Younger men on AS was...... Answers, Ideas and Comments, Please

August 14, 2008

Alan,

You said <snip> In general,

I'm inclined to think that the younger a man is when diagnosed with cancer, the

more attractive becomes the idea of treatment. If, for example, your husband is

55 years old and might reasonably expect to live for another 30 years, then

even a small cancer could well become life threatening during that period, and

treating it early, while it is still small, may give a better chance for a

complete cure. <snip>

I know that this is a general view and I

cannot say it is incorrect, but I have often speculated about its validity and

wonder if you would care to expand a little. Here’s my view:

we

know that the median age for death from PCa is a little over 80 years of

age – so clearly most of the men diagnosed with PCa will live until

they are older than 80.

the

mortality rates rise very sharply with age. I understand that more than

90% of deaths occur in men over the age of 70

PCa

deaths account for about 3% of all male deaths: 97% of male deaths are

from some cause other than PCa.

the

diagnostic pointer most often associated with fatal forms of PCa is the

Gleason Grade with high Gleason Grades (over 4+3) being the most

consistent pointer.

Given these basics (and there are other

issues that might sharpen the focus) then my personal view is that the chances

are very much greater that a man aged 55 choosing Active Surveillance would

have a very much higher chance of dying within 30 years from something other

than PCa. This would be especially true if he has one small focus of what might

be termed “prostatic tubular neogenesis” if Dr Jon Oppenheimer’s

suggestion were ever adopted – see http://theprostateblog.blogspot.com/

What do you think – where am I going

wrong?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Alan Meyer

Sent: Thursday, 14 August 2008

2:27 PM

To: ProstateCancerSupport

Subject:

Re: Answers, Ideas and Comments, Please

>

> Hello,

> I'm new to the group and my husband has just been diagnosed w/

> PC, PCA: 7.5, Gleason: 6 (from 12 areas of prostate - only one

> area showed a cancer cell). He has mild hypertension and

> possible diabetes 2, but otherwise very healthy and active.

> I'm in " the maze " of confusing physician opinions which range

> from Watchful Waiting to IMRT, and would really appreciate some

> input from this experienced group!

,

You haven't said how old your husband is. In general, I'm

inclined to think that the younger a man is when diagnosed with

cancer, the more attractive becomes the idea of treatment. If,

for example, your husband is 55 years old and might reasonably

expect to live for another 30 years, then even a small cancer

could well become life threatening during that period, and

treating it early, while it is still small, may give a better

chance for a complete cure.

On the other hand, if he's 75 years old, then it may be

reasonable to expect that he'll never have any problem with the

cancer and shouldn't treat it at all.

Having said that, I nevertheless have to say that I agree with

Terry that your husband's cancer may be small and insignificant

enough that no treatment is warranted for a quite a long time.

If that's true (and I'm not a doctor and certainly not qualified

to say if it is true), the benefits of " watchful waiting " or

" active surveillance " as it is now called, are that there are no

treatment side effects, no costs, and the possibility that better

treatments will be available if and when he needs them.

You have seen more than one doctor to get second opinions.

That's an excellent idea. You might also get a second opinion on

the biopsy slides. Analyzing cancer cells under a microscope is

a notoriously difficult thing to do and the best labs sometimes

come up with a different report than the low bidder labs. If the

Gleason is really 7 instead of 6, or if the cancer is really in 5

samples, not 1, then it's a different situation. (Mine were

evaluated by three labs and I got three different reports.)

Insurers do usually pay for second opinions on biopsy slides.

Search through the archives of this list for postings by Steve

Jordan.

He has listed a number of the best labs for prostate

biopsy analysis.

If you do decide on watchful waiting, the key thing is

watchfulness. You should discuss it with a doctor, setup a

program of regular PSA tests, and discuss with the doctor what

should signal the end of waiting and the beginning of treatment.

If the signal arrives, take action.

As to what actions to take, in my personal view, the major

treatments - surgery, external beam radiation (proton or x-ray),

brachytherapy (implanted radioactive seeds) - all work well when

the cancer has not grown beyond the prostate. To my mind, the

key thing is to find a highly experienced, competent, caring, and

committed doctor to perform the treatment, whatever it is. The

best doctors in any specialty have a significantly higher rate of

success than average run-of-the-mill doctors. I had a

combination of external beam x-ray therapy plus " high dose rate "

brachytherapy, and have had a good outcome with limited side

effects. I know others who can say the same with each of the

treatment modalities.

You mentioned M.D. . It's a famous cancer center with

very good doctors. There are many other such places. I think

most large cities will have at least one really good cancer

clinic.

Whatever happens, the situation is probably more optimistic than

it first appeared. There are men in this group diagnosed 10 or

more years ago that are still with us and still in good health.

Best of luck.

Alan

August 14, 2008

>

> Alan,

>

> You said <snip> In general, I'm inclined to think that the younger

a man is

> when diagnosed with cancer, the more attractive becomes the idea of

> treatment. If, for example, your husband is 55 years old and might

> reasonably expect to live for another 30 years, then even a small cancer

> could well become life threatening during that period, and treating it

> early, while it is still small, may give a better chance for a complete

> cure. <snip>

>

> I know that this is a general view and I cannot say it is incorrect,

but I

> have often speculated about its validity and wonder if you would care to

> expand a little.

....

Terry,

I'll have to do some research and get back to you on this.

It is my recollection that the 5 and 10 year survival rates

after diagnosis are very good, but that the 20 year survival

rate is poor, and not very good even for cancers diagnosed

as Gleason 6 at the outset.

But, that's just my recollection. I'll see if I can find the

facts and some citations to back them up.

Alan

August 14, 2008

>

> Alan,

>

> You said <snip> In general, I'm inclined to think that the younger

a man is

> when diagnosed with cancer, the more attractive becomes the idea of

> treatment. If, for example, your husband is 55 years old and might

> reasonably expect to live for another 30 years, then even a small cancer

> could well become life threatening during that period, and treating it

> early, while it is still small, may give a better chance for a complete

> cure. <snip>

>

> I know that this is a general view and I cannot say it is incorrect,

but I

> have often speculated about its validity and wonder if you would care to

> expand a little.

....

Terry,

I'll have to do some research and get back to you on this.

It is my recollection that the 5 and 10 year survival rates

after diagnosis are very good, but that the 20 year survival

rate is poor, and not very good even for cancers diagnosed

as Gleason 6 at the outset.

But, that's just my recollection. I'll see if I can find the

facts and some citations to back them up.

Alan

August 14, 2008

Terry we have to be careful to not assume

that an individual should make a treatment decision based on a medium

statistical based report. We all know men who have died in their 40’s or

50’s

Unfortunately there is no good data for

younger men using AS as an option. We lack good information on other treatments

also.

That said, I believe that there are men in

this age group who should and could use AS BUT at this time we do not know who

they are.

Item 3 is irrelevant to a person who has

been diagnosed with prostate cancer.

The decision has to be made after learning

as much as a person can and made on an individual basis. AS is one of the

options that every man should consider.

Kathy

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Terry Herbert

Sent: Thursday, August 14, 2008

4:20 AM

To:

ProstateCancerSupport

Subject:

Younger men on AS was...... Answers, Ideas and Comments, Please

Alan,

You said <snip> In general, I'm inclined to think that

the younger a man is when diagnosed with cancer, the more attractive becomes

the idea of treatment. If, for example, your husband is 55 years old and might

reasonably expect to live for another 30 years, then even a small cancer could

well become life threatening during that period, and treating it early, while

it is still small, may give a better chance for a complete cure. <snip>

I know that this is a general view and I cannot say it is

incorrect, but I have often speculated about its validity and wonder if you

would care to expand a little. Here’s my view:

we know that the median age for

death from PCa is a little over 80 years of age – so clearly most of

the men diagnosed with PCa will live until they are older than 80.

the mortality rates rise very

sharply with age. I understand that more than 90% of deaths occur in men

over the age of 70

PCa deaths account for about 3%

of all male deaths: 97% of male deaths are from some cause other than PCa.

the diagnostic pointer most

often associated with fatal forms of PCa is the Gleason Grade with high

Gleason Grades (over 4+3) being the most consistent pointer.

Given these basics (and there are other issues that might sharpen

the focus) then my personal view is that the chances are very much greater that

a man aged 55 choosing Active Surveillance would have a very much higher chance

of dying within 30 years from something other than PCa. This would be

especially true if he has one small focus of what might be termed

“prostatic tubular neogenesis” if Dr Jon Oppenheimer’s

suggestion were ever adopted – see http://theprostateblog.blogspot.com/

What do you think – where am I going wrong?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr “Snuffy” Myers : " As a physician, I am painfully aware that

most of the decisions we make with regard to prostate cancer are made with

inadequate data "

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Alan Meyer

Sent: Thursday, 14 August 2008

2:27 PM

To: ProstateCancerSupport

Subject:

Re: Answers, Ideas and Comments, Please

>

> Hello,

> I'm new to the group and my husband has just been diagnosed w/

> PC, PCA: 7.5, Gleason: 6 (from 12 areas of prostate - only one

> area showed a cancer cell). He has mild hypertension and

> possible diabetes 2, but otherwise very healthy and active.

> I'm in " the maze " of confusing physician opinions which range

> from Watchful Waiting to IMRT, and would really appreciate some

> input from this experienced group!

,

You haven't said how old your husband is. In general, I'm

inclined to think that the younger a man is when diagnosed with

cancer, the more attractive becomes the idea of treatment. If,

for example, your husband is 55 years old and might reasonably

expect to live for another 30 years, then even a small cancer

could well become life threatening during that period, and

treating it early, while it is still small, may give a better

chance for a complete cure.

On the other hand, if he's 75 years old, then it may be

reasonable to expect that he'll never have any problem with the

cancer and shouldn't treat it at all.

Having said that, I nevertheless have to say that I agree with

Terry that your husband's cancer may be small and insignificant

enough that no treatment is warranted for a quite a long time.

If that's true (and I'm not a doctor and certainly not qualified

to say if it is true), the benefits of " watchful waiting " or

" active surveillance " as it is now called, are that there are no

treatment side effects, no costs, and the possibility that better

treatments will be available if and when he needs them.

You have seen more than one doctor to get second opinions.

That's an excellent idea. You might also get a second opinion on

the biopsy slides. Analyzing cancer cells under a microscope is

a notoriously difficult thing to do and the best labs sometimes

come up with a different report than the low bidder labs. If the

Gleason is really 7 instead of 6, or if the cancer is really in 5

samples, not 1, then it's a different situation. (Mine were

evaluated by three labs and I got three different reports.)

Insurers do usually pay for second opinions on biopsy slides.

Search through the archives of this list for postings by Steve

Jordan.

He has listed a number of the best labs for prostate

biopsy analysis.

If you do decide on watchful waiting, the key thing is

watchfulness. You should discuss it with a doctor, setup a

program of regular PSA tests, and discuss with the doctor what

should signal the end of waiting and the beginning of treatment.

If the signal arrives, take action.

As to what actions to take, in my personal view, the major

treatments - surgery, external beam radiation (proton or x-ray),

brachytherapy (implanted radioactive seeds) - all work well when

the cancer has not grown beyond the prostate. To my mind, the

key thing is to find a highly experienced, competent, caring, and

committed doctor to perform the treatment, whatever it is. The

best doctors in any specialty have a significantly higher rate of

success than average run-of-the-mill doctors. I had a

combination of external beam x-ray therapy plus " high dose rate "

brachytherapy, and have had a good outcome with limited side

effects. I know others who can say the same with each of the

treatment modalities.

You mentioned M.D. . It's a famous cancer center with

very good doctors. There are many other such places. I think

most large cities will have at least one really good cancer

clinic.

Whatever happens, the situation is probably more optimistic than

it first appeared. There are men in this group diagnosed 10 or

more years ago that are still with us and still in good health.

Best of luck.

Alan

August 14, 2008

Terry we have to be careful to not assume

that an individual should make a treatment decision based on a medium

statistical based report. We all know men who have died in their 40’s or

50’s

Unfortunately there is no good data for

younger men using AS as an option. We lack good information on other treatments

also.

That said, I believe that there are men in

this age group who should and could use AS BUT at this time we do not know who

they are.

Item 3 is irrelevant to a person who has

been diagnosed with prostate cancer.

The decision has to be made after learning

as much as a person can and made on an individual basis. AS is one of the

options that every man should consider.

Kathy

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Terry Herbert

Sent: Thursday, August 14, 2008

4:20 AM

To:

ProstateCancerSupport

Subject:

Younger men on AS was...... Answers, Ideas and Comments, Please

Alan,

You said <snip> In general, I'm inclined to think that

the younger a man is when diagnosed with cancer, the more attractive becomes

the idea of treatment. If, for example, your husband is 55 years old and might

reasonably expect to live for another 30 years, then even a small cancer could

well become life threatening during that period, and treating it early, while

it is still small, may give a better chance for a complete cure. <snip>

I know that this is a general view and I cannot say it is

incorrect, but I have often speculated about its validity and wonder if you

would care to expand a little. Here’s my view:

we know that the median age for

death from PCa is a little over 80 years of age – so clearly most of

the men diagnosed with PCa will live until they are older than 80.

the mortality rates rise very

sharply with age. I understand that more than 90% of deaths occur in men

over the age of 70

PCa deaths account for about 3%

of all male deaths: 97% of male deaths are from some cause other than PCa.

the diagnostic pointer most

often associated with fatal forms of PCa is the Gleason Grade with high

Gleason Grades (over 4+3) being the most consistent pointer.

Given these basics (and there are other issues that might sharpen

the focus) then my personal view is that the chances are very much greater that

a man aged 55 choosing Active Surveillance would have a very much higher chance

of dying within 30 years from something other than PCa. This would be

especially true if he has one small focus of what might be termed

“prostatic tubular neogenesis” if Dr Jon Oppenheimer’s

suggestion were ever adopted – see http://theprostateblog.blogspot.com/

What do you think – where am I going wrong?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr “Snuffy” Myers : " As a physician, I am painfully aware that

most of the decisions we make with regard to prostate cancer are made with

inadequate data "

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Alan Meyer

Sent: Thursday, 14 August 2008

2:27 PM

To: ProstateCancerSupport

Subject:

Re: Answers, Ideas and Comments, Please

>

> Hello,

> I'm new to the group and my husband has just been diagnosed w/

> PC, PCA: 7.5, Gleason: 6 (from 12 areas of prostate - only one

> area showed a cancer cell). He has mild hypertension and

> possible diabetes 2, but otherwise very healthy and active.

> I'm in " the maze " of confusing physician opinions which range

> from Watchful Waiting to IMRT, and would really appreciate some

> input from this experienced group!

,

You haven't said how old your husband is. In general, I'm

inclined to think that the younger a man is when diagnosed with

cancer, the more attractive becomes the idea of treatment. If,

for example, your husband is 55 years old and might reasonably

expect to live for another 30 years, then even a small cancer

could well become life threatening during that period, and

treating it early, while it is still small, may give a better

chance for a complete cure.

On the other hand, if he's 75 years old, then it may be

reasonable to expect that he'll never have any problem with the

cancer and shouldn't treat it at all.

Having said that, I nevertheless have to say that I agree with

Terry that your husband's cancer may be small and insignificant

enough that no treatment is warranted for a quite a long time.

If that's true (and I'm not a doctor and certainly not qualified

to say if it is true), the benefits of " watchful waiting " or

" active surveillance " as it is now called, are that there are no

treatment side effects, no costs, and the possibility that better

treatments will be available if and when he needs them.

You have seen more than one doctor to get second opinions.

That's an excellent idea. You might also get a second opinion on

the biopsy slides. Analyzing cancer cells under a microscope is

a notoriously difficult thing to do and the best labs sometimes

come up with a different report than the low bidder labs. If the

Gleason is really 7 instead of 6, or if the cancer is really in 5

samples, not 1, then it's a different situation. (Mine were

evaluated by three labs and I got three different reports.)

Insurers do usually pay for second opinions on biopsy slides.

Search through the archives of this list for postings by Steve

Jordan.

He has listed a number of the best labs for prostate

biopsy analysis.

If you do decide on watchful waiting, the key thing is

watchfulness. You should discuss it with a doctor, setup a

program of regular PSA tests, and discuss with the doctor what

should signal the end of waiting and the beginning of treatment.

If the signal arrives, take action.

As to what actions to take, in my personal view, the major

treatments - surgery, external beam radiation (proton or x-ray),

brachytherapy (implanted radioactive seeds) - all work well when

the cancer has not grown beyond the prostate. To my mind, the

key thing is to find a highly experienced, competent, caring, and

committed doctor to perform the treatment, whatever it is. The

best doctors in any specialty have a significantly higher rate of

success than average run-of-the-mill doctors. I had a

combination of external beam x-ray therapy plus " high dose rate "

brachytherapy, and have had a good outcome with limited side

effects. I know others who can say the same with each of the

treatment modalities.

You mentioned M.D. . It's a famous cancer center with

very good doctors. There are many other such places. I think

most large cities will have at least one really good cancer

clinic.

Whatever happens, the situation is probably more optimistic than

it first appeared. There are men in this group diagnosed 10 or

more years ago that are still with us and still in good health.

Best of luck.

Alan

August 14, 2008

Kathy

I suppose there are some things that will always be true.

That despite the knowledge about choices including AS it will be in the nature of some men to opt for radical treatment. We should not criticise this choice. Our aim is to get the full info about choice out to enable the new patient knowledge on which to base his decision in consultation with those who are close to him.

The choice of AS includes the implication that if there is signs of progression then treatment will be taken up.

As you say we don't know yet what proportion of men with low grade PCa diagnosed in their 40s and 50s will never need to do any more than ensure they eat a good diet. I think as AS is studied further the regime will be refined and even better info can be given.

The knack is spotting movement before the tumour escapes from the gland....

RE: Younger men on AS was...... Answers, Ideas and Comments, Please

Terry we have to be careful to not assume that an individual should make a treatment decision based on a medium statistical based report. We all know men who have died in their 40’s or 50’s

Unfortunately there is no good data for younger men using AS as an option. We lack good information on other treatments also.

That said, I believe that there are men in this age group who should and could use AS BUT at this time we do not know who they are.

Item 3 is irrelevant to a person who has been diagnosed with prostate cancer.

The decision has to be made after learning as much as a person can and made on an individual basis. AS is one of the options that every man should consider.

Kathy

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Terry HerbertSent: Thursday, August 14, 2008 4:20 AMTo: ProstateCancerSupport Subject: Younger men on AS was...... Answers, Ideas and Comments, Please

Alan,

You said <snip> In general, I'm inclined to think that the younger a man is when diagnosed with cancer, the more attractive becomes the idea of treatment. If, for example, your husband is 55 years old and might reasonably expect to live for another 30 years, then even a small cancer could well become life threatening during that period, and treating it early, while it is still small, may give a better chance for a complete cure. <snip>

I know that this is a general view and I cannot say it is incorrect, but I have often speculated about its validity and wonder if you would care to expand a little. Here’s my view:

we know that the median age for death from PCa is a little over 80 years of age – so clearly most of the men diagnosed with PCa will live until they are older than 80.

the mortality rates rise very sharply with age. I understand that more than 90% of deaths occur in men over the age of 70

PCa deaths account for about 3% of all male deaths: 97% of male deaths are from some cause other than PCa.

the diagnostic pointer most often associated with fatal forms of PCa is the Gleason Grade with high Gleason Grades (over 4+3) being the most consistent pointer.

Given these basics (and there are other issues that might sharpen the focus) then my personal view is that the chances are very much greater that a man aged 55 choosing Active Surveillance would have a very much higher chance of dying within 30 years from something other than PCa. This would be especially true if he has one small focus of what might be termed “prostatic tubular neogenesis” if Dr Jon Oppenheimer’s suggestion were ever adopted – see http://theprostateblog.blogspot.com/

What do you think – where am I going wrong?

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data"

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Alan MeyerSent: Thursday, 14 August 2008 2:27 PMTo: ProstateCancerSupport Subject: Re: Answers, Ideas and Comments, Please

>> Hello,> I'm new to the group and my husband has just been diagnosed w/> PC, PCA: 7.5, Gleason: 6 (from 12 areas of prostate - only one> area showed a cancer cell). He has mild hypertension and> possible diabetes 2, but otherwise very healthy and active.> I'm in "the maze" of confusing physician opinions which range> from Watchful Waiting to IMRT, and would really appreciate some> input from this experienced group!,You haven't said how old your husband is. In general, I'minclined to think that the younger a man is when diagnosed withcancer, the more attractive becomes the idea of treatment. If,for example, your husband is 55 years old and might reasonablyexpect to live for another 30 years, then even a small cancercould well become life threatening during that period, andtreating it early, while it is still small, may give a betterchance for a complete cure.On the other hand, if he's 75 years old, then it may bereasonable to expect that he'll never have any problem with thecancer and shouldn't treat it at all.Having said that, I nevertheless have to say that I agree withTerry that your husband's cancer may be small and insignificantenough that no treatment is warranted for a quite a long time.If that's true (and I'm not a doctor and certainly not qualifiedto say if it is true), the benefits of "watchful waiting" or"active surveillance" as it is now called, are that there are notreatment side effects, no costs, and the possibility that bettertreatments will be available if and when he needs them.You have seen more than one doctor to get second opinions.That's an excellent idea. You might also get a second opinion onthe biopsy slides. Analyzing cancer cells under a microscope isa notoriously difficult thing to do and the best labs sometimescome up with a different report than the low bidder labs. If theGleason is really 7 instead of 6, or if the cancer is really in 5samples, not 1, then it's a different situation. (Mine wereevaluated by three labs and I got three different reports.)Insurers do usually pay for second opinions on biopsy slides.Search through the archives of this list for postings by SteveJordan. He has listed a number of the best labs for prostatebiopsy analysis.If you do decide on watchful waiting, the key thing iswatchfulness. You should discuss it with a doctor, setup aprogram of regular PSA tests, and discuss with the doctor whatshould signal the end of waiting and the beginning of treatment.If the signal arrives, take action.As to what actions to take, in my personal view, the majortreatments - surgery, external beam radiation (proton or x-ray),brachytherapy (implanted radioactive seeds) - all work well whenthe cancer has not grown beyond the prostate. To my mind, thekey thing is to find a highly experienced, competent, caring, andcommitted doctor to perform the treatment, whatever it is. Thebest doctors in any specialty have a significantly higher rate ofsuccess than average run-of-the-mill doctors. I had acombination of external beam x-ray therapy plus "high dose rate"brachytherapy, and have had a good outcome with limited sideeffects. I know others who can say the same with each of thetreatment modalities.You mentioned M.D. . It's a famous cancer center withvery good doctors. There are many other such places. I thinkmost large cities will have at least one really good cancerclinic.Whatever happens, the situation is probably more optimistic thanit first appeared. There are men in this group diagnosed 10 ormore years ago that are still with us and still in good health.Best of luck.Alan

August 14, 2008

,

I agree with you 100% and I am sorry if I

sounded as if I was “pushing” any treatment. If a man has learned

all his options then his decision is the correct decision for him.

Kathy

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Metcalf

Sent: Thursday, August 14, 2008

6:39 PM

To:

ProstateCancerSupport

Subject: Re:

Younger men on AS was...... Answers, Ideas and

Comments, Please

Kathy

I suppose there are some things that will always be true.

That despite the knowledge about choices including AS it

will be in the nature of some men to opt for radical treatment. We should

not criticise this choice. Our aim is to get the full info about choice out to

enable the new patient knowledge on which to base his decision in consultation

with those who are close to him.

The choice of AS includes the implication that if there is

signs of progression then treatment will be taken up.

As you say we don't know yet what proportion of men with low

grade PCa diagnosed in their 40s and 50s will never need to do any more than

ensure they eat a good diet. I think as AS is studied further the regime will

be refined and even better info can be given.

The knack is spotting movement before the tumour escapes

from the gland....

Re: Answers, Ideas and Comments, Please

>

> Hello,

> I'm new to the group and my husband has just been diagnosed w/

> PC, PCA: 7.5, Gleason: 6 (from 12 areas of prostate - only one

> area showed a cancer cell). He has mild hypertension and

> possible diabetes 2, but otherwise very healthy and active.

> I'm in " the maze " of confusing physician opinions which range

> from Watchful Waiting to IMRT, and would really appreciate some

> input from this experienced group!

,

You haven't said how old your husband is. In general, I'm

inclined to think that the younger a man is when diagnosed with

cancer, the more attractive becomes the idea of treatment. If,

for example, your husband is 55 years old and might reasonably

expect to live for another 30 years, then even a small cancer

could well become life threatening during that period, and

treating it early, while it is still small, may give a better

chance for a complete cure.

On the other hand, if he's 75 years old, then it may be

reasonable to expect that he'll never have any problem with the

cancer and shouldn't treat it at all.

Having said that, I nevertheless have to say that I agree with

Terry that your husband's cancer may be small and insignificant

enough that no treatment is warranted for a quite a long time.

If that's true (and I'm not a doctor and certainly not qualified

to say if it is true), the benefits of " watchful waiting " or

" active surveillance " as it is now called, are that there are no

treatment side effects, no costs, and the possibility that better

treatments will be available if and when he needs them.

You have seen more than one doctor to get second opinions.

That's an excellent idea. You might also get a second opinion on

the biopsy slides. Analyzing cancer cells under a microscope is

a notoriously difficult thing to do and the best labs sometimes

come up with a different report than the low bidder labs. If the

Gleason is really 7 instead of 6, or if the cancer is really in 5

samples, not 1, then it's a different situation. (Mine were

evaluated by three labs and I got three different reports.)

Insurers do usually pay for second opinions on biopsy slides.

Search through the archives of this list for postings by Steve

Jordan.

He has listed a number of the best labs for prostate

biopsy analysis.

If you do decide on watchful waiting, the key thing is

watchfulness. You should discuss it with a doctor, setup a

program of regular PSA tests, and discuss with the doctor what

should signal the end of waiting and the beginning of treatment.

If the signal arrives, take action.

As to what actions to take, in my personal view, the major

treatments - surgery, external beam radiation (proton or x-ray),

brachytherapy (implanted radioactive seeds) - all work well when

the cancer has not grown beyond the prostate. To my mind, the

key thing is to find a highly experienced, competent, caring, and

committed doctor to perform the treatment, whatever it is. The

best doctors in any specialty have a significantly higher rate of

success than average run-of-the-mill doctors. I had a

combination of external beam x-ray therapy plus " high dose rate "

brachytherapy, and have had a good outcome with limited side

effects. I know others who can say the same with each of the

treatment modalities.

You mentioned M.D. . It's a famous cancer center with

very good doctors. There are many other such places. I think

most large cities will have at least one really good cancer

clinic.

Whatever happens, the situation is probably more optimistic than

it first appeared. There are men in this group diagnosed 10 or

more years ago that are still with us and still in good health.

Best of luck.

Alan

August 14, 2008

,

I agree with you 100% and I am sorry if I

sounded as if I was “pushing” any treatment. If a man has learned

all his options then his decision is the correct decision for him.

Kathy

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Metcalf

Sent: Thursday, August 14, 2008

6:39 PM

To:

ProstateCancerSupport

Subject: Re:

Younger men on AS was...... Answers, Ideas and

Comments, Please

Kathy

I suppose there are some things that will always be true.

That despite the knowledge about choices including AS it

will be in the nature of some men to opt for radical treatment. We should

not criticise this choice. Our aim is to get the full info about choice out to

enable the new patient knowledge on which to base his decision in consultation

with those who are close to him.

The choice of AS includes the implication that if there is

signs of progression then treatment will be taken up.

As you say we don't know yet what proportion of men with low

grade PCa diagnosed in their 40s and 50s will never need to do any more than

ensure they eat a good diet. I think as AS is studied further the regime will

be refined and even better info can be given.

The knack is spotting movement before the tumour escapes

from the gland....

Re: Answers, Ideas and Comments, Please

>

> Hello,

> I'm new to the group and my husband has just been diagnosed w/

> PC, PCA: 7.5, Gleason: 6 (from 12 areas of prostate - only one

> area showed a cancer cell). He has mild hypertension and

> possible diabetes 2, but otherwise very healthy and active.

> I'm in " the maze " of confusing physician opinions which range

> from Watchful Waiting to IMRT, and would really appreciate some

> input from this experienced group!

,

You haven't said how old your husband is. In general, I'm

inclined to think that the younger a man is when diagnosed with

cancer, the more attractive becomes the idea of treatment. If,

for example, your husband is 55 years old and might reasonably

expect to live for another 30 years, then even a small cancer

could well become life threatening during that period, and

treating it early, while it is still small, may give a better

chance for a complete cure.

On the other hand, if he's 75 years old, then it may be

reasonable to expect that he'll never have any problem with the

cancer and shouldn't treat it at all.

Having said that, I nevertheless have to say that I agree with

Terry that your husband's cancer may be small and insignificant

enough that no treatment is warranted for a quite a long time.

If that's true (and I'm not a doctor and certainly not qualified

to say if it is true), the benefits of " watchful waiting " or

" active surveillance " as it is now called, are that there are no

treatment side effects, no costs, and the possibility that better

treatments will be available if and when he needs them.

You have seen more than one doctor to get second opinions.

That's an excellent idea. You might also get a second opinion on

the biopsy slides. Analyzing cancer cells under a microscope is

a notoriously difficult thing to do and the best labs sometimes

come up with a different report than the low bidder labs. If the

Gleason is really 7 instead of 6, or if the cancer is really in 5

samples, not 1, then it's a different situation. (Mine were

evaluated by three labs and I got three different reports.)

Insurers do usually pay for second opinions on biopsy slides.

Search through the archives of this list for postings by Steve

Jordan.

He has listed a number of the best labs for prostate

biopsy analysis.

If you do decide on watchful waiting, the key thing is

watchfulness. You should discuss it with a doctor, setup a

program of regular PSA tests, and discuss with the doctor what

should signal the end of waiting and the beginning of treatment.

If the signal arrives, take action.

As to what actions to take, in my personal view, the major

treatments - surgery, external beam radiation (proton or x-ray),

brachytherapy (implanted radioactive seeds) - all work well when

the cancer has not grown beyond the prostate. To my mind, the

key thing is to find a highly experienced, competent, caring, and

committed doctor to perform the treatment, whatever it is. The

best doctors in any specialty have a significantly higher rate of

success than average run-of-the-mill doctors. I had a

combination of external beam x-ray therapy plus " high dose rate "

brachytherapy, and have had a good outcome with limited side

effects. I know others who can say the same with each of the

treatment modalities.

You mentioned M.D. . It's a famous cancer center with

very good doctors. There are many other such places. I think

most large cities will have at least one really good cancer

clinic.

Whatever happens, the situation is probably more optimistic than

it first appeared. There are men in this group diagnosed 10 or

more years ago that are still with us and still in good health.

Best of luck.

Alan

August 14, 2008

,

I agree with you 100% and I am sorry if I

sounded as if I was “pushing” any treatment. If a man has learned

all his options then his decision is the correct decision for him.

Kathy

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Metcalf

Sent: Thursday, August 14, 2008

6:39 PM

To:

ProstateCancerSupport

Subject: Re:

Younger men on AS was...... Answers, Ideas and

Comments, Please

Kathy

I suppose there are some things that will always be true.

That despite the knowledge about choices including AS it

will be in the nature of some men to opt for radical treatment. We should

not criticise this choice. Our aim is to get the full info about choice out to

enable the new patient knowledge on which to base his decision in consultation

with those who are close to him.

The choice of AS includes the implication that if there is

signs of progression then treatment will be taken up.

As you say we don't know yet what proportion of men with low

grade PCa diagnosed in their 40s and 50s will never need to do any more than

ensure they eat a good diet. I think as AS is studied further the regime will

be refined and even better info can be given.

The knack is spotting movement before the tumour escapes

from the gland....

Re: Answers, Ideas and Comments, Please

>

> Hello,

> I'm new to the group and my husband has just been diagnosed w/

> PC, PCA: 7.5, Gleason: 6 (from 12 areas of prostate - only one

> area showed a cancer cell). He has mild hypertension and

> possible diabetes 2, but otherwise very healthy and active.

> I'm in " the maze " of confusing physician opinions which range

> from Watchful Waiting to IMRT, and would really appreciate some

> input from this experienced group!

,

You haven't said how old your husband is. In general, I'm

inclined to think that the younger a man is when diagnosed with

cancer, the more attractive becomes the idea of treatment. If,

for example, your husband is 55 years old and might reasonably

expect to live for another 30 years, then even a small cancer

could well become life threatening during that period, and

treating it early, while it is still small, may give a better

chance for a complete cure.

On the other hand, if he's 75 years old, then it may be

reasonable to expect that he'll never have any problem with the

cancer and shouldn't treat it at all.

Having said that, I nevertheless have to say that I agree with

Terry that your husband's cancer may be small and insignificant

enough that no treatment is warranted for a quite a long time.

If that's true (and I'm not a doctor and certainly not qualified

to say if it is true), the benefits of " watchful waiting " or

" active surveillance " as it is now called, are that there are no

treatment side effects, no costs, and the possibility that better

treatments will be available if and when he needs them.

You have seen more than one doctor to get second opinions.

That's an excellent idea. You might also get a second opinion on

the biopsy slides. Analyzing cancer cells under a microscope is

a notoriously difficult thing to do and the best labs sometimes

come up with a different report than the low bidder labs. If the

Gleason is really 7 instead of 6, or if the cancer is really in 5

samples, not 1, then it's a different situation. (Mine were

evaluated by three labs and I got three different reports.)

Insurers do usually pay for second opinions on biopsy slides.

Search through the archives of this list for postings by Steve

Jordan.

He has listed a number of the best labs for prostate

biopsy analysis.

If you do decide on watchful waiting, the key thing is

watchfulness. You should discuss it with a doctor, setup a

program of regular PSA tests, and discuss with the doctor what

should signal the end of waiting and the beginning of treatment.

If the signal arrives, take action.

As to what actions to take, in my personal view, the major

treatments - surgery, external beam radiation (proton or x-ray),

brachytherapy (implanted radioactive seeds) - all work well when

the cancer has not grown beyond the prostate. To my mind, the

key thing is to find a highly experienced, competent, caring, and

committed doctor to perform the treatment, whatever it is. The

best doctors in any specialty have a significantly higher rate of

success than average run-of-the-mill doctors. I had a

combination of external beam x-ray therapy plus " high dose rate "

brachytherapy, and have had a good outcome with limited side

effects. I know others who can say the same with each of the

treatment modalities.

You mentioned M.D. . It's a famous cancer center with

very good doctors. There are many other such places. I think

most large cities will have at least one really good cancer

clinic.

Whatever happens, the situation is probably more optimistic than

it first appeared. There are men in this group diagnosed 10 or

more years ago that are still with us and still in good health.

Best of luck.

Alan

August 14, 2008

> >

> > Hello,

> > I'm new to the group and my husband has just been diagnosed w/

> > PC, PCA: 7.5, Gleason: 6 (from 12 areas of prostate - only one

> > area showed a cancer cell). He has mild hypertension and

> > possible diabetes 2, but otherwise very healthy and active.

> > I'm in " the maze " of confusing physician opinions which range

> > from Watchful Waiting to IMRT, and would really appreciate some

> > input from this experienced group!

>

> ,

>

> You haven't said how old your husband is. In general, I'm

> inclined to think that the younger a man is when diagnosed with

> cancer, the more attractive becomes the idea of treatment. If,

> for example, your husband is 55 years old and might reasonably

> expect to live for another 30 years, then even a small cancer

> could well become life threatening during that period, and

> treating it early, while it is still small, may give a better

> chance for a complete cure.

>

> On the other hand, if he's 75 years old, then it may be

> reasonable to expect that he'll never have any problem with the

> cancer and shouldn't treat it at all.

>

> Having said that, I nevertheless have to say that I agree with

> Terry that your husband's cancer may be small and insignificant

> enough that no treatment is warranted for a quite a long time.

> If that's true (and I'm not a doctor and certainly not qualified

> to say if it is true), the benefits of " watchful waiting " or

> " active surveillance " as it is now called, are that there are no

> treatment side effects, no costs, and the possibility that better

> treatments will be available if and when he needs them.

>

> You have seen more than one doctor to get second opinions.

> That's an excellent idea. You might also get a second opinion on

> the biopsy slides. Analyzing cancer cells under a microscope is

> a notoriously difficult thing to do and the best labs sometimes

> come up with a different report than the low bidder labs. If the

> Gleason is really 7 instead of 6, or if the cancer is really in 5

> samples, not 1, then it's a different situation. (Mine were

> evaluated by three labs and I got three different reports.)

> Insurers do usually pay for second opinions on biopsy slides.

> Search through the archives of this list for postings by Steve

> Jordan. He has listed a number of the best labs for prostate

> biopsy analysis.

>

> If you do decide on watchful waiting, the key thing is

> watchfulness. You should discuss it with a doctor, setup a

> program of regular PSA tests, and discuss with the doctor what

> should signal the end of waiting and the beginning of treatment.

> If the signal arrives, take action.

>

> As to what actions to take, in my personal view, the major

> treatments - surgery, external beam radiation (proton or x-ray),

> brachytherapy (implanted radioactive seeds) - all work well when

> the cancer has not grown beyond the prostate. To my mind, the

> key thing is to find a highly experienced, competent, caring, and

> committed doctor to perform the treatment, whatever it is. The

> best doctors in any specialty have a significantly higher rate of

> success than average run-of-the-mill doctors. I had a

> combination of external beam x-ray therapy plus " high dose rate "

> brachytherapy, and have had a good outcome with limited side

> effects. I know others who can say the same with each of the

> treatment modalities.

>

> You mentioned M.D. . It's a famous cancer center with

> very good doctors. There are many other such places. I think

> most large cities will have at least one really good cancer

> clinic.

>

> Whatever happens, the situation is probably more optimistic than

> it first appeared. There are men in this group diagnosed 10 or

> more years ago that are still with us and still in good health.

>

> Best of luck.

>

> Alan

August 14, 2008