RE: Let Sleeping Dogs Lie

[Guest guest]

Harry,

As our dear departed friend Aubrey Pilgrim

used to say to newcomers about prostate cancer : The Golden Rule is There Are

No Rules.

Having said that, you are right when you

say that the Gleason Grading system is the prime indicator of aggressiveness,

but there are other aspects to consider. It is simply not possible to say

beyond any doubt that in any specific case there is the certainty of prostate

cancer related death (albeit it in many years time), or on the other hand that there

is absolutely no danger of prostate cancer related death. I have suggested, in

the piece I wrote The Elephant In The Room at http://www.yananow.net/elephant.htm

the specific aspects of the disease that indicate aggressiveness.

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Harry Trentes

Sent: Friday, 12 November 2010

11:09 AM

To: ProstateCancerSupport

Subject: Re:

Let Sleeping Dogs Lie

Hi Terry

I have just finished reading the book and found

it very interesting. Of course since I have already had surgery, Radiation

and hormone theray it was not helpful from that point of view. I do wonder

however, how it is really determined which type of cancer cells are the agressive

kind that quickly kill and the ones that are there but just stay there and

one dies with them rather than from them. I always thought the Gleason score

was a measure of that.

Maybe not. I am also 76 years old so I guess I am a

head of the game. Anyway, it was an interesting book.

Harry

Subject: Let Sleeping Dogs Lie

To: ProstateCancerSupport , newdx@...,

ww@...

Date: Thursday, November 11, 2010, 3:51 PM

Simon Chapman has just published a

small book (134pp) with two colleagues from the University

of Sydney in Australia ,

about the prostate cancer controversy. It is titled " Let Sleeping

Dogs Lie? What men should know before being tested for prostate cancer. "

and is written for men wondering what they should do about getting tested for

prostate cancer. The book is available for purchase at $A25 or as a free pdf

download here: http://purl.library.usyd.edu.au/sup/9781920899684

I think the book is very well

written. It sets out the pros and cons of screening but does not rule out diagnostic

testing. There is a difference between these two aspects of the disease and

they are often confused. It should be given to very man as he hits his 40s

and moves into what so many interested parties say is the 'danger zone'. If

this were done each man would have a clearer understanding of the risks and

benefits of PSA/DRE testing and would be in a better, because he is more

informed, position to make the decision that suits him and his personality

better.

Of course, there has already been

a negative reaction to the book on one Mailing List but I really fail to

understand why anyone would be opposed to the book - after all, we encourage

newly diagnosed men to examine all options before making a life changing

decision. Why not advance the examination one step further down the line?

All the best

Prostate men need enlightening,

not frightening

Terry Herbert - diagnosed in 1996

and still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

[Guest guest]

From what I read about Gleason scores,

they reflect how different, appearance wise, the cancerous cells are from

normal non-cancerous cells. A pathologist looks at a tissue sample and if it

closely resembles a prostate cell then it gets a low score. The worse it

looks like higher the score is given. The aggressiveness is determined by

how it is acting like growing and causing a rising PSA.

On the other hand I believe someone is coming

up with the process where they are actually looking at the samples and try to

determine what the best drugs are that will attack it and kill it.

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Harry Trentes

Sent: Thursday, November 11, 2010

7:09 PM

To: ProstateCancerSupport

Subject: Re:

Let Sleeping Dogs Lie

Hi Terry

I have just finished reading the book and found

it very interesting. Of course since I have already had surgery, Radiation

and hormone theray it was not helpful from that point of view. I do wonder

however, how it is really determined which type of cancer cells are the

agressive kind that quickly kill and the ones that are there but just stay

there and one dies with them rather than from them. I always thought the

Gleason score was a measure of that.

Maybe not. I am also 76 years old so I guess I am a

head of the game. Anyway, it was an interesting book.

Harry

---

[Guest guest]

I think of the Gleason score as a snapshot of the cancer at the time of the biopsy. It shows how far the cancer has progressed in it's development. If it is neat and orderly then the Gleason number is low. If it is messy and disorderly the the cancer is growing more actively. It doesn't have time to be neat. That said, it isn't a way to predict perfectly what will happen with an individual especially with treatment. Gleason 8 and above in most cases need aggressive treatment. About 50% of Gleason 7 cancers need aggressive treatment. Gleason 6 and below most likely can do AS. That said, biopsy is inexact and that is how we get the Gleason score. Think of it as sticking a needle into a haystack to get a sample of all of the straw in a haystack. That is probably why some men's Gleason score is upgraded after surgery. Then unfortunately you have the situation where the tools that we have now still can't see all the cancer and give us a complete evaluation of the cancer for decision making. That is why researchers are working so hard to identify better markers that can differentiate between aggressive and nonagressive cancers. Right now decisions have to be made with the tools that we have which is better than people have with most other cancers.KathyReply-To: <ProstateCancerSupport >Date: Fri, 12 Nov 2010 12:12:22 +1100To: <ProstateCancerSupport >Subject: RE: Let Sleeping Dogs Lie

Harry, As our dear departed friend Aubrey Pilgrim

used to say to newcomers about prostate cancer : The Golden Rule is There Are

No Rules. Having said that, you are right when you

say that the Gleason Grading system is the prime indicator of aggressiveness,

but there are other aspects to consider. It is simply not possible to say

beyond any doubt that in any specific case there is the certainty of prostate

cancer related death (albeit it in many years time), or on the other hand that there

is absolutely no danger of prostate cancer related death. I have suggested, in

the piece I wrote The Elephant In The Room at http://www.yananow.net/elephant.htm

the specific aspects of the disease that indicate aggressiveness. All the best Prostate men need enlightening, not

frighteningTerry Herbert - diagnosed in 1996 andstill going strongRead A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Harry TrentesSent: Friday, 12 November 2010

11:09 AMTo: ProstateCancerSupport Subject: Re:

Let Sleeping Dogs Lie

Hi Terry

I have just finished reading the book and found

it very interesting. Of course since I have already had surgery, Radiation

and hormone theray it was not helpful from that point of view. I do wonder

however, how it is really determined which type of cancer cells are the agressive

kind that quickly kill and the ones that are there but just stay there and

one dies with them rather than from them. I always thought the Gleason score

was a measure of that.

Maybe not. I am also 76 years old so I guess I am a

head of the game. Anyway, it was an interesting book.

Harry

-

[Guest guest]

For me it is to late to read the book to help make a decision on what to do since I had robotic three and a half years ago. But I will still read it and print a cop for my two sons(now 32 and 27). I have a question in regards to the biopsy Gleason score and the pathology Gleason score after removal. I can understand a score going up once the gland is removed and looked at more completely. But one that goes down like mine(3+3 at biopsy and 3+2 after surgery)is a little more confusing. To me it kinda means that the two doctors that graded the two cell configurations had different opinions of what they say and grading is a bit of a matter of opinion. Am I correct in assuming that?

To: ProstateCancerSupport Sent: Fri, November 12, 2010 10:03:06 AMSubject: Re: Let Sleeping Dogs Lie

I think of the Gleason score as a snapshot of the cancer at the time of the biopsy. It shows how far the cancer has progressed in it's development. If it is neat and orderly then the Gleason number is low. If it is messy and disorderly the the cancer is growing more actively. It doesn't have time to be neat.

That said, it isn't a way to predict perfectly what will happen with an individual especially with treatment. Gleason 8 and above in most cases need aggressive treatment. About 50% of Gleason 7 cancers need aggressive treatment. Gleason 6 and below most likely can do AS. That said, biopsy is inexact and that is how we get the Gleason score. Think of it as sticking a needle into a haystack to get a sample of all of the straw in a haystack. That is probably why some men's Gleason score is upgraded after surgery.

Then unfortunately you have the situation where the tools that we have now still can't see all the cancer and give us a complete evaluation of the cancer for decision making. That is why researchers are working so hard to identify better markers that can differentiate between aggressive and nonagressive cancers.

Right now decisions have to be made with the tools that we have which is better than people have with most other cancers.

Kathy

Reply-To: <ProstateCancerSupport >Date: Fri, 12 Nov 2010 12:12:22 +1100To: <ProstateCancerSupport >Subject: RE: Let Sleeping Dogs Lie

Harry,

As our dear departed friend Aubrey Pilgrim used to say to newcomers about prostate cancer : The Golden Rule is There Are No Rules.

Having said that, you are right when you say that the Gleason Grading system is the prime indicator of aggressiveness, but there are other aspects to consider. It is simply not possible to say beyond any doubt that in any specific case there is the certainty of prostate cancer related death (albeit it in many years time), or on the other hand that there is absolutely no danger of prostate cancer related death. I have suggested, in the piece I wrote The Elephant In The Room at http://www.yananow.net/elephant.htm the specific aspects of the disease that indicate aggressiveness.

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 andstill going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Harry TrentesSent: Friday, 12 November 2010 11:09 AMTo: ProstateCancerSupport Subject: Re: Let Sleeping Dogs Lie

Hi Terry

I have just finished reading the book and found it very interesting. Of course since I have already had surgery, Radiation and hormone theray it was not helpful from that point of view. I do wonder however, how it is really determined which type of cancer cells are the agressive kind that quickly kill and the ones that are there but just stay there and one dies with them rather than from them. I always thought the Gleason score was a measure of that.

Maybe not. I am also 76 years old so I guess I am a head of the game. Anyway, it was an interesting book.

Harry-

[Guest guest]

The Gleason Score assigns the first number

to the grade of the most dominant cell pattern in the sample. The next

number is assigned to the next dominant pattern. This is why a 4+3 is

worse than a 3+4. In the first case most of the cells were a grade 4

while in the second case most of the cells were a grade 3 with some grade 4

visible. When the whole gland can be looked at a more accurate reading

can be made. The biopsy also only takes a small section from a random

spot. If it hits a spot in a small highly damaged area then after review

in the post op pathology the Gleason score will be down graded because a larger

percentage of healthier cells are actually found. Conversely if the

biopsy had hit a healthier section of the gland then the post op pathology will

be upgraded. It is possible to have PCa in a small area of the gland and the

biopsy would show negative because it didn’t “sample” from an

area with damaged tissue.

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of White

Sent: Saturday, November 13, 2010

7:26 AM

To: ProstateCancerSupport

Subject: Re:

Let Sleeping Dogs Lie

For me it is to late to read the book to help make a decision on what

to do since I had robotic three and a half years ago. But I will still read it

and print a cop for my two sons(now 32 and 27). I have a question in regards to

the biopsy Gleason score and the pathology Gleason score after removal. I

can understand a score going up once the gland is removed and looked

at more completely. But one that goes down like mine(3+3 at biopsy and 3+2

after surgery)is a little more confusing. To me it kinda means that the two

doctors that graded the two cell configurations had different opinions of what

they say and grading is a bit of a matter of opinion. Am I correct in assuming

that?

From: Kathy Meade

To: ProstateCancerSupport

Sent: Fri, November 12, 2010

10:03:06 AM

Subject: Re:

Let Sleeping Dogs Lie

I think of the Gleason score as a snapshot of the cancer at the time of

the biopsy. It shows how far the cancer has progressed in it's development. If

it is neat and orderly then the Gleason number is low. If it is messy and

disorderly the the cancer is growing more actively. It doesn't have time to be

neat.

That said, it isn't a way to predict perfectly what will happen with an

individual especially with treatment. Gleason 8 and above in most cases need

aggressive treatment. About 50% of Gleason 7 cancers need aggressive treatment.

Gleason 6 and below most likely can do AS. That said, biopsy is inexact and

that is how we get the Gleason score. Think of it as sticking a needle into a

haystack to get a sample of all of the straw in a haystack. That is probably

why some men's Gleason score is upgraded after surgery.

Then unfortunately you have the situation where the tools that we have

now still can't see all the cancer and give us a complete evaluation of the

cancer for decision making. That is why researchers are working so hard to

identify better markers that can differentiate between aggressive and

nonagressive cancers.

Right now decisions have to be made with the tools that we have which

is better than people have with most other cancers.

Kathy

From:

Terry Herbert

Reply-To: <ProstateCancerSupport >

Date: Fri, 12 Nov 2010 12:12:22

+1100

To: <ProstateCancerSupport >

Subject: RE:

Let Sleeping Dogs Lie

Harry,

As our dear departed friend Aubrey Pilgrim

used to say to newcomers about prostate cancer : The Golden Rule is There Are

No Rules.

Having said that, you are right when you

say that the Gleason Grading system is the prime indicator of aggressiveness,

but there are other aspects to consider. It is simply not possible to say

beyond any doubt that in any specific case there is the certainty of prostate

cancer related death (albeit it in many years time), or on the other hand that

there is absolutely no danger of prostate cancer related death. I have

suggested, in the piece I wrote The Elephant In The Room at http://www.yananow.net/elephant.htm

the specific aspects of the disease that indicate aggressiveness.

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 andstill

going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of Harry Trentes

Sent: Friday, 12 November 2010

11:09 AM

To: ProstateCancerSupport

Subject: Re:

Let Sleeping Dogs Lie

Hi Terry

I have just

finished reading the book and found it very interesting. Of course since

I have already had surgery, Radiation and hormone theray it was not helpful

from that point of view. I do wonder however, how it is really determined

which type of cancer cells are the agressive kind that quickly kill and the

ones that are there but just stay there and one dies with them rather than

from them. I always thought the Gleason score was a measure of that.

Maybe not. I am

also 76 years old so I guess I am a head of the game. Anyway, it was an

interesting book.

Harry

-