Re: Re: Re: I don't know who to thank

[Guest guest]

Hi dear,

If your husband has a Gleason 9 cancer, the odds are very

great that the cancer is outside the prostate. In that case,

removing the prostate would only affect the cancer in the

prostate and not the cancer that may be outside it.

If it were me, I would stay on the hormone ablation therapy,

which would include Proscar or Avodart. Dr. Leibowitz has

had some very good success with his triple hormone therapy.

He has his patients stay on the triple therapy for a year, then

if their PSA is undetectable, has them go off the therapy except

that he keeps them on Proscar or Avodart as a maintenance

therapy.

Of course he monitors their PSA and if it begins to rise, then

the patients go back on therapy as Intermittent Therapy. It

seems to work very well for most patients.

I wish you all the bestAubrey Pilgrim, DC (Ret.) Author ofA Revolutionary Approach to Prostate Cancer-Read the original book for FREE at: http://www.prostatepointers.org/prostate/lay/apilgrim/Read new edition for FREE at http://www.cancer.prostate-help.org/capilgr.htmDr. E. Crawford is co-author of the revision

Hi Alan,

My husband is 62 years old and his general health is good. He has a PSA of 7.1 (taken two months ago) Gleason #9 and the doctors have said it was hard to stage because of the aggressiveness of the cancer but guessed about stage 2B.

I am against radiation and long term Hormonal Therapy, mainly because of the side effects. Both surgery and radiation have horrible side effects. But the Oncologist said not to have surgery and go with the radiation and Hormonal Therapy for three years. We have been to two Urologists and they both said surgery. We are both confused. But my husband is leaning towards surgery. He is now on Casodex for 10 days, a three month injection then surgery in May if he continues on this path.

He has had a bone scan and that was inconclusive. So he has a MRI on Thursday just to make sure the cancer has not spread. We see a Radiologist in about two weeks and I'm sure will hear another form of treatment. It is all so scary and confusing.

SheilaThe year's hottest artists on the red carpet at the Grammy Awards. AOL Music takes you there.

[Guest guest]

Sheila,You stated " My husband went see an Oncologist to see if his cancer had spread to the bone, he has tor have a MRI to rule that out now. " As far as I know an MRI will determine if the PCa has spread to organs, a full body

scan (x-ray) will determine if it has spread to bone. The latter test is also not the mostaccurate due to the sometime mircoscopic size of PCa bone metatsicis.

>

> My husband went see an Oncologist to see if his cancer had

> spread to the bone, he has tor have a MRI to rule that out now.

> But the Oncologist told him not to have the surgery but to have

> radiation and Hormonal Therapy for three years. He also said he

> would be a candidate for a Clinical Study Trial which would

> consist of chemo, radiation and Hormonal Therapy. He said no to

> that. He is doing more research on the radiation therapy now,

> He is so confused. I'm against it because some of the side

> effects are permanent. All I can do is support what ever his

> decision will be. Any input would be greatly appriciated.

Hello Sheila,

Are you against the radiation, the hormonal therapy, both, or any

treatment of any kind (i.e., surgery too)?

You haven't said how old your husband is, what his general health

is, or what his disease characteristics are (Gleason score, PSA,

PSA doubling time, staging). Those are important things to

consider when trying to decide for or against treatment.

Given your husband's age and general health, you may be able to

make an estimate of how many years are left to him assuming no

cancer. Given his Gleason score, PSA, etc., his doctor may be

able to make an estimate of how long it would take before he

starts to suffer cancer pain, and how long before he dies of

cancer.

In my personal opinion, unless there is reason to believe that

his life expectancy is less than it will take for the cancer to

get to him, or unless there is reason to believe that the cancer

has already spread and is no longer amenable to primary

treatment (which his doctor is trying to figure out with the

MRI), then it should be treated. The side effects of any of the

treatments are not as bad as having advanced cancer.

Treatment may not work. The doctor can give you odds of success

based on your husband's disease characteristics. But a good

doctor normally won't recommend treatment at all unless he

thinks there is a reasonable chance of success.

Don't be too afraid of the side effects. I went through

radiation and a short course of hormone therapy and I came out of

it relatively okay. There were side effects. It would have been

nicer not to have them. I particularly disliked what the HT did

to my libido and my ability to exercise. But they have not

really affected my life long term. Now, four years after

treatment, my PSA is very low and I'm looking forward to life

without feeling that it's just a matter of time before prostate

cancer kills me. I know something else will get me before too

many years, but maybe there will be a few more years than I would

otherwise have had.

Best of luck to both of you.

Alan Meyer

ameyer2@...

__________________________________________________________

Be a better friend, newshound, and

know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

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[Guest guest]

Hi Alan,

My husband is 62 years old and his general health is good. He has a PSA of 7.1 (taken two months ago) Gleason #9 and the doctors have said it was hard to stage because of the aggressiveness of the cancer but guessed about stage 2B.

I am against radiation and long term Hormonal Therapy, mainly because of the side effects. Both surgery and radiation have horrible side effects. But the Oncologist said not to have surgery and go with the radiation and Hormonal Therapy for three years. We have been to two Urologists and they both said surgery. We are both confused. But my husband is leaning towards surgery. He is now on Casodex for 10 days, a three month injection then surgery in May if he continues on this path.

He has had a bone scan and that was inconclusive. So he has a MRI on Thursday just to make sure the cancer has not spread. We see a Radiologist in about two weeks and I'm sure will hear another form of treatment. It is all so scary and confusing.

Sheila

-------------- Original message --------------

>> My husband went see an Oncologist to see if his cancer had> spread to the bone, he has tor have a MRI to rule that out now.> But the Oncologist told him not to have the surgery but to have> radiation and Hormonal Therapy for three years. He also said he> would be a candidate for a Clinical Study Trial which would> consist of chemo, radiation and Hormonal Therapy. He said no to> that. He is doing more research on the radiation therapy now,> He is so confused. I'm against it because some of the side> effects are permanent. All I can do is support what ever his> decision will be. Any input would be greatly appriciated.Hello Sheila,Are you against the radiation, the hormonal therapy, both, or anytreatment of any kind (i.e., surgery too)?

You haven't said how old your husband is, what his general healthis, or what his disease characteristics are (Gleason score, PSA,PSA doubling time, staging). Those are important things toconsider when trying to decide for or against treatment.Given your husband's age and general health, you may be able tomake an estimate of how many years are left to him assuming nocancer. Given his Gleason score, PSA, etc., his doctor may beable to make an estimate of how long it would take before hestarts to suffer cancer pain, and how long before he dies ofcancer.In my personal opinion, unless there is reason to believe thathis life expectancy is less than it will take for the cancer toget to him, or unless there is reason to believe that the cancerhas already spread and is no longer amenable to primarytreatment (which his doctor is trying to figure out with theMRI), then it should be treated. The side effects of any of thet

reatments are not as bad as having advanced cancer.Treatment may not work. The doctor can give you odds of successbased on your husband's disease characteristics. But a gooddoctor normally won't recommend treatment at all unless he thinks there is a reasonable chance of success.Don't be too afraid of the side effects. I went throughradiation and a short course of hormone therapy and I came out ofit relatively okay. There were side effects. It would have beennicer not to have them. I particularly disliked what the HT didto my libido and my ability to exercise. But they have notreally affected my life long term. Now, four years aftertreatment, my PSA is very low and I'm looking forward to lifewithout feeling that it's just a matter of time before prostatecancer kills me. I know something else will get me before toomany years, but maybe there will be a few more years than I wouldotherwise have had.Best of luck

to both of you.Alan Meyerameyer2__________________________________________________________Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

[Guest guest]

Sheila wrote:

<snip>"I am against radiation and long term Hormonal Therapy, mainly because of the side effects. Both surgery and radiation have horrible side effects. But the Oncologist said not to have surgery and go with the radiation and Hormonal Therapy for three years."<snip>

Hi Sheila.

I have had hormone therapy for the last 3 years. During that time i have led the same life I led before I was confronted with a diagnosis of Cancer except for minor declines in the quality of some passing moments. All present treatments come with the risk of side effects to a varying degree. I try to stay focused on the disease, the tumor/tumors, and how I can best prolong my life. Try to keep in mind that each specialist will lobby for the treatment he performs. The financial realities of the practice of medicine.

If you have not already done it, please read Dr. Strum's article at :

http://prostate-cancer.org/education/riskases/Strum_StrategyOfSuccess1.html

"Given the choice between the experience of pain and nothing,I would choose pain" ~ Faulkner

Re: Re: Re: I don't know who to thank

Hi Alan,

My husband is 62 years old and his general health is good. He has a PSA of 7.1 (taken two months ago) Gleason #9 and the doctors have said it was hard to stage because of the aggressiveness of the cancer but guessed about stage 2B.

I am against radiation and long term Hormonal Therapy, mainly because of the side effects. Both surgery and radiation have horrible side effects. But the Oncologist said not to have surgery and go with the radiation and Hormonal Therapy for three years. We have been to two Urologists and they both said surgery. We are both confused. But my husband is leaning towards surgery. He is now on Casodex for 10 days, a three month injection then surgery in May if he continues on this path.

He has had a bone scan and that was inconclusive. So he has a MRI on Thursday just to make sure the cancer has not spread. We see a Radiologist in about two weeks and I'm sure will hear another form of treatment. It is all so scary and confusing.

Sheila

[Guest guest]

> I am against radiation and long term Hormonal Therapy, mainly because of

> the side effects. Both surgery and radiation have horrible side effects.

(snip)

Not necessarily.

And what does Sheila, and more importantly her husband, consider to be

" horrible? "

There are tens of thousands, probably more, men and their ladies living

quite well, thank you, with the side effects (SEs) of treatment (tx).

Each of us is different from others; what affects A might not be noticed

by B, and vice versa.

And if a SE is experienced, how long? A month? Six? More? Less? And to

what degree? That's a subjective assessment that no one can make except

the individual patient.

Lastly, bear in mind this fact, too often glossed over: death from PCa

is more than horrible.

> But the Oncologist said not to have surgery and go with the radiation

> and Hormonal Therapy for three years. We have been to two Urologists and

> they both said surgery. We are both confused.

Not surprising. Each is advocating his special approach, the one on

which he has been educated.

> But my husband is leaning towards surgery.

A Gleason 9 is very aggressive, as I know from personal experience and

from my studies. I believe that it is more likely than not that the PCa

is systemic (which is not the same as metastatic) and that a local tx

such as surgery or RT will not be curative.

That is not necessarily a death sentence. Systemic PCa is treated as a

chronic condition. Done properly, such tx can extend the patient's

survival until something else takes him down. But it also means that it

will never be over and done with.

Can the patient and his lady live long and well in such circumstances?

Given adjustments to the new facts, *absolutely*.

> He is now on Casodex for 10 days, a three month

> injection then surgery in May if he continues on this path.

As above, I doubt that surgery will be curative. It can, however,

" debulk " the primary source of PCa cells.

> He has had a bone scan and that was inconclusive.

A bone scan (presumably a nuclear scan) is usually not reliable.

However, in a Gleason 9 case, it can be helpful. Bear in mind, though,

that it is limited in its ability to detect what are called

micrometastases (micromets).

> So he has a MRI on

> Thursday just to make sure the cancer has not spread.

I have to disagree respectfully with some other posters. An MRI can most

definitely detect mets in bone, as I know very well from personal

experience. But, again, it is not able to detect metastatic lesions that

are less than its detection limit.

> We see a

> Radiologist in about two weeks and I'm sure will hear another form of

> treatment. It is all so scary and confusing.

It absolutely is, especially when one is new to this thing.

I suspect that Sheila means " radiation oncologist " rather than

" radiologist. " It's easy to confuse the two. The latter's job is to

interpret radiological images. The former treats cancer via radiation.

And what is the foundation for my advice? Nothing more than experience

wrestling with this thing, same as the other folks who have responded.

Education is the key, the absolutely essential key to selecting the

future course.

Here are my recommendations:

(1) Post Husband's (what's his name?) PCa history on P2P (Physician to

Patient) at http://www.prostatepointers.org/p2p/

At least one expert in PCa tx will likely reply within a few days. Cost:

zero. Value: infinite. I know.

(2) Explore the objective, encyclopedic and reliable information on the

website of the Prostate Cancer Research Institute (PCRI) at:

http://prostate-cancer.org/index.html

(3) Invest in and study _A Primer on Prostate Cancer_ 2nd ed., subtitled

" The Empowered Patient's Guide " by medical oncologist and PCa specialist

B. Strum, MD and PCa warrior Donna Pogliano. It is available

from the PCRI website and the like, as well as Amazon (30+ five-star

reviews), & Noble, and bookstores. A lifesaver, as I very well know.

(4) Before it's too late, consult a genuine cancer specialist, a medical

oncologist; preferably one who is trained in tx of PCa. Some of such

specialists can be found via this page on the PCRI site:

http://prostate-cancer.org/resource/find-a-physician.html

A med onc could serve as the coach of H's treatment team, presenting H

with tx choices, with H being the team owner and the one who makes the

decisions.

None of this is easy. Properly done, it requires study and dedication to

one's own welfare. But many folks are available to provide support.

Regards,

Steve J

" Empowerment: taking responsibility for and authority over one's own

outcomes based on education and knowledge of the consequences and

contingencies involved in one's own decisions. This focus provides the

uplifting energy that can sustain in the face of crisis. "

--Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled

" The Empowered Patient's Guide. "

[Guest guest]

Steve, thank you for all your help and info. I'm sorry if you took the "horrible" in such a bad way. I just meant that the side effects are not pleasant and yes many people live with them and are doing just fine. But I wasn't sure how my husband would handle some of these side effects. But you do what you gotta do. We are all new at this and the shock still hasn't worn off yet I guess. I want my husband

to chose what treatment he feels most comfortable with and the doctor who he feels is the best at what he does. The doctor he will most likely go with ranks the second best prostate cancer specialist in New England and the 13th in the country.

I hope you didn't think I was being flip or insensitive. I'm sorry if you took what I wrote the wrong way. My husband is the most important person in this picture and he will make his decision when we can read all the info. But you do agree it is all very confusing, especially at first. Thank you again for all the important info.

Sheila

-------------- Original mesthsage -------------- t

> I am against radiation and long term Hormonal Therapy, mainly because of > the side effects. Both surgery and radiation have horrible side effects. (snip)Not necessarily.And what does Sheila, and more importantly her husband, consider to be "horrible?"There are tens of thousands, probably more, men and their ladies living quite well, thank you, with the side effects (SEs) of treatment (tx).Each of us is different from others; what affects A might not be noticed by B, and vice versa.And if a SE is experienced, how long? A month? Six? More? Less? And to what degree? That's a subjective assessment that no one can make except the individual patient.Lastly, bear in mind this fact, too often glossed over: death from PCa is more than horrible.> But the Oncologist said not to have surgery and go with the radiation > and Hormonal Therapy for t

hree years. We have been to two Urologists and > they both said surgery. We are both confused. Not surprising. Each is advocating his special approach, the one on which he has been educated.> But my husband is leaning towards surgery. A Gleason 9 is very aggressive, as I know from personal experience and from my studies. I believe that it is more likely than not that the PCa is systemic (which is not the same as metastatic) and that a local tx such as surgery or RT will not be curative.That is not necessarily a death sentence. Systemic PCa is treated as a chronic condition. Done properly, such tx can extend the patient's survival until something else takes him down. But it also means that it will never be over and done with.Can the patient and his lady live long and well in such circumstances? Given adjustments to the new facts, *absolutely*.> He is now on Casodex for 10 days, a three month > injection then surgery in May if he continues on this path.As above, I doubt that surgery will be curative. It can, however, "debulk" the primary source of PCa cells.> He has had a bone scan and that was inconclusive. A bone scan (presumably a nuclear scan) is usually not reliable. However, in a Gleason 9 case, it can be helpful. Bear in mind, though, that it is limited in its ability to detect what are called micrometastases (micromets).> So he has a MRI on > Thursday just to make sure the cancer has not spread. I have to disagree respectfully with some other posters. An MRI can most definitely detect mets in bone, as I know very well from personal experience. But, again, it is not able to detect metastatic lesions that are less than its detection limit.> We see a > Radiologist in about two weeks and I'm sure will hear another form of > treatment. It is all so s

cary and confusing.It absolutely is, especially when one is new to this thing.I suspect that Sheila means "radiation oncologist" rather than "radiologist." It's easy to confuse the two. The latter's job is to interpret radiological images. The former treats cancer via radiation.And what is the foundation for my advice? Nothing more than experience wrestling with this thing, same as the other folks who have responded.Education is the key, the absolutely essential key to selecting the future course.Here are my recommendations:(1) Post Husband's (what's his name?) PCa history on P2P (Physician to Patient) at http://www.prostatepointers.org/p2p/At least one expert in PCa tx will likely reply within a few days. Cost: zero. Value: infinite. I know.(2) Explore the objective, encyclopedic and reliable information on the website of the Pro

state Cancer Research Institute (PCRI) at: http://prostate-cancer.org/index.html(3) Invest in and study _A Primer on Prostate Cancer_ 2nd ed., subtitled "The Empowered Patient's Guide" by medical oncologist and PCa specialist B. Strum, MD and PCa warrior Donna Pogliano. It is available from the PCRI website and the like, as well as Amazon (30+ five-star reviews), & Noble, and bookstores. A lifesaver, as I very well know.(4) Before it's too late, consult a genuine cancer specialist, a medical oncologist; preferably one who is trained in tx of PCa. Some of such specialists can be found via this page on the PCRI site: http://prostate-cancer.org/resource/find-a-physician.htmlA med onc could serve as the coach of H's treatment team, presenting H with tx choices,

with H being the team owner and the one who makes the decisions.None of this is easy. Properly done, it requires study and dedication to one's own welfare. But many folks are available to provide support.Regards,Steve J"Empowerment: taking responsibility for and authority over one's ownoutcomes based on education and knowledge of the consequences andcontingencies involved in one's own decisions. This focus provides theuplifting energy that can sustain in the face of crisis."--Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled"The Empowered Patient's Guide."

[Guest guest]

Alan, my husband has a Gleason #9 and he had a MRI yesterday. Won't that tell us is the cancer has spread? He has choosen to go with the surgery. He's on Casodex now and gets his first injection tomorrow. I'm not sure what the drug is. We'll find out tomorrow. We were told by on Oncologist that if he chooses surgery that there is a 35% chance the cancer will come back. We have a top notch surgeon. So we just have to wait for the MRI results.

-------------- Original message --t ------------ '

...> If your husband has a Gleason 9 cancer, the odds are very> great that the cancer is outside the prostate. In that case,> removing the prostate would only affect the cancer in the> prostate and not the cancer that may be outside it.Aubrey is clearly right about this. BUT, some cases of Gleason 9cancer apparently ARE cured by primary treatment.The odds go down as compared to Gleason 6 or 7, but not to zero.A lot depends on individual choice. If the odds of a cure are25% - 60% (radically different numbers I know, but I seem toremember seeing both of them), is that worth taking thetreatment?Only you and your husband can decide.If you decide for it, go with the very best doctor you canto get the highest odds for success.> If it were me, I would stay

on the hormone ablation therapy,> which would include Proscar or Avodart. Dr. Leibowitz has> had some very good success with his triple hormone therapy.> He has his patients stay on the triple therapy for a year, then> if their PSA is undetectable, has them go off the therapy except> that he keeps them on Proscar or Avodart as a maintenance> therapy.> > Of course he monitors their PSA and if it begins to rise, then> the patients go back on therapy as Intermittent Therapy. It> seems to work very well for most patients.This also seems like reasonable advice. However, do bear in mindthat some men have highly hormone sensitive cancers and survivemany, many years on ADT, and others don't. Some only get acouple of years from ADT. I think one published study claimed anaverage of 18 months. That's the number quoted in the NCItreatment summary for PCa. However that may have been forordinar

y ADT, not triple ADT, and may have mostly been for menwho didn't start ADT until after their cancer was metastatic.I respect Aubrey's approach. It's perfectly valid. However myown, highly personal, inclination would probably be to try forthe cure even though the odds aren't great.> I wish you all the best.I second that.Alan Meyerameyer2__________________________________________________________Never miss a thing. Make Yahoo your home page. http://www.yahoo.com/r/hs