Guest guest Posted April 3, 2011 Report Share Posted April 3, 2011 Bob, Just some comments on your conclusions and questions: 1. Some prostate cancers are more dangerous than others. You are absolutely correct. This has been known for many years and led leading prostate cancer expert Dr Willet Whitmore to say “ " When the results are good, we tend to say, 'That's a good treatment.' When treatment fails, we shake our head and say, 'That's a bad cancer.' A recent study suggested that 24 variants and that most men diagnosed these days were likely to have one of the indolent forms – see http://www.yananow.org/24Variants.pdf 2. There is currently no way of telling which they are. This is not absolutely correct. There is no way of telling with absolute certainty which variant has been acquired. That is true. But there are certainly some very good pointers, even within the poor diagnostic tools we have at present. A rapidly and consistently climbing PSA, a positive DRE (Digital Rectal Examination), multiple and high percentage positive material in biopsy needles, positive identification of a large tumour in scans, a high Gleason Score - 8, 9 or 10 all point to the dangerously aggressive variant. But there are no guarantees. But then it would surely be foolish to think that prostate cancer was the one aspect of life and living where there is absolutely certainty. The people in Japan, Australia, Brazil, Sri Lanka whose lives have been taken or upturned by recent catastrophic events were unlikely to have been less than certain about their lives continuing unchanged in the minutes prior. Given the fact that more men die in auto accidents than from prostate cancer, how many consider the certainty of arriving at their destination when starting the engine of their car? 3. Any treatment seems to make little difference to the eventual outcome. This is the point that has been argued for some years now. To quote Dr Whitmore again ““Is cure necessary in those in whom it may be possible, and is cure possible in those in whom it is necessary?”” There are very few long term studies, but the ones that are available do show a marginal advantage in some men who were given conventional therapy over those who did not. Soon after I was diagnosed in 1996 I read an interesting presentation by Dr Logothetis – it is at http://www.prostatepointers.org/prostate/talks/logo/logo2.html - where he first confirmed my view that prostatectomy might not be the only answer to the question “What should I do?” However, here are some further thoughts/questions: 1. Is this also true of breast cancer? It is very similar in many ways – slow growing (usually), hormone sensitive, some cancers much more aggressive than others, produces micro-metasteses which can remain undetectable for long periods. I have certainly seen articles recently which suggest that doctors think that some breast cancers are not serious enough to be worth treating and that women under 50 should not be screened. Normally I do not get involved in any discussions on breast cancer since BCa activists tend to be VERY feisty and aggressive if a mere man steps on their turf, From my (male) point of view, the situation with PCa is analogous to that for PCa – overdiagnosis and overtreatment being the issues. Some doctors, bolder than the rest have published papers demonstrating that this may be so. 2. What does the statement ‘to prevent one death from cancer’ mean? Most treatments for advanced PC aim to prolong life by slowing down the development of the tumours. There seem s to be good evidence that this is achieved in many cases though not all. No-one pretends to have a cure. There are two issues here: treating advanced PCa and ‘curing’ all PCa. There is agreement that advanced PCa cannot be cured. This statement, like many others, may not be entirely correct and would have to depend on definitions of ‘advanced’ and ‘cure’. Does a man diagnosed with a Gleason 10 T3 disease conform with the definition of advanced disease? If that man, twenty years later has no indication of the disease being present, does that mean he is cured or in remission? (See http://www.yananow.net/Mentors/DougA.htm story)There is some evidence that advanced disease can indeed be managed better than it was in the past, resulting in some men with that diagnosis living longer than they might have done in the past. Although you say <snip> No-one pretends to have a cure.<snip> That is precisely what is claimed by so much of the publicity surrounding the creation of awareness for the disease – that it is ‘curable’ if diagnosed and treated early. It is that very fact that has led to what one US journal to suggest that more than one million men have been treated with no benefit http://www.yananow.org/Overdiagnosis.pdf Is a young man diagnosed with what might be termed and ‘insignificant’ tumour – PSA under 10, GS 6, less than three positive needles – ‘cured’ because he has no detectable PSA five years after his surgery? The studies that attempt to calculate how many deaths are saved per men treated are based on theoretical mortality rates that may or may not be correct. These are then applied to data that may or may not match the original data. The European study which concluded that there might be some small value in screening and early treatment was in fact a collection of data from a number of countries which had to be ‘reverse engineered’ so to speak – data was adjusted to conform to a revised ‘standard’ for the purposes of the study. The US study, published at the same time, and which concluded that there was no ‘saving of life’ in screening did not suffer from quite the same issues but was rejected – possibly because it did not conform to the ‘scientific belief’ upon which the multi-billion prostate cancer industry is based. 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 Bob Bishop Sent: Sunday, 3 April 2011 7:09 PM To: ProstateCancerSupport Subject: Re: Swedish Study Hi again I was interested to see other people’s reactions before I make my own comments. I have now read reams and reams of stuff about PCa and all I can conclude at the end of it is: 1. Some prostate cancers are more dangerous than others. 2. There is currently no way of telling which they are. 3. Any treatment seems to make little difference to the eventual outcome. However, here are some further thoughts/questions: 1. Is this also true of breast cancer? It is very similar in many ways – slow growing (usually), hormone sensitive, some cancers much more aggressive than others, produces micro-metasteses which can remain undetectable for long periods. I have certainly seen articles recently which suggest that doctors think that some breast cancers are not serious enough to be worth treating and that women under 50 should not be screened. 2. What does the statement ‘to prevent one death from cancer’ mean? Most treatments for advanced PC aim to prolong life by slowing down the development of the tumours. There seem s to be good evidence that this is achieved in many cases though not all. No-one pretends to have a cure. 3. In my own case (which proves absolutely nothing) I have had RRP and EBRT, neither of which reduced my PSA below 2, in spite of the fact that the operation revealed no evidence of cancer in either seminal vesicles or lymph nodes and my bone scan was clear – Original PSA 7.2, Gleason 4+3, T3aN0M0. Since the end of radiotherapy my PSA has risen to 10.3 with a current doubling time of about 3 months. I am now on 50mg bicalutamide and start Zoladex on Friday. Obviously I’m hoping for the best but even if my PSA goes undetectable, I’m not sure what that proves. The general conclusion is that my cancer has metastasised but, other than the PSA level, there is no other evidence of this. I get lower back pain and the odd pain in my lower abdomen but then I always did. My doctor says I should stop worrying but the potential effects of hormone treatment are pretty frightening. Keep smiling – I am. Bob Quote Link to comment Share on other sites More sharing options...
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