Re: Active surveillance with diet/lifestyle changes in a Gleason 7?

[Guest guest]

Joe,

If I were in your shoes I would get myself a few serial PSA tests done before

making a decision. I'd ask the urologist to Rx me a %free PSA and estimate of

PSA density at the start of all this, and then after six months.

Just two tests separated by a month or so will give you a pretty good idea of

PSAV (PSA velocity) using standard tumor kinetic algorithms described in the

study quoted below[1]. [ Interestingly, that study did not look at serum vitamin

D or amount of circulating growth factors, or amount of exercise, or

vegetarian & non-dairy vs 'normal' diet. BTW Sherri, I think your advice is well

worth trying ! Good luck to your husband. ]

Joe - A few months of active surveillance with diet and lifestyle changes may be

enough to give you a negative PSA velocity. If it does not produce the desired

effect you can go on to the next stage with the confiodence of knowing you (and

your doctor) are not overreacting to the diagnosis.

Best of luck,

Sammy.

http://fitcare.org.uk/

1. Tumour Biol. 2010 Apr;31(2):97-102. Epub 2010 Feb 16.

Serum micronutrient and antioxidant levels at baseline and the natural history

of

men with localised prostate cancer on active surveillance.

Venkitaraman R, K, Grace P, Dearnaley DP, Horwich A, Huddart RA,

CC.

Department of Clinical Oncology, Ipswich Hospital NHS Trust, Ipswich, Suffolk,

UK, drvramachandran@....

The aim of this study was to determine whether serum concentrations of

micronutrients, antioxidants and vitamins predict rate of disease progression in

untreated, localised prostate cancer. Patients with localised prostatic

adenocarcinoma on a prospective study of active surveillance underwent

monitoring

with serial PSA levels and repeat prostate biopsies. Disease progression was

defined as either adverse histology on repeat biopsy (primary Gleason grade >/=4

or >50% positive cores of total) or radical treatment for PSA velocity >1 ng

ml(-1) year(-1). Time to disease progression was analysed with respect to

baseline levels of alpha-tocopherol, gamma-tocopherol, alpha-carotene and

beta-carotene, lycopene, retinol and selenium. One hundred four patients were

evaluable, with a median follow-up of 2.5 years. Thirty-eight patients

experienced disease progression, 13 biochemical and 25 histologic progression.

Median time to disease progression was 2.62 years. No significant association

was

seen between time to disease progression and baseline serum levels of

alpha-tocopherol (p = 0.86), gamma-tocopherol (p = 0.84), alpha-carotenoid (p =

0.66), beta-carotene (p = 0.65), lycopene (p = 0.0.15), retinol (p = 0.76) or

selenium (p = 0.76). No significant association was seen between serum levels of

the micronutrients, antioxidants or vitamins and either adverse histology on

repeat biopsy or PSA velocity. Our data do not support the hypothesis that high

serum concentrations of micronutrients, antioxidants and vitamins prevent

disease

progression in men with localised prostate cancer.

PMID: 20358422

>

> A week ago I received the diagnosis of PC and am amazed at how much

information and support is out there. It definitely softens the blow. I've been

doing some hard thinking and would greatly value feedback on the way I'm

thinking about treatment.

>

> Basic stats: 62 y.o. in decent health. psa 6.9, dre benign, Stage T1c, Gleason

3+4, 3/10 samples have cancer, all on the right side. In 2 about 1/2 of the

sample is involved (6 and 9 mm). No evidence of extraprostate extension and

remaining cores are benign. I've been having some minor, but definite

symptoms--frequency/urgency increase, discomfort at end of ejaculation and at

night voiding can be difficult.

>

> The urologist recommends radical prostatectomy. Brachytherapy would have a

similar cure rate. I will be seeing a rad'n oncologist for opinion.

>

> I would like to try active surveillance for 6 months with intensive

diet/lifestyle changes (something like the Ornish method --see J. Urol,

2005,174, 1065-9). But, it seems that this approach is pretty low on the

treatment totem pole for a G7 with my cancer volume.

>

> Does it make sense to do this given my age and maybe another 20 to 30 years

to go? Are there studies? Does it make sense to get the slides reviewed by

someone else? What is the likely outcome if I don't treat? What's the

probability of death from the cancer and when? Data on that?

> Many thanks for feedback,

>

> Joe

>

> B.C., Canada

>

[Guest guest]

Joe,

If I were in your shoes I would get myself a few serial PSA tests done before

making a decision. I'd ask the urologist to Rx me a %free PSA and estimate of

PSA density at the start of all this, and then after six months.

Just two tests separated by a month or so will give you a pretty good idea of

PSAV (PSA velocity) using standard tumor kinetic algorithms described in the

study quoted below[1]. [ Interestingly, that study did not look at serum vitamin

D or amount of circulating growth factors, or amount of exercise, or

vegetarian & non-dairy vs 'normal' diet. BTW Sherri, I think your advice is well

worth trying ! Good luck to your husband. ]

Joe - A few months of active surveillance with diet and lifestyle changes may be

enough to give you a negative PSA velocity. If it does not produce the desired

effect you can go on to the next stage with the confiodence of knowing you (and

your doctor) are not overreacting to the diagnosis.

Best of luck,

Sammy.

http://fitcare.org.uk/

1. Tumour Biol. 2010 Apr;31(2):97-102. Epub 2010 Feb 16.

Serum micronutrient and antioxidant levels at baseline and the natural history

of

men with localised prostate cancer on active surveillance.

Venkitaraman R, K, Grace P, Dearnaley DP, Horwich A, Huddart RA,

CC.

Department of Clinical Oncology, Ipswich Hospital NHS Trust, Ipswich, Suffolk,

UK, drvramachandran@....

The aim of this study was to determine whether serum concentrations of

micronutrients, antioxidants and vitamins predict rate of disease progression in

untreated, localised prostate cancer. Patients with localised prostatic

adenocarcinoma on a prospective study of active surveillance underwent

monitoring

with serial PSA levels and repeat prostate biopsies. Disease progression was

defined as either adverse histology on repeat biopsy (primary Gleason grade >/=4

or >50% positive cores of total) or radical treatment for PSA velocity >1 ng

ml(-1) year(-1). Time to disease progression was analysed with respect to

baseline levels of alpha-tocopherol, gamma-tocopherol, alpha-carotene and

beta-carotene, lycopene, retinol and selenium. One hundred four patients were

evaluable, with a median follow-up of 2.5 years. Thirty-eight patients

experienced disease progression, 13 biochemical and 25 histologic progression.

Median time to disease progression was 2.62 years. No significant association

was

seen between time to disease progression and baseline serum levels of

alpha-tocopherol (p = 0.86), gamma-tocopherol (p = 0.84), alpha-carotenoid (p =

0.66), beta-carotene (p = 0.65), lycopene (p = 0.0.15), retinol (p = 0.76) or

selenium (p = 0.76). No significant association was seen between serum levels of

the micronutrients, antioxidants or vitamins and either adverse histology on

repeat biopsy or PSA velocity. Our data do not support the hypothesis that high

serum concentrations of micronutrients, antioxidants and vitamins prevent

disease

progression in men with localised prostate cancer.

PMID: 20358422

>

> A week ago I received the diagnosis of PC and am amazed at how much

information and support is out there. It definitely softens the blow. I've been

doing some hard thinking and would greatly value feedback on the way I'm

thinking about treatment.

>

> Basic stats: 62 y.o. in decent health. psa 6.9, dre benign, Stage T1c, Gleason

3+4, 3/10 samples have cancer, all on the right side. In 2 about 1/2 of the

sample is involved (6 and 9 mm). No evidence of extraprostate extension and

remaining cores are benign. I've been having some minor, but definite

symptoms--frequency/urgency increase, discomfort at end of ejaculation and at

night voiding can be difficult.

>

> The urologist recommends radical prostatectomy. Brachytherapy would have a

similar cure rate. I will be seeing a rad'n oncologist for opinion.

>

> I would like to try active surveillance for 6 months with intensive

diet/lifestyle changes (something like the Ornish method --see J. Urol,

2005,174, 1065-9). But, it seems that this approach is pretty low on the

treatment totem pole for a G7 with my cancer volume.

>

> Does it make sense to do this given my age and maybe another 20 to 30 years

to go? Are there studies? Does it make sense to get the slides reviewed by

someone else? What is the likely outcome if I don't treat? What's the

probability of death from the cancer and when? Data on that?

> Many thanks for feedback,

>

> Joe

>

> B.C., Canada

>

[Guest guest]

Hi Norm,

You address a critical issue. In one study, Louie-sun, M. et al, BJU Intl,

2009, 104, 1501-4, 23% of patients were upgraded from an initial GS=6. So,

caution is necessary. In my case, I'm starting with a GS=7 so first I will ask

for 2nd opinion and also inquire about other diagnostic procedures to assess the

severity of the cancer while doing A.S.

It sounds like it's going well for you post-operatively, Great. I hope that the

June psa reading is a good one for you.

All the best and thanks for your input,

Joe

>

> I'm 57. Last February 09, I was diagnosed with prostate cancer. 1/12 positive,

Gleason 3+3. less that 10% of the sample positive. DRE negative. Based on that

information and the fact that I had no symptoms, I chose to take some time to

determine a course of action. My psa at the time of diagnosis was 4.5. I had

another psa test done in May that showed a rise to 5.5. My oncologist suggested

that I enjoy the summer and then have what is known as a saturation biopsy in

the fall. In the Oct/Nov time frame, I had a 20 core biposy performed that

resulted in 3/20 positive, all 10% or less, but one sample was 4+3 Gleason 7. I

followed that up with an MRI that showed an area in the apex that appeared to be

cancer. The doctor who performed the biopsy, called and told me that the area

where the MRI showed potential cancer isn't usually biopsied and it's unusual

for cancer to develop there. All of this scared me enough that I engaged the

best surgeon that I could

> find and had open surgery on March 15, 2010. The subsequent pathology

upgraded the cancer from a Gleason 7 to a 9. The surgeon thinks that he got

everything, the surgery went great, but (I think) in the report there was a

suggestion of some cancer in the margin. He recommended that I sign up to see an

oncologist and a radiologist asap after my next psa test to be performed on June

15. That meeting is set for July 1.

>

> So, I have gone from what I thought was a low grade cancer to a high grade

cancer in the course of about a year.

>

> I write this to suggest to you that because biopsies are not definitive, it's

prudent to get as much information on you particular condition as you can,

whether through a saturation biopsy, an MRI or by whatever other means is

available before taking 6 months to try active surveillance rather than waiting

until after.

>

> NFW- Boston

>

>

>

> ________________________________

>

> To: ProstateCancerSupport

> Sent: Thu, April 8, 2010 3:17:31 AM

> Subject: Active surveillance with diet/lifestyle

changes in a Gleason 7?

>

>

> A week ago I received the diagnosis of PC and am amazed at how much

information and support is out there. It definitely softens the blow. I've been

doing some hard thinking and would greatly value feedback on the way I'm

thinking about treatment.

>

> Basic stats: 62 y.o. in decent health. psa 6.9, dre benign, Stage T1c, Gleason

3+4, 3/10 samples have cancer, all on the right side. In 2 about 1/2 of the

sample is involved (6 and 9 mm). No evidence of extraprostate extension and

remaining cores are benign. I've been having some minor, but definite

symptoms--frequency /urgency increase, discomfort at end of ejaculation and at

night voiding can be difficult.

>

> The urologist recommends radical prostatectomy. Brachytherapy would have a

similar cure rate. I will be seeing a rad'n oncologist for opinion.

>

> I would like to try active surveillance for 6 months with intensive

diet/lifestyle changes (something like the Ornish method --see J. Urol,

2005,174, 1065-9). But, it seems that this approach is pretty low on the

treatment totem pole for a G7 with my cancer volume.

>

> Does it make sense to do this given my age and maybe another 20 to 30 years to

go? Are there studies? Does it make sense to get the slides reviewed by someone

else? What is the likely outcome if I don't treat? What's the probability of

death from the cancer and when? Data on that?

> Many thanks for feedback,

>

> Joe

>

> B.C., Canada

>

[Guest guest]

Hi Harry,

Thanks for your feedback. As I gather more info and as time goes in I may come

to the point of having to decide between surgery, brachytherapy or some other

modality.

Best wishes, Joe

>

>

>

> Subject: Active surveillance with diet/lifestyle

changes in a Gleason 7?

> To: ProstateCancerSupport

> Date: Thursday, April 8, 2010, 3:17 AM

>

>

>  

>

>

>

> A week ago I received the diagnosis of PC and am amazed at how much

information and support is out there. It definitely softens the blow. I've been

doing some hard thinking and would greatly value feedback on the way I'm

thinking about treatment.

>

> Basic stats: 62 y.o. in decent health. psa 6.9, dre benign, Stage T1c, Gleason

3+4, 3/10 samples have cancer, all on the right side. In 2 about 1/2 of the

sample is involved (6 and 9 mm). No evidence of extraprostate extension and

remaining cores are benign. I've been having some minor, but definite

symptoms--frequency /urgency increase, discomfort at end of ejaculation and at

night voiding can be difficult.

>

> The urologist recommends radical prostatectomy. Brachytherapy would have a

similar cure rate. I will be seeing a rad'n oncologist for opinion.

>

> I would like to try active surveillance for 6 months with intensive

diet/lifestyle changes (something like the Ornish method --see J. Urol,

2005,174, 1065-9). But, it seems that this approach is pretty low on the

treatment totem pole for a G7 with my cancer volume.

>

> Does it make sense to do this given my age and maybe another 20 to 30 years to

go? Are there studies? Does it make sense to get the slides reviewed by someone

else? What is the likely outcome if I don't treat? What's the probability of

death from the cancer and when? Data on that?

> Many thanks for feedback,

>

> Joe

>

> B.C., Canada

>

[Guest guest]

Hi Harry,

Thanks for your feedback. As I gather more info and as time goes in I may come

to the point of having to decide between surgery, brachytherapy or some other

modality.

Best wishes, Joe

>

>

>

> Subject: Active surveillance with diet/lifestyle

changes in a Gleason 7?

> To: ProstateCancerSupport

> Date: Thursday, April 8, 2010, 3:17 AM

>

>

>  

>

>

>

> A week ago I received the diagnosis of PC and am amazed at how much

information and support is out there. It definitely softens the blow. I've been

doing some hard thinking and would greatly value feedback on the way I'm

thinking about treatment.

>

> Basic stats: 62 y.o. in decent health. psa 6.9, dre benign, Stage T1c, Gleason

3+4, 3/10 samples have cancer, all on the right side. In 2 about 1/2 of the

sample is involved (6 and 9 mm). No evidence of extraprostate extension and

remaining cores are benign. I've been having some minor, but definite

symptoms--frequency /urgency increase, discomfort at end of ejaculation and at

night voiding can be difficult.

>

> The urologist recommends radical prostatectomy. Brachytherapy would have a

similar cure rate. I will be seeing a rad'n oncologist for opinion.

>

> I would like to try active surveillance for 6 months with intensive

diet/lifestyle changes (something like the Ornish method --see J. Urol,

2005,174, 1065-9). But, it seems that this approach is pretty low on the

treatment totem pole for a G7 with my cancer volume.

>

> Does it make sense to do this given my age and maybe another 20 to 30 years to

go? Are there studies? Does it make sense to get the slides reviewed by someone

else? What is the likely outcome if I don't treat? What's the probability of

death from the cancer and when? Data on that?

> Many thanks for feedback,

>

> Joe

>

> B.C., Canada

>

[Guest guest]

Hi Alan,

Thanks for your reply. A lot of wisdom and good advice in it.

I feel as if I don't have to rush in to anything at this point. Which helps in

keeping my cool. I feel as if I can for a limited time " play " with A.S. (maybe

I'm in denial) while also being cautious, taking steps to verify and further

assess the findings. Good idea to emphasize the Active. I'm interested in

hearing your story and not sure since I've not been part of a forum or group

before whether it's more appropriate for you to email me separately if you wish.

Best wishes,

Joe

>

> Hello Joe,

>

> Sorry to hear about the diagnosis.

>

> It seems to me that you're asking all of the right questions. I

> only wish I had the right answers for you.

>

> My suspicion is that your symptoms are not due to cancer.

> Perhaps you have BPH or prostatitis or a urinary tract infection

> in addition to the cancer, or perhaps you are experiencing some

> changes that accompany older age. Your urologist should be able

> to give you more information. But, as far as I know, the cancer

> itself, unless it's far, far more developed than the biopsy

> indicated, would not produce any symptoms at all. In fact,

> before PSA testing became common, many men didn't even know they

> had prostate cancer until their PSA was in the hundreds and they

> had pain from metastasis in the bones.

>

> When I was diagnosed with cancer I thought, well, I'll just read

> up on what the experts say and follow the best scientific advice.

> Then I found out that the experts disagree and there is no

> straightforward consensus view about what should be done.

>

> Sheri's response described a man for whom everything worked out

> much better than the initial diagnosis indicated. Norman

> described his experience where everything turned out quite a bit

> worse than the initial diagnosis indicated. The literature is

> full of reports of people who took a particular course of action

> and did extremely well, and others with seemingly similar

> diagnostic indicators who took the same course and had a terrible

> time.

>

> My understanding is that the latest guidelines on active

> surveillance only recommend it for Gleason 6 or lower. But there

> are men with Gleason 7 who have chosen to do it.

>

> A second opinion on the biopsy might help with this. If it comes

> back 3+3 you have more hope for AS. If it comes back 4+3, you

> have less. I had three opinions on mine: 3+3, 3+4, and 4+3 - the

> last one (4+3) from the organization (the National Cancer

> Institute - where I entered a clinical trial) that I trusted the

> most.

>

> Since you are attracted to active surveillance but are unsure if

> it's reasonable to do, perhaps the best things to do are:

>

> 1. Discuss it with your doctors.

>

> Ask each one how many patients they are following with active

> surveillance. If the answer is zero, then that doctor

> doesn't believe in it and may not be the right person to

> advise you about it. See if you can find someone for a

> second opinion who advises some of his patients to try active

> surveillance and advises other to get treatment. At least he

> isn't biased either way.

>

> 2. If you try AS, perhaps increase the " active " part of the

> surveillance.

>

> Maybe get a PSA test in 3 months instead of 6 months. Maybe

> even get one every one month. That might provide as much

> noise as information but even that can be helpful because you

> might find out that your PSA goes up and down a lot -

> possibly indicating something like prostatitis accounts for a

> lot it. PSA tests are cheap and non-invasive. If something

> starts to happen you'll see it more quickly and more likely

> see a trend.

>

> Be sure not to stress the prostate before the test. There

> should be no sex and no digital rectal exam for 2-3 days

> before testing.

>

> I wish I could give you more concrete advice.

>

> Best of luck.

>

> Alan

>

[Guest guest]

Hi Alan,

Thanks for your reply. A lot of wisdom and good advice in it.

I feel as if I don't have to rush in to anything at this point. Which helps in

keeping my cool. I feel as if I can for a limited time " play " with A.S. (maybe

I'm in denial) while also being cautious, taking steps to verify and further

assess the findings. Good idea to emphasize the Active. I'm interested in

hearing your story and not sure since I've not been part of a forum or group

before whether it's more appropriate for you to email me separately if you wish.

Best wishes,

Joe

>

> Hello Joe,

>

> Sorry to hear about the diagnosis.

>

> It seems to me that you're asking all of the right questions. I

> only wish I had the right answers for you.

>

> My suspicion is that your symptoms are not due to cancer.

> Perhaps you have BPH or prostatitis or a urinary tract infection

> in addition to the cancer, or perhaps you are experiencing some

> changes that accompany older age. Your urologist should be able

> to give you more information. But, as far as I know, the cancer

> itself, unless it's far, far more developed than the biopsy

> indicated, would not produce any symptoms at all. In fact,

> before PSA testing became common, many men didn't even know they

> had prostate cancer until their PSA was in the hundreds and they

> had pain from metastasis in the bones.

>

> When I was diagnosed with cancer I thought, well, I'll just read

> up on what the experts say and follow the best scientific advice.

> Then I found out that the experts disagree and there is no

> straightforward consensus view about what should be done.

>

> Sheri's response described a man for whom everything worked out

> much better than the initial diagnosis indicated. Norman

> described his experience where everything turned out quite a bit

> worse than the initial diagnosis indicated. The literature is

> full of reports of people who took a particular course of action

> and did extremely well, and others with seemingly similar

> diagnostic indicators who took the same course and had a terrible

> time.

>

> My understanding is that the latest guidelines on active

> surveillance only recommend it for Gleason 6 or lower. But there

> are men with Gleason 7 who have chosen to do it.

>

> A second opinion on the biopsy might help with this. If it comes

> back 3+3 you have more hope for AS. If it comes back 4+3, you

> have less. I had three opinions on mine: 3+3, 3+4, and 4+3 - the

> last one (4+3) from the organization (the National Cancer

> Institute - where I entered a clinical trial) that I trusted the

> most.

>

> Since you are attracted to active surveillance but are unsure if

> it's reasonable to do, perhaps the best things to do are:

>

> 1. Discuss it with your doctors.

>

> Ask each one how many patients they are following with active

> surveillance. If the answer is zero, then that doctor

> doesn't believe in it and may not be the right person to

> advise you about it. See if you can find someone for a

> second opinion who advises some of his patients to try active

> surveillance and advises other to get treatment. At least he

> isn't biased either way.

>

> 2. If you try AS, perhaps increase the " active " part of the

> surveillance.

>

> Maybe get a PSA test in 3 months instead of 6 months. Maybe

> even get one every one month. That might provide as much

> noise as information but even that can be helpful because you

> might find out that your PSA goes up and down a lot -

> possibly indicating something like prostatitis accounts for a

> lot it. PSA tests are cheap and non-invasive. If something

> starts to happen you'll see it more quickly and more likely

> see a trend.

>

> Be sure not to stress the prostate before the test. There

> should be no sex and no digital rectal exam for 2-3 days

> before testing.

>

> I wish I could give you more concrete advice.

>

> Best of luck.

>

> Alan

>

[Guest guest]

Hi Joe.

Here is a link to the site of one of the best and brightest in

the PCa field, Fernand LaBrie, MD: http://www.fernandlabrie.com/

He is at Laval University, Québec.

He trained one of the Yank best and brightest, B. Strum, MD.

Us Too International is a PCa support and education organization

that has seven chapters in Canada. Here's their website:

http://www.ustoo.com/

Often, meeting with other patients can be very helpful.

Regards,

Steve J

[Guest guest]

Hi Sammy,

Your response is timely because I'm just now poring through my psa lab results

which I requested from my dr. And, trying to understand concepts of psa

density, velocity, free psa, doubling time and their relationship to underlying

cancer activity and monitoring. I will read the article.

I requested all the lab reports from my dr.and recently received them.

All are from the same lab except the Dec/o9 one.

Jan 18/10 - 6.9; free PSA 6% (most recent)

Dec 4/09 5.73; fPSA 6%

Jun/09 4.5; no fPSA

Dec/07 2.9 no fpsa

Oct/05 1.5 no fpsa

MAy/03 0.9 "

May/02 0.9 "

My prostate according to the US is about 33cc.

If you have any comments, I'd welcome them.

Thanks for your reply.

Bestw ishes,

Joe

>

>

> Joe,

>

> If I were in your shoes I would get myself a few serial PSA tests done before

making a decision. I'd ask the urologist to Rx me a %free PSA and estimate of

PSA density at the start of all this, and then after six months.

>

> Just two tests separated by a month or so will give you a pretty good idea of

PSAV (PSA velocity) using standard tumor kinetic algorithms described in the

study quoted below[1]. [ Interestingly, that study did not look at serum vitamin

D or amount of circulating growth factors, or amount of exercise, or

vegetarian & non-dairy vs 'normal' diet. BTW Sherri, I think your advice is well

worth trying ! Good luck to your husband. ]

>

> Joe - A few months of active surveillance with diet and lifestyle changes may

be enough to give you a negative PSA velocity. If it does not produce the

desired effect you can go on to the next stage with the confiodence of knowing

you (and your doctor) are not overreacting to the diagnosis.

>

> Best of luck,

>

> Sammy.

>

> http://fitcare.org.uk/

>

>

>

> 1. Tumour Biol. 2010 Apr;31(2):97-102. Epub 2010 Feb 16.

>

> Serum micronutrient and antioxidant levels at baseline and the natural history

of

> men with localised prostate cancer on active surveillance.

>

> Venkitaraman R, K, Grace P, Dearnaley DP, Horwich A, Huddart RA,

> CC.

>

> Department of Clinical Oncology, Ipswich Hospital NHS Trust, Ipswich, Suffolk,

> UK, drvramachandran@...

>

> The aim of this study was to determine whether serum concentrations of

> micronutrients, antioxidants and vitamins predict rate of disease progression

in

> untreated, localised prostate cancer. Patients with localised prostatic

> adenocarcinoma on a prospective study of active surveillance underwent

monitoring

> with serial PSA levels and repeat prostate biopsies. Disease progression was

> defined as either adverse histology on repeat biopsy (primary Gleason grade

>/=4

> or >50% positive cores of total) or radical treatment for PSA velocity >1 ng

> ml(-1) year(-1). Time to disease progression was analysed with respect to

> baseline levels of alpha-tocopherol, gamma-tocopherol, alpha-carotene and

> beta-carotene, lycopene, retinol and selenium. One hundred four patients were

> evaluable, with a median follow-up of 2.5 years. Thirty-eight patients

> experienced disease progression, 13 biochemical and 25 histologic progression.

> Median time to disease progression was 2.62 years. No significant association

was

> seen between time to disease progression and baseline serum levels of

> alpha-tocopherol (p = 0.86), gamma-tocopherol (p = 0.84), alpha-carotenoid (p

=

> 0.66), beta-carotene (p = 0.65), lycopene (p = 0.0.15), retinol (p = 0.76) or

> selenium (p = 0.76). No significant association was seen between serum levels

of

> the micronutrients, antioxidants or vitamins and either adverse histology on

> repeat biopsy or PSA velocity. Our data do not support the hypothesis that

high

> serum concentrations of micronutrients, antioxidants and vitamins prevent

disease

> progression in men with localised prostate cancer.

>

> PMID: 20358422

>

>

>

[Guest guest]

Hi Sammy,

Your response is timely because I'm just now poring through my psa lab results

which I requested from my dr. And, trying to understand concepts of psa

density, velocity, free psa, doubling time and their relationship to underlying

cancer activity and monitoring. I will read the article.

I requested all the lab reports from my dr.and recently received them.

All are from the same lab except the Dec/o9 one.

Jan 18/10 - 6.9; free PSA 6% (most recent)

Dec 4/09 5.73; fPSA 6%

Jun/09 4.5; no fPSA

Dec/07 2.9 no fpsa

Oct/05 1.5 no fpsa

MAy/03 0.9 "

May/02 0.9 "

My prostate according to the US is about 33cc.

If you have any comments, I'd welcome them.

Thanks for your reply.

Bestw ishes,

Joe

>

>

> Joe,

>

> If I were in your shoes I would get myself a few serial PSA tests done before

making a decision. I'd ask the urologist to Rx me a %free PSA and estimate of

PSA density at the start of all this, and then after six months.

>

> Just two tests separated by a month or so will give you a pretty good idea of

PSAV (PSA velocity) using standard tumor kinetic algorithms described in the

study quoted below[1]. [ Interestingly, that study did not look at serum vitamin

D or amount of circulating growth factors, or amount of exercise, or

vegetarian & non-dairy vs 'normal' diet. BTW Sherri, I think your advice is well

worth trying ! Good luck to your husband. ]

>

> Joe - A few months of active surveillance with diet and lifestyle changes may

be enough to give you a negative PSA velocity. If it does not produce the

desired effect you can go on to the next stage with the confiodence of knowing

you (and your doctor) are not overreacting to the diagnosis.

>

> Best of luck,

>

> Sammy.

>

> http://fitcare.org.uk/

>

>

>

> 1. Tumour Biol. 2010 Apr;31(2):97-102. Epub 2010 Feb 16.

>

> Serum micronutrient and antioxidant levels at baseline and the natural history

of

> men with localised prostate cancer on active surveillance.

>

> Venkitaraman R, K, Grace P, Dearnaley DP, Horwich A, Huddart RA,

> CC.

>

> Department of Clinical Oncology, Ipswich Hospital NHS Trust, Ipswich, Suffolk,

> UK, drvramachandran@...

>

> The aim of this study was to determine whether serum concentrations of

> micronutrients, antioxidants and vitamins predict rate of disease progression

in

> untreated, localised prostate cancer. Patients with localised prostatic

> adenocarcinoma on a prospective study of active surveillance underwent

monitoring

> with serial PSA levels and repeat prostate biopsies. Disease progression was

> defined as either adverse histology on repeat biopsy (primary Gleason grade

>/=4

> or >50% positive cores of total) or radical treatment for PSA velocity >1 ng

> ml(-1) year(-1). Time to disease progression was analysed with respect to

> baseline levels of alpha-tocopherol, gamma-tocopherol, alpha-carotene and

> beta-carotene, lycopene, retinol and selenium. One hundred four patients were

> evaluable, with a median follow-up of 2.5 years. Thirty-eight patients

> experienced disease progression, 13 biochemical and 25 histologic progression.

> Median time to disease progression was 2.62 years. No significant association

was

> seen between time to disease progression and baseline serum levels of

> alpha-tocopherol (p = 0.86), gamma-tocopherol (p = 0.84), alpha-carotenoid (p

=

> 0.66), beta-carotene (p = 0.65), lycopene (p = 0.0.15), retinol (p = 0.76) or

> selenium (p = 0.76). No significant association was seen between serum levels

of

> the micronutrients, antioxidants or vitamins and either adverse histology on

> repeat biopsy or PSA velocity. Our data do not support the hypothesis that

high

> serum concentrations of micronutrients, antioxidants and vitamins prevent

disease

> progression in men with localised prostate cancer.

>

> PMID: 20358422

>

>

>

[Guest guest]

Thanks, Steve.

>

> Hi Joe.

>

> Here is a link to the site of one of the best and brightest in

> the PCa field, Fernand LaBrie, MD: http://www.fernandlabrie.com/

>

> He is at Laval University, Québec.

>

> He trained one of the Yank best and brightest, B. Strum, MD.

>

> Us Too International is a PCa support and education organization

> that has seven chapters in Canada. Here's their website:

> http://www.ustoo.com/

>

> Often, meeting with other patients can be very helpful.

>

> Regards,

>

> Steve J

>