Re: Active surveillance now acceptable - who knew?

[Guest guest]

The roast has minutes before it leaps from

the oven for me to carve, so this is a quick response before I close down.

Bob says in conclusion:

The big question of course being that we have still not been able to

discern with any degree of certainty which patients will go on to develop

aggressive PCa and which men will continue for a decade or longer with a much

more benign and slow growing (indolent) form of the disease. Or more

importantly, why do some men remain low risk and why do others develop

aggressive disease?

Can these questions be answered for any disease?

Why do some smokers live long lives while others succumb to secondary smoke? Why

do some people who seem to be fit, healthy and careful with their lives succumb

to heart attacks, while overweight smokers and drinkers who over-eat too live

on and on (my grandfather comes to mind – the dear old boy! Smoked like a

chimney loved his brandy and was as porky as a piglet – but made it through to

his late 80s).

Wherever we look we see medical ‘Rules’

and ‘Beliefs’ which are constantly challenged by examples that break the rules

and contradict beliefs. The idea that early stage prostate cancer is ‘cureable’

needs some defining.

There’s the roast. Good bye (for the

moment)

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.org/StrangePlace/index.html

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of

Sent: Friday, 10 June 2011 5:51 PM

To: ProstateCancerSupport

Subject: Fw:

Active surveillance now acceptable - who knew?

I'm

hearing the same things you are i.e. that it's not considered a

viable option. But, I think that has a lot to do with whom you come into

contact with when you are first Dx. Meeting with a Urologist will almost

always assure that the first and only option should be surgery and as quickly

as possible. Same for Radiation Oncologists with their favoured method of

treatment. Medical Oncologists may be giving some different advice but I do

not believe that active surveilance is one of the choices. They may advise

for the more esoteric patients seeds, cryotherapy or even HIFU. Dealerships

that sell BMW's do not tell their customers how good they would look behind

the wheel of a Volkswagon.

However, I do believe that the pressure is building and will continue to

build as the baby boomer generation becomes the main patient population. The

first baby boomers are turning 65 this year as they are men born

between the years 1946 and 1961. This is going to constitute a generational

shift not only in the population but in the thinking that is coming with that

population. Men of this generation are overall computer savvy

whereas most of the WWII generation with PCa missed out and did

not get the benefit of the internet and were least likely to question their

doctors orders, treatment options, or go outside the sphere of the hospital

that was treating them for support or information. The baby boomer

generation is going to be quite different in my opinion and rather than obey

orders, they are going to be making demands. Initially those demands

may appear unreasonable but that is because I believe that such demands

have never been made of the medical profession and research communities

before. The average baby boomer despite their educations , experience

and confidence with computers , knows little yet of PCa or the

details of it's treatment. Within 4 years the majority of men being Dx

will be coming from that generation and I bet dollars to doughnuts that

you are going to hear a lot more publicly about PCa. In fact, I think you can

count on it. It's going to come front and center and be discussed

openly. The polite euphamisms surrounding treatment today you won't be

hearing much about any longer. Mostly because until quite recently it was

next to impossible to discuss any kind of medical treatment that related

to either male or female sexual organs in a public forum outside

of internet support groups. That has all changed dramatically within

the past 5 years and I expect it to become even more open as time goes

on. I believe that discussions that men and their wives may have been

hesitant to discuss even on a semi-private board such as this will be

discussed openly on television in the not too distant future. It will I

believe push the envelope on the discussion

of treatments, research and side effects. I also personally

believe that it's healthy and needs to be discussed and discussed openly

without embaressment or shame. I think that one of the greatest hurdles we

have to surrmount is that most men don't really want to talk openly and

publicly regarding treatment outcomes that did not go as doctors told

patients to expect. I think we have already come a long way from the

cloistered hospital environment and small patient support groups moderated

and run by hospitals to the open international experience of the internet.

Who would have dreamed 10 years ago that PCa patients from all corners of the

planet would be connecting on the internet and discussing prostate cancer

with one another? It's really amazing when you contemplate it . But we

now take this for granted. Which is why I believe that in very short order

the discussion will expand beyond the internet into a wider public

forum. I think that this is exciting because it will be the impetus

we need to drive the research and drive for better treatment options that are

so desperately needed.

What I

think is happening as far as AS is concerned is that some men who

opted out of treatment 10 and 15 years ago for whatever reasons are still

around today and that does not fit the medical picture that we have been led

to believe would be the outcome. In fact such outcomes were considered

impossible. Not to mention that a lot of men fell through the cracks as their

doctors refused to keep them as patients if they refused treatment. Which

meant that no one was tracking them at all until they reached retirement age

and became eligable for Medicare. There is some recognition that these men

exist and it makes sense because even today the facts surrounding PCa are not

really known so all physicians have really is a guide. Well, if everyone goes

into treatment then there will be no patient population that went untreated

and you would therefore not know if the projected outcomes of patients

would have come true or not. I think that there are now a sufficient

population of patients who have forgone treatment that there is some

realization in the medical profession that it is not as cut and dry as they

have been projecting. Considering also that the cures have not really been

cures in the sense that we normally think of cures, and the morbid side

effects of treatment become more generally known, an AS strategy for men will

low risk PCa looks a lot more appealing. The big question of course being that

we have still not been able to discern with any degree of certainty which

patients will go on to develop aggressive PCa and which men will continue for

a decade or longer with a much more beneign and slow growing (indolent) form

of the disease. Or more importantly, why do some men remain low risk and why

do others develop aggressive disease?

BOB

Subject: Active surveillance now acceptable - who

knew?

To: ProstateCancerSupport ,

newdx@..., " 'ww' "

Date: Thursday, June 9, 2011, 10:33 PM

There is a long piece in Medscape

titled Active Surveillance for Low-risk Prostate Cancer at http://www.medscape.com/viewarticle/743233

which, I think, should be required reading for urologists as well as all men

of all ages diagnosed with what is referred to as “..low-risk localized

prostate cancer…”

I’m not too sure that I agree with

everything in the piece. For example the opening sentence is:

<snip>Active surveillance is

now an accepted management strategy for men with low-risk localized prostate

cancer, in recognition of the knowledge that the majority of men with such

cancers are likely to die from other causes. <snip>

Is it really an accepted

management strategy? Are newly diagnosed men told that this is one of their

options? Maybe in some cases, but I am still getting mail from men with

‘low-risk localized prostate cancer’ who have been told that surgery is their

only option and the sooner the better. Men with ‘low-risk localized prostate

cancer’ tell their stories on the Yana site

with no mention of being told about AS (Active Surveillance) as an option let

lone that it is an accepted management strategy.

After all these years when

Watchful Waiting and AS (Active Surveillance) were subjects which attracted

attacks and abuse when trying to discuss them as logical choices for SOME –

not ALL men – it warms the cockles of my heart to read a paragraph like this one:

<SNIP> Prostate cancer

screening using digital rectal examination (DRE), PSA testing and biopsy

leads to the detection of disease that is not clinically significant in many

patients, meaning that if untreated the cancer would not pose a threat to health

or cause death. Treating men with clinically insignificant tumors involves

the risk of unnecessary morbidity. Hence, AS seems to be a solution to the

widely acknowledged problems of overdiagnosis and overtreatment that

inevitably accompany the early detection of prostate cancer. Furthermore,

prostate cancer has a long lead-time before it becomes clinically apparent.

As such, AS is an excellent way of buying time until the aggressiveness of

disease in any particular patient can be identified, reserving radical

treatment for those in whom it is necessary. <SNIP>

And this one:

<SNIP> In summary, AS for

favorable-risk prostate cancer is feasible and seems safe according to the

10–15 years of available data. AS provides an individualized approach to

low-risk prostate cancer based on the demonstrated risk of clinical or

biochemical progression over time; large series of AS have revealed that the

likelihood of dying as a result of causes other than prostate cancer is far

greater than disease-specific death. Uncertainty remains regarding the

long-term impact of delayed treatment in men reclassified as higher risk

after a period of observation and repeat biopsy. Results from prospective,

randomized trials comparing AS to radical treatment and larger cohort studies

are required, and are currently underway. Men with favorable-risk disease

should be offered AS as a possible treatment option, and educated regarding

the risks and benefits of this approach. <SNIP>

Couldn’t have put it better

myself!! Yes, there is uncertainty associated with AS (Active Surveillance)

but show me any other therapy where there is certainty. It simply doesn’t

exist and more than certainty exists in or any other aspect of life. We each

have a theoretical life span that has a range starting a few minutes or hours

from now (heart attack, accident, natural disaster) to age 120 which at

present represents the greatest possible age for anyone to live to. None of

us has any real idea when, in that range we will pass on.

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.org/StrangePlace/index.html

[Guest guest]

The roast has minutes before it leaps from

the oven for me to carve, so this is a quick response before I close down.

Bob says in conclusion:

The big question of course being that we have still not been able to

discern with any degree of certainty which patients will go on to develop

aggressive PCa and which men will continue for a decade or longer with a much

more benign and slow growing (indolent) form of the disease. Or more

importantly, why do some men remain low risk and why do others develop

aggressive disease?

Can these questions be answered for any disease?

Why do some smokers live long lives while others succumb to secondary smoke? Why

do some people who seem to be fit, healthy and careful with their lives succumb

to heart attacks, while overweight smokers and drinkers who over-eat too live

on and on (my grandfather comes to mind – the dear old boy! Smoked like a

chimney loved his brandy and was as porky as a piglet – but made it through to

his late 80s).

Wherever we look we see medical ‘Rules’

and ‘Beliefs’ which are constantly challenged by examples that break the rules

and contradict beliefs. The idea that early stage prostate cancer is ‘cureable’

needs some defining.

There’s the roast. Good bye (for the

moment)

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.org/StrangePlace/index.html

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of

Sent: Friday, 10 June 2011 5:51 PM

To: ProstateCancerSupport

Subject: Fw:

Active surveillance now acceptable - who knew?

I'm

hearing the same things you are i.e. that it's not considered a

viable option. But, I think that has a lot to do with whom you come into

contact with when you are first Dx. Meeting with a Urologist will almost

always assure that the first and only option should be surgery and as quickly

as possible. Same for Radiation Oncologists with their favoured method of

treatment. Medical Oncologists may be giving some different advice but I do

not believe that active surveilance is one of the choices. They may advise

for the more esoteric patients seeds, cryotherapy or even HIFU. Dealerships

that sell BMW's do not tell their customers how good they would look behind

the wheel of a Volkswagon.

However, I do believe that the pressure is building and will continue to

build as the baby boomer generation becomes the main patient population. The

first baby boomers are turning 65 this year as they are men born

between the years 1946 and 1961. This is going to constitute a generational

shift not only in the population but in the thinking that is coming with that

population. Men of this generation are overall computer savvy

whereas most of the WWII generation with PCa missed out and did

not get the benefit of the internet and were least likely to question their

doctors orders, treatment options, or go outside the sphere of the hospital

that was treating them for support or information. The baby boomer

generation is going to be quite different in my opinion and rather than obey

orders, they are going to be making demands. Initially those demands

may appear unreasonable but that is because I believe that such demands

have never been made of the medical profession and research communities

before. The average baby boomer despite their educations , experience

and confidence with computers , knows little yet of PCa or the

details of it's treatment. Within 4 years the majority of men being Dx

will be coming from that generation and I bet dollars to doughnuts that

you are going to hear a lot more publicly about PCa. In fact, I think you can

count on it. It's going to come front and center and be discussed

openly. The polite euphamisms surrounding treatment today you won't be

hearing much about any longer. Mostly because until quite recently it was

next to impossible to discuss any kind of medical treatment that related

to either male or female sexual organs in a public forum outside

of internet support groups. That has all changed dramatically within

the past 5 years and I expect it to become even more open as time goes

on. I believe that discussions that men and their wives may have been

hesitant to discuss even on a semi-private board such as this will be

discussed openly on television in the not too distant future. It will I

believe push the envelope on the discussion

of treatments, research and side effects. I also personally

believe that it's healthy and needs to be discussed and discussed openly

without embaressment or shame. I think that one of the greatest hurdles we

have to surrmount is that most men don't really want to talk openly and

publicly regarding treatment outcomes that did not go as doctors told

patients to expect. I think we have already come a long way from the

cloistered hospital environment and small patient support groups moderated

and run by hospitals to the open international experience of the internet.

Who would have dreamed 10 years ago that PCa patients from all corners of the

planet would be connecting on the internet and discussing prostate cancer

with one another? It's really amazing when you contemplate it . But we

now take this for granted. Which is why I believe that in very short order

the discussion will expand beyond the internet into a wider public

forum. I think that this is exciting because it will be the impetus

we need to drive the research and drive for better treatment options that are

so desperately needed.

What I

think is happening as far as AS is concerned is that some men who

opted out of treatment 10 and 15 years ago for whatever reasons are still

around today and that does not fit the medical picture that we have been led

to believe would be the outcome. In fact such outcomes were considered

impossible. Not to mention that a lot of men fell through the cracks as their

doctors refused to keep them as patients if they refused treatment. Which

meant that no one was tracking them at all until they reached retirement age

and became eligable for Medicare. There is some recognition that these men

exist and it makes sense because even today the facts surrounding PCa are not

really known so all physicians have really is a guide. Well, if everyone goes

into treatment then there will be no patient population that went untreated

and you would therefore not know if the projected outcomes of patients

would have come true or not. I think that there are now a sufficient

population of patients who have forgone treatment that there is some

realization in the medical profession that it is not as cut and dry as they

have been projecting. Considering also that the cures have not really been

cures in the sense that we normally think of cures, and the morbid side

effects of treatment become more generally known, an AS strategy for men will

low risk PCa looks a lot more appealing. The big question of course being that

we have still not been able to discern with any degree of certainty which

patients will go on to develop aggressive PCa and which men will continue for

a decade or longer with a much more beneign and slow growing (indolent) form

of the disease. Or more importantly, why do some men remain low risk and why

do others develop aggressive disease?

BOB

Subject: Active surveillance now acceptable - who

knew?

To: ProstateCancerSupport ,

newdx@..., " 'ww' "

Date: Thursday, June 9, 2011, 10:33 PM

There is a long piece in Medscape

titled Active Surveillance for Low-risk Prostate Cancer at http://www.medscape.com/viewarticle/743233

which, I think, should be required reading for urologists as well as all men

of all ages diagnosed with what is referred to as “..low-risk localized

prostate cancer…”

I’m not too sure that I agree with

everything in the piece. For example the opening sentence is:

<snip>Active surveillance is

now an accepted management strategy for men with low-risk localized prostate

cancer, in recognition of the knowledge that the majority of men with such

cancers are likely to die from other causes. <snip>

Is it really an accepted

management strategy? Are newly diagnosed men told that this is one of their

options? Maybe in some cases, but I am still getting mail from men with

‘low-risk localized prostate cancer’ who have been told that surgery is their

only option and the sooner the better. Men with ‘low-risk localized prostate

cancer’ tell their stories on the Yana site

with no mention of being told about AS (Active Surveillance) as an option let

lone that it is an accepted management strategy.

After all these years when

Watchful Waiting and AS (Active Surveillance) were subjects which attracted

attacks and abuse when trying to discuss them as logical choices for SOME –

not ALL men – it warms the cockles of my heart to read a paragraph like this one:

<SNIP> Prostate cancer

screening using digital rectal examination (DRE), PSA testing and biopsy

leads to the detection of disease that is not clinically significant in many

patients, meaning that if untreated the cancer would not pose a threat to health

or cause death. Treating men with clinically insignificant tumors involves

the risk of unnecessary morbidity. Hence, AS seems to be a solution to the

widely acknowledged problems of overdiagnosis and overtreatment that

inevitably accompany the early detection of prostate cancer. Furthermore,

prostate cancer has a long lead-time before it becomes clinically apparent.

As such, AS is an excellent way of buying time until the aggressiveness of

disease in any particular patient can be identified, reserving radical

treatment for those in whom it is necessary. <SNIP>

And this one:

<SNIP> In summary, AS for

favorable-risk prostate cancer is feasible and seems safe according to the

10–15 years of available data. AS provides an individualized approach to

low-risk prostate cancer based on the demonstrated risk of clinical or

biochemical progression over time; large series of AS have revealed that the

likelihood of dying as a result of causes other than prostate cancer is far

greater than disease-specific death. Uncertainty remains regarding the

long-term impact of delayed treatment in men reclassified as higher risk

after a period of observation and repeat biopsy. Results from prospective,

randomized trials comparing AS to radical treatment and larger cohort studies

are required, and are currently underway. Men with favorable-risk disease

should be offered AS as a possible treatment option, and educated regarding

the risks and benefits of this approach. <SNIP>

Couldn’t have put it better

myself!! Yes, there is uncertainty associated with AS (Active Surveillance)

but show me any other therapy where there is certainty. It simply doesn’t

exist and more than certainty exists in or any other aspect of life. We each

have a theoretical life span that has a range starting a few minutes or hours

from now (heart attack, accident, natural disaster) to age 120 which at

present represents the greatest possible age for anyone to live to. None of

us has any real idea when, in that range we will pass on.

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.org/StrangePlace/index.html

[Guest guest]

With all due respect to all of these reports, unless I'm completely off base not

in any of these studies does this Active Surveillance mention age groups for

acceptance. I've read multiple articles as well as this one and if someone can

point out where I may have missed the age thing I'd appreciate it.

I was 45 when diagnosed took a year to make a decision and went through Proton

therapy and am currently fine with some minor issues. The article speaks that

for low risk patients who are to die from other issues can only refer to persons

of a more advanced age but does not specify.

There is no way to determine how a person of a relatively young age will react

to long term AS as to how it may spread, become aggressive or in my case the

mental strain and pressure of knowing you have cancer and have not dealt with it

yet.

> >

> > There is a long piece in Medscape titled Active Surveillance for Low-risk

> > Prostate Cancer at http://www.medscape.com/viewarticle/743233 which, I

> > think, should be required reading for urologists as well as all men of all

> > ages diagnosed with what is referred to as " ..low-risk localized prostate

> > cancer. "

> >

> >

> >

> > I'm not too sure that I agree with everything in the piece. For example the

> > opening sentence is:

> >

> >

> >

> > <snip>Active surveillance is now an accepted management strategy for men

> > with low-risk localized prostate cancer, in recognition of the knowledge

> > that the majority of men with such cancers are likely to die from other

> > causes. <snip>

> >

> >

> >

> > Is it really an accepted management strategy? Are newly diagnosed men told

> > that this is one of their options? Maybe in some cases, but I am still

> > getting mail from men with 'low-risk localized prostate cancer' who have

> > been told that surgery is their only option and the sooner the better. Men

> > with 'low-risk localized prostate cancer' tell their stories on the Yana

> > site with no mention of being told about AS (Active Surveillance) as an

> > option let lone that it is an accepted management strategy.

> >

> >

> >

> > After all these years when Watchful Waiting and AS (Active Surveillance)

> > were subjects which attracted attacks and abuse when trying to discuss them

> > as logical choices for SOME - not ALL men - it warms the cockles of my heart

> > to read a paragraph like this one:

> >

> >

> >

> > <SNIP> Prostate cancer screening using digital rectal examination (DRE), PSA

> > testing and biopsy leads to the detection of disease that is not clinically

> > significant in many patients, meaning that if untreated the cancer would not

> > pose a threat to health or cause death. Treating men with clinically

> > insignificant tumors involves the risk of unnecessary morbidity. Hence, AS

> > seems to be a solution to the widely acknowledged problems of overdiagnosis

> > and overtreatment that inevitably accompany the early detection of prostate

> > cancer. Furthermore, prostate cancer has a long lead-time before it becomes

> > clinically apparent. As such, AS is an excellent way of buying time until

> > the aggressiveness of disease in any particular patient can be identified,

> > reserving radical treatment for those in whom it is necessary. <SNIP>

> >

> >

> >

> > And this one:

> >

> >

> >

> > <SNIP> In summary, AS for favorable-risk prostate cancer is feasible and

> > seems safe according to the 10-15 years of available data. AS provides an

> > individualized approach to low-risk prostate cancer based on the

> > demonstrated risk of clinical or biochemical progression over time; large

> > series of AS have revealed that the likelihood of dying as a result of

> > causes other than prostate cancer is far greater than disease-specific

> > death. Uncertainty remains regarding the long-term impact of delayed

> > treatment in men reclassified as higher risk after a period of observation

> > and repeat biopsy. Results from prospective, randomized trials comparing AS

> > to radical treatment and larger cohort studies are required, and are

> > currently underway. Men with favorable-risk disease should be offered AS as

> > a possible treatment option, and educated regarding the risks and benefits

> > of this approach. <SNIP>

> >

> >

> >

> > Couldn't have put it better myself!! Yes, there is uncertainty associated

> > with AS (Active Surveillance) but show me any other therapy where there is

> > certainty. It simply doesn't exist and more than certainty exists in or any

> > other aspect of life. We each have a theoretical life span that has a range

> > starting a few minutes or hours from now (heart attack, accident, natural

> > disaster) to age 120 which at present represents the greatest possible age

> > for anyone to live to. None of us has any real idea when, in that range we

> > will pass on.

> >

> >

> >

> >

> >

> > 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.org/StrangePlace/index.html

> > <http://www.yananow.net/StrangePlace/index.html>

> >

>

[Guest guest]

With all due respect to all of these reports, unless I'm completely off base not

in any of these studies does this Active Surveillance mention age groups for

acceptance. I've read multiple articles as well as this one and if someone can

point out where I may have missed the age thing I'd appreciate it.

I was 45 when diagnosed took a year to make a decision and went through Proton

therapy and am currently fine with some minor issues. The article speaks that

for low risk patients who are to die from other issues can only refer to persons

of a more advanced age but does not specify.

There is no way to determine how a person of a relatively young age will react

to long term AS as to how it may spread, become aggressive or in my case the

mental strain and pressure of knowing you have cancer and have not dealt with it

yet.

> >

> > There is a long piece in Medscape titled Active Surveillance for Low-risk

> > Prostate Cancer at http://www.medscape.com/viewarticle/743233 which, I

> > think, should be required reading for urologists as well as all men of all

> > ages diagnosed with what is referred to as " ..low-risk localized prostate

> > cancer. "

> >

> >

> >

> > I'm not too sure that I agree with everything in the piece. For example the

> > opening sentence is:

> >

> >

> >

> > <snip>Active surveillance is now an accepted management strategy for men

> > with low-risk localized prostate cancer, in recognition of the knowledge

> > that the majority of men with such cancers are likely to die from other

> > causes. <snip>

> >

> >

> >

> > Is it really an accepted management strategy? Are newly diagnosed men told

> > that this is one of their options? Maybe in some cases, but I am still

> > getting mail from men with 'low-risk localized prostate cancer' who have

> > been told that surgery is their only option and the sooner the better. Men

> > with 'low-risk localized prostate cancer' tell their stories on the Yana

> > site with no mention of being told about AS (Active Surveillance) as an

> > option let lone that it is an accepted management strategy.

> >

> >

> >

> > After all these years when Watchful Waiting and AS (Active Surveillance)

> > were subjects which attracted attacks and abuse when trying to discuss them

> > as logical choices for SOME - not ALL men - it warms the cockles of my heart

> > to read a paragraph like this one:

> >

> >

> >

> > <SNIP> Prostate cancer screening using digital rectal examination (DRE), PSA

> > testing and biopsy leads to the detection of disease that is not clinically

> > significant in many patients, meaning that if untreated the cancer would not

> > pose a threat to health or cause death. Treating men with clinically

> > insignificant tumors involves the risk of unnecessary morbidity. Hence, AS

> > seems to be a solution to the widely acknowledged problems of overdiagnosis

> > and overtreatment that inevitably accompany the early detection of prostate

> > cancer. Furthermore, prostate cancer has a long lead-time before it becomes

> > clinically apparent. As such, AS is an excellent way of buying time until

> > the aggressiveness of disease in any particular patient can be identified,

> > reserving radical treatment for those in whom it is necessary. <SNIP>

> >

> >

> >

> > And this one:

> >

> >

> >

> > <SNIP> In summary, AS for favorable-risk prostate cancer is feasible and

> > seems safe according to the 10-15 years of available data. AS provides an

> > individualized approach to low-risk prostate cancer based on the

> > demonstrated risk of clinical or biochemical progression over time; large

> > series of AS have revealed that the likelihood of dying as a result of

> > causes other than prostate cancer is far greater than disease-specific

> > death. Uncertainty remains regarding the long-term impact of delayed

> > treatment in men reclassified as higher risk after a period of observation

> > and repeat biopsy. Results from prospective, randomized trials comparing AS

> > to radical treatment and larger cohort studies are required, and are

> > currently underway. Men with favorable-risk disease should be offered AS as

> > a possible treatment option, and educated regarding the risks and benefits

> > of this approach. <SNIP>

> >

> >

> >

> > Couldn't have put it better myself!! Yes, there is uncertainty associated

> > with AS (Active Surveillance) but show me any other therapy where there is

> > certainty. It simply doesn't exist and more than certainty exists in or any

> > other aspect of life. We each have a theoretical life span that has a range

> > starting a few minutes or hours from now (heart attack, accident, natural

> > disaster) to age 120 which at present represents the greatest possible age

> > for anyone to live to. None of us has any real idea when, in that range we

> > will pass on.

> >

> >

> >

> >

> >

> > 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.org/StrangePlace/index.html

> > <http://www.yananow.net/StrangePlace/index.html>

> >

>

[Guest guest]

I think that a lot of it has to do with immunology and all that immunology entails. It's interesting because I have been reading lately that probiotics have a much greater inpact on ones health than do many Vitamins and mineral supplements. Most of your Vit K 2 that is essential for maintaining bone integrity (of paramount importance for someone with PCa)

is synthesized by bacteria in the intestines. You have about a kilo of bugs in your gut that have a healthful and symbiotic relationship with you , the host. We now know that 80 pct of our immune systems reside in our gut and that many of the species of bacteria that reside there are intricately tied into and comprise part of our immune systems. Which poses a multitude of questions for someone who has cancer or who has to take antibiotics. There are studies that have been done to induce cancer in lab animals that have used varieties of analogs of Tetracycline to accomplish that task. What does Tetracycline do?

I think that part of the reason why some individuals get cancer from smoking and others do not may be tied up with our immune systems and strangely enough, we now find that bacteria that reside within our bodies are an intricate and little understood part of that system. This of course is speculation but there are people right now structuring research studies to that end. I hope that they do not run too long and that perhaps we will have something else with which to deal with this disease and others. There are studies being conducted right now with bacteria being used instead of antibiotics to fight bacterial infections. There is a rare form of eye cancer that is caused by the same bacteria that causes stomach ulcers, Helio Bachter Plyori. Ordinarily in such cases the affected eye is removed to effect a cure. In one such case it was decided to cure the infection prior to doing the

surgery as a safety measure so as not to spread the infection. When the infection was erradicated the patients immune system then erradicated the cancer without any further treatment. Why? Well, that is the thing that needs to be studied.

There is a doctor in Australia (I believe his name is Brody) who has pioneered a project of using fecal implantations from close relatives as a means of curing, yes curing, various forms of severe and incurable Irritable Bowel Syndrome and other serious and life threatening bowel disorders with an 85 pct cure rate. He has up to now only used patients who were left with two choices, either try the fecal implantation or have your entire large intestine surgically removed. I think that once he establishes that this protocol will work in those patients conclusively, then it will be a therapy offered as a first line treatment for patients with various long standing bowel and colon disorders and not just those facing removal of their colon's. Why let it get to that point if you can cure it with a method, although quite disgusting, is very,

very effective? .

There may also be elements of individual genetics that are involved but then again, we now know that genes are not necessarily static entities. That they can be turned on or off like an electronic flip/flop gate/nand gate. That further, there are chemical signals that do the turning on and off and that those chemical signals are tied into what we put into our mouths and what be put into our mouths comes into contact with critters living in our bowels. It's a real complicated mess but if we can begin to make some sense out of what is going on and how and why our immune systems behave the way that they do, then we will be on to a whole new area of medicine that we have yet to touch even a small part.

This approach is something i'm very interested in and have been following now for about a year. I'm interested because it's obviously a very safe and practical application of knowledge that can be understood and whose methods can be controlled and observed. Only when we truely understand the process by which cancer develops will we be able to effectively treat it. Right now all we are doing is the old shotgun approach. We use surgery and radiation to destory the prostate but now there is mounting evidence that there may be stem cells involved. This is going to pose a very serious problem for all current methodologies in treating PCa because the stem cells that may be the cause of PCa may also not reside within the confines of the prosate. In fact some researchers believe that the reason why there are so many failures in treatment is due to the fact that stem cells cannot be erradicated with either

surgery or radiation and that the chemo drugs currently in use for PCa do not affect stem cells, only their daugher cells. Which could explain why it keeps reccuring. These are all of course speculations by researchers in the field but we already know that P53 in some forms of this disease is shut down and if we were able to find a method to turn it back on again, that it would do it's job and erradicate cancer in the host.

The reason we do surgery and radiation to treat cancer is because we understand so little about it. If we really understood the mechanisms behind how it worked, we would have far more pleasant ways of treating it. One hundred and fifty years ago we had no

understanding of bacteriology and therefore when someone had a serious infection then the only thing that could be done was to remove the offending limb or flesh. It was the shotgun approach of it's day. If you cannot figure it out, then you must cut it out. It was a simple logical process that worked so long as you got all of the infection (identical to the approach we now take with cancer). Now that we know more about the infectious process , and more importantly have been able to synthesize antibiotics to combat that process we no longer perform these horrible surgeries , or rarely perform them. Antibiotics are the chemotherapy for bacterial infections. Unfortuntely chemotherapy for cancer is not quite so effective and the side effects immensely more damaging to the host patient. Much of the reason for this is that we really do not understand cancer the same way that we understand bacteria. Chemotherapy for

cancer is still quite crude as is evidenced by both it's lack of effectiveness and it's destructive effects upon the patient. A better understanding of the cause of the disease should yield the information that will allow for more effective treatments with fewer morbid side effects.

Cheers, BOB

Subject: Active surveillance now acceptable - who knew?To: ProstateCancerSupport , newdx@..., "'ww'" Date: Thursday, June 9, 2011, 10:33 PM

There is a long piece in Medscape titled Active Surveillance for Low-risk Prostate Cancer at http://www.medscape.com/viewarticle/743233 which, I think, should be required reading for urologists as well as all men of all ages diagnosed with what is referred to as “..low-risk localized prostate cancer…â€

I’m not too sure that I agree with everything in the piece. For example the opening sentence is:

<snip>Active surveillance is now an accepted management strategy for men with low-risk localized prostate cancer, in recognition of the knowledge that the majority of men with such cancers are likely to die from other causes. <snip>

Is it really an accepted management strategy? Are newly diagnosed men told that this is one of their options? Maybe in some cases, but I am still getting mail from men with ‘low-risk localized prostate cancer’ who have been told that surgery is their only option and the sooner the better. Men with ‘low-risk localized prostate cancer’ tell their stories on the Yana site with no mention of being told about AS (Active Surveillance) as an option let lone that it is an accepted management strategy.

After all these years when Watchful Waiting and AS (Active Surveillance) were subjects which attracted attacks and abuse when trying to discuss them as logical choices for SOME – not ALL men – it warms the cockles of my heart to read a paragraph like this one:

<SNIP> Prostate cancer screening using digital rectal examination (DRE), PSA testing and biopsy leads to the detection of disease that is not clinically significant in many patients, meaning that if untreated the cancer would not pose a threat to health or cause death. Treating men with clinically insignificant tumors involves the risk of unnecessary morbidity. Hence, AS seems to be a solution to the widely acknowledged problems of overdiagnosis and overtreatment that inevitably accompany the early detection of prostate cancer. Furthermore, prostate cancer has a long lead-time before it becomes clinically apparent. As such, AS is an excellent way of buying time until the aggressiveness of disease in any particular patient can be identified, reserving radical treatment for those in whom it is necessary. <SNIP>

And this one:

<SNIP> In summary, AS for favorable-risk prostate cancer is feasible and seems safe according to the 10–15 years of available data. AS provides an individualized approach to low-risk prostate cancer based on the demonstrated risk of clinical or biochemical progression over time; large series of AS have revealed that the likelihood of dying as a result of causes other than prostate cancer is far greater than disease-specific death. Uncertainty remains regarding the long-term impact of delayed treatment in men reclassified as higher risk after a period of observation and repeat biopsy. Results from prospective, randomized trials comparing AS to radical treatment and larger cohort studies are required, and are currently underway. Men with favorable-risk disease should be offered AS as a possible treatment option, and educated

regarding the risks and benefits of this approach. <SNIP>

Couldn’t have put it better myself!! Yes, there is uncertainty associated with AS (Active Surveillance) but show me any other therapy where there is certainty. It simply doesn’t exist and more than certainty exists in or any other aspect of life. We each have a theoretical life span that has a range starting a few minutes or hours from now (heart attack, accident, natural disaster) to age 120 which at present represents the greatest possible age for anyone to live to. None of us has any real idea when, in that range we will pass on.

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.org/StrangePlace/index.html

[Guest guest]

Chuck:

I posted my experience to show the decision process and not as an example for

others to follow, as one person's experience is worthless in determining your

own course of action.

But in any case my pre surgical biopsy results were:

3 out of 12 cores, one side only, don't remember the pct in each core

Gleason of 6.

And my post surgery pathology was:

PCa involvement in both sides, negative margins, no lymph node involvement

Gleason of 7 (almost always rises in surgical pathology results)

Currently (five years later) negligible PSAs, totally continent, moderate ED.

[Guest guest]

Well, probably not....(one more thought!)

Research on health care in this country in attempts to reduce varying costs in

differing areas has shown that treatment modalities vary considerably between

medical centers and hospitals for the same disease and set of conditions. Where

one location takes a more expensive and extensive approach another may be less

invasive, less costly and so on for no apparent reason than the " accepted views "

or " standards " of the staff. Typically, these views often do NOT match with the

latest research but rather reflect either an approach learned in school years

before or a particular thought leader in the locale. That is one huge issue with

health care cost control.

So, why should prostate cancer be any different?

Rich L

Green Bay, WI

>

> Last word from me (for the moment at least) on this subject.

>

>

>

> This excellent article sums the way things will go, I hope - .

> http://www.cuaj.ca/cuaj-jauc/vol5-no3/11076.pdf but I reckon I won't be

> around to see it:-)

>

>

>

> 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.org/StrangePlace/index.html

> <http://www.yananow.net/StrangePlace/index.html>

>

>

>

> _____

>

> From: ProstateCancerSupport

> [mailto:ProstateCancerSupport ] On Behalf Of

> Sent: Saturday, 11 June 2011 2:01 PM

> To: ProstateCancerSupport

> Subject: Fw: Re: Re: Active surveillance now

> acceptable - who knew?

>

>

>

>

>

>

> As for thinking 20 or 30 years out, I cannot imagine that what

> passes for PCa treatment today will in any way resemble what PCa treatment

> will look like 20 years hence. At least I hope that it does not. It would

> be really regretable if the treatment for this disease remained unchanged

> over such a long period of time.... <REMAINDER OF MESSAGE DELETED FOR

> SPACE REASONS>

>