Re: See the doctor next week and need help!

[Guest guest]

Chuck,

It doesn't.

Reduced prostate volume on its own might favor the detection of more

cancer, both low and high grade (less area to sample).

For some unexplained reason. 5-ARIs seem to result in less overall

cancer, but more high grade cancer. This has been shown in several studies.

More high grade is the reason the FDA gave for rejecting the use of

5-ARIs for chemoprevention.

Doug

My journey (nightmare) with PC continues. I have an appointment to talk

with the doctor next week about treatment for my PC. I had one positive

sample and 11 negative from the biopsy. Gleason score of 7. I am

guessing the doctor is going to recommmend removing the prostate. PSA

was 4 and DRE is normal. I took propecia (finasteride) for 10 years

for my hair loss. From the National Institute of Health:

The Prostate Cancer Prevention Trial (PCPT) demonstrated a 24.8%

reduction in the 7-year prevalence of prostate cancer among patients

treated with finasteride (5 mg daily) compared with that among

patients treated with placebo; however, a 25.5% increase in the

prevalence of high-Gleason grade tumors was observed, the clinical

significance of which is unknown. One hypothesized explanation for

this increase is thatfinasteride reduced prostate volume, leading to

detection of more high-grade tumors due to increased sampling

density. This possibility was investigated in an observational

reanalysis of the PCPT data, with adjustment for sampling density.

Median prostate volume was 25% lower in the finasteride group (median

= 25.1 cm3) than in the placebo group (median = 33.5 cm3).

Later studies showed finasteride does not cause increases in high grade

PC and actually reduces the risk of developing PC!!! The orginal studies

that showed more high grade PC was caused by the reduced size of the

prostate in mem taking finasteride.

I called the doctors office and ask for a copy of the pathology report.

I will read it and try to make some sense of it. I am worried the use of

finasteride has changed my Gleason score and made it higher. I sent a

letter to the doctor requesting the samples be sent to a Dr Epstein at

Hopkins for a second opinion.

My question is: Why does the reduced volume of my prostate make my

Gleason score higher?

Thanks to anyone who can help.

Chuck

[Guest guest]

Chuck,

A friend of mine had a situation almost identical to yours.

He was operated on by Pete Carrol at UCSF, and 3 moths

after surgery he has undetectable PSA and almost no side

effects. They do a Color Doppler prior to surgery, which

helps them know what they are dealing with pre-surgery.

Doug