accordingly.

You should also be aware that last year the FDA rejected 5-alpha reductase inhibitors (finasteride, Proscar, and dutasteride Avodart which are currently approved to treat benign prostatic hypertrophy) as a cancer fighting drug. The reason they did so primarily is because of situations similar to yours. 5-alpha reductase inhibitors can mask the existence of aggressive cancer cells.

In my own experience, after I was diagnosed with prostate cancer, my oncologist gave me a 'off label' prescription to Avodart (dutasteride) with the intent of reducing the size of my prostate and ostensibly cutting off the fuel (DHT) that prostate cancer cells feed on. When I had PSA done, the rule of thumb was to double the score, e.g. a 4 was considered an 8. I again suggest to you that the progression of PSA scores are of more value in diagnosing the aggressiveness of the cancer cells. (All of this information has been posted multiple times on this board for you to read and consider.)

As Allen suggested, stuff happens without rhyme or reason. I only asked about incidence of cancer in your family and ethnic background because statistically, there is a greater chance of cancer for someone if a family member has cancer and if you are African American. It is not a given, but it is factored in the diagnosis or likelihood of someone having cancer.

I highly recommend that you get a second opinion on the core samples. I sent my samples to Epstein at John Hopkins and he reversed my highest scores of 4+3 to 3+4. That was good but it was frustrating because the scores for each core were based on a significantly different (IMHO) percentage of cancer cells. To me it was like the core samples could be from 2 different people. Now, I've no doubt they were mine but it was disconcerting to find such a variance. I asked my urologist and he deemed it as common. In short, pathology is in some ways more an art than a science. Epstein (with all due respect) is an exceptionally good artist. Bostwick is considered another great choice.

As you go down this road, understand that the more information you can accumulate about your condition, the better prepared you are in making the best decision for you. Every doctor has a perspective based on their experience and on their chosen specialty. Those views must be considered - in context with other doctors and your study of your situation. I wish you well in your journey to making the best decision for you.

P.S. there is a wealth of information on this board - I suggest you absorb as much of it as you can.

Cheers!
Don





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