 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate Cancer / May 2004NY Doctors
I was diagnosed with prostate cancer about three weeks ago. Had an unusually high PSA (10), but also had a colon infection...urologist retested, 2nd result was 6. Had 8-point biopsy, positive in one-tenth of one sample, Gleason 6 (3+3). I'm 45 years old. I've done a lot of research already -- read the books, talked to many people, read the very helpful posts here. I haven't yet selected a treatment, but I have activated a lot of folks to find the best doctors for my 2nd opinions (surgery and radiation). However, I'd like very much to hear from people who have had good experiences with doctors in New York, and get their recommendations. How old are you? Important! No, I am in Calif. Seems with your biopsy, etc. RP will do the job. I am not a Dr. but an informed survivor! Good wishes and sorry you belong to this group! John Loomis 49 @ RP now 54.....hummmmmanyway, I never like to gleat over my time... Just thanking god...God! > I was diagnosed with prostate cancer about three weeks ago. Had an > unusually high PSA (10), but also had a colon infection...urologist [quoted text clipped - 8 lines] > However, I'd like very much to hear from people who have had good > experiences with doctors in New York, and get their recommendations. >However, I'd like very much to hear from people who have had good >experiences with doctors in New York, and get their recommendations. New York is a big state. If you live in the City, you are in luck: Memorial Sloan Kettering http://www.mskcc.org/mskcc/html/44.cfm Virtually all treatments available; filled with experienced physicians. Talk to them and find out what suits you. If you live in CNY, e-mail me and I'll give you specific feedback. Hi Glenn, Sorry to hear about your PCA but at least you caught it early enough to hopefully cure it before it exits the prostate. Your age is probably the most important factor in determining what course of action to take. The GOLD standard and proven cure is radical prostectomy. If done by an experienced and skilled surgeon, the cancer will be removed WITH the prostate. Contrary to what is published, all other treatments are experimental and haven't been monitored long enough to be able to make definitive statements about the long term success. At your age long term would be 30 to 40yrs. You would hope to live that long at best unless you have other deliberating illnesses. The other treatments are attempts to kill the cancer cells while still inside your body. The gamble is? Did they get all the cancer cells without too much damage to your body and if not how much more damage will they do while trying. The magic cut-off age for RRP, LRP or DeVinci Robotic is 70yrs. Most treatment options other than RRP are targeted for men with a naturally shorter life expectancy. Most people die between 85 and 95 or even earliar. So those treatments are designed to manage the cancer until you die of something else. A lot of oncologist market various forms of radiation as a cure for early stage localized cancer but there haven't been enough studies done for a realistic period of time to support there conclusion because they haven't been doing them long enough. I also have done a lot of research on the subject and I put my bet on Cancer Research Institutes that are recognized as the top in the field such as John Hopkins ( Brady Urology Institute), Memorial Sloan Kettering of New York and Mayo Clinic. If you research John Hopkins and the other sites deep enough; such as there archives, you will see the for yourself how radiation treatments are best suited for PCA that have penetrated the capsules and for an older population. I was 62 last year when I was diagnosed with PCA Stage 1 Gleason 3+4=7 PSA 6.7. My urologist stated without hesitation that because I was relative young and healthy and my cancer was moderately aggressive that he recommended RP as the only option. I asked him about seed because I had heard so much about them and he stated what I reference about them above. It's been 10 months since my LRP and "knock on wood", I'm still non-detectable <.1. Ron >I also have done a lot of research on the subject and I put my bet on >Cancer Research Institutes that are recognized as the top in the field [quoted text clipped - 3 lines] >how radiation treatments are best suited for PCA that have penetrated the >capsules and for an older population. Ever get the feeling that PCa treatments are like politics and religion? There are some "true believers" out there. Here is my list of "Truths" about this disease and it's treatments: 1) Once you are diagnosed, DON'T PANIC. The disease generally progresses slowly, so you have plenty of time to find out as much as you can from a variety of sources before you decide on treatment. 2) Your life will never be the same after diagnosis and treatment as before, no matter what. You have curable form of cancer but there will be side effects after treatment - whatever treatment you choose. There are worse diseases and worse fates. Deal with it. 3) Don't rely on any advice from anyone whose title doesn't end in "M.D.", who isn't being paid by you to give the advice, and whose malpractice policy isn't in effect, present company included. Listen, digest, take it with a grain of salt, DON'T rely. 99% of the people in this n.g. are just regular patients just like you and are not medical professionals. Those who are medical professionals (I can think of only one) would NEVER presume to give any specific medical advice over the Internet. Hello! 4) Get an opinion from more than one M.D., all of whom have extensive expertise and experience in treating prostate cancer, including at least one surgeon and at least one radiation oncologist. 5) There is no Perfect Treatment. Each man is different, each diagnosis is different, each treatment has advantages, each treatment has disadvantages. Treatment, cure and side effects are all about probabilities and statistics. Each man has to make his own treatment decision based upon his own situation, including age, stage of tumor, philosophy of life, etc. Good luck. I must interject that I am rather opinionated when it comes to RPP for those < 50. But, Doug is right. None of us are PCa medical experts.  SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 > >I also have done a lot of research on the subject and I put my bet on > >Cancer Research Institutes that are recognized as the top in the field [quoted text clipped - 39 lines] > > Good luck. >I must interject that I am rather opinionated when it comes to RPP for those >< 50. But, Doug is right. None of us are PCa medical experts. In a support group, people must try to respect other people's choices and decisions. There are those of us "young'uns" who chose radiation over RP. We - at least I - didn't do it without MORE THAN ONE Dr. supporting the decision. Sure, I heard what I wanted to hear, which was that RP was NOT the only alternative. But it wasn't some kind of easy, ad hoc, spur of the moment choice. It was second thought at least 3 times, anguished and stressful. But it is now done and over, and there is nothing I can do now but look ahead and hope for the best. As must we ALL, no matter what the treatment. Back to the support group. New men come in daily, as freaked out as we all were when we were first diagnosed. Our hearts go out to them, and as battle scarred vets, we owe them the benefit of our experience. Which is, again, to stay calm, get informed, and get the advice of more than one M.D.'s experienced in treating PCa. Not to stand up on a soap box and tout OUR chosen treatment, or worse, badmouth another. What each man chooses is completely personal and completely irrelevant to another. Surely, it is valid to post statistics, cite studies, etc., which may support one treatment over another given a set of variables. But, again, there is simply no such thing as the "only" way to treat this disease. The decision is between the man, his doctors, and his family. Period. What YOU chose is YOUR business, god bless you. I sure hope it was right for you. But it is not my place to tell you that you blew it, to make you worry, to second guess yourself, while justifying my choice. That is irresponsible, self-centered, and counter-productive in a support group. --dt > >I must interject that I am rather opinionated when it comes to RPP for those > >< 50. But, Doug is right. None of us are PCa medical experts. [quoted text clipped - 8 lines] > and there is nothing I can do now but look ahead and hope for the > best. As must we ALL, no matter what the treatment. ... It's hard to add anything to Doug's excellent postings here and in the previous one but, for what it's worth, I'll mention that I also did a lot of research and opted for radiation at age 57 rather than surgery. For me, and your mileage may well vary, the side effects and complications have been less than what I would have expected with surgery. So far, my PSA is way down, I never had any continence problems and, once the Lupron wore off, my potency is only slightly diminished. I'm hoping that 25-30 years from now I'll be able to report to you that I am still very pleased with my choice. Having said all that, I still can't argue with the logic of the RP guys who say, "Got a tumor? Get rid of it!" The good thing about your situation is that you've caught it early when both surgery and radiation are most likely to succeed. Since you are young, you may want to move quickly on this. I think the theory is that the younger you are, the more likely you are to have a fast growing cancer. However as Doug implies, medical advice from me is worth exactly what you're paying for it. Best of luck. Alan > I was diagnosed with prostate cancer about three weeks ago. Had an > unusually high PSA (10), but also had a colon infection...urologist [quoted text clipped - 8 lines] > However, I'd like very much to hear from people who have had good > experiences with doctors in New York, and get their recommendations. I'm in the LI area, and recommend Dr. Joph Steckel. Head of Uro surgery. He's with North Shore, one of the highest rated hopsitals in the country. I'm 54 and 18 months post RP with him, and I'm pretty much back to normal. Feel free to email me, or phone. SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories I did not make clear in my message that my question concerned New York City, not New York State. > > I was diagnosed with prostate cancer about three weeks ago. Had an > > unusually high PSA (10), but also had a colon infection...urologist [quoted text clipped - 13 lines] > I'm 54 and 18 months post RP with him, and I'm pretty much back to normal. > Feel free to email me, or phone. > I did not make clear in my message that my question concerned New York > City, not New York State. Long Island is about 20 miles from NYC... SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories >ubject: Re: NY Doctors >From: "jk" jksinrod@aol.com [quoted text clipped - 5 lines] > > Long Island is about 20 miles from NYC... The NE end of Long Island is about a hundred miles from NYC. My B-in-L designs houses that are built out there- very big and very expensive. > >ubject: Re: NY Doctors > >From: "jk" jksinrod@aol.com [quoted text clipped - 8 lines] > The NE end of Long Island is about a hundred miles from NYC. My B-in-L designs > houses that are built out there- very big and very expensive. My point was that the doc and hospital I mentioned are only 20 miles away. The US is right next to Canada even though Florida is 2000 miles away... SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories Glenn, Sorry about your diagnosis; however, I truly believe you'll find this experience just another stepping stone to some kind of self awareness. Chin up, bucko...we're all here to walk you down this road. Although I'm in Texas (Dallas-Ft. Worth), I trust that all the resources available here will, too, be accessible in the Big Apple...perhaps four-fold. That being said, I had the DaVinci Robotic LRP. The hospital stay was a tad over 24 hours, the recovery (at home) was smooth, and I was back to work in three weeks (could have been two, but I got lazy and enjoyed my time at home. I work for a wonderfull company that did not require me to take sick time or vacation time, yet still paid me for the time off). I'm now 5 weeks post op....two weeks back to work. I returned to full continence in two and one-half weeks. The impotence thing is my next hurdle; however, I don't worry....I'm on medication (for blood pressure issues) so I've been dealing with ED for some time. I'm sure that if not for that, I'd be back in the saddle on that, too. I am not a paid spokesperson. I have no other interest in this other than an offer to pass on my good luck. I encourage you to look into Robotic LRP....and no doubt there are at least a few facilities ther in NYC that offer this procedure. At least look into it should you choose surgery as your final decision...... Good Luck and welcome to the greatest buncha friends you'll ever want to know. Jeff > I was diagnosed with prostate cancer about three weeks ago. Had an > unusually high PSA (10), but also had a colon infection...urologist [quoted text clipped - 8 lines] > However, I'd like very much to hear from people who have had good > experiences with doctors in New York, and get their recommendations. Sloan Kettering would be a great choice as they have many Dr's that perform 100's of RP's a year and are also known for their radiation therapies. Another great source is Dr. Herb Lepore NYU Med Center. He does over 300 RP's a year and helped pioneer the nerve sparing procedure. Dave P. > I was diagnosed with prostate cancer about three weeks ago. Had an > unusually high PSA (10), but also had a colon infection...urologist [quoted text clipped - 8 lines] > However, I'd like very much to hear from people who have had good > experiences with doctors in New York, and get their recommendations. Glenn, your numbers suggest that you have plenty of time to research all the treatment options and the best facilities to perform them. This NG tends to be very pro-RP, but radiation is NOT an "experimental" approach and not something I would write off without further investigation. I am 62, diagnosed with a PSA of 4.6 and a Gleason of 3+3. Cancer in 10% of one core and less than 5% of two others. I was strongly advised by my uro and many here and elsewhere to "get it cut out," but after several months of research, I have decided to have a seed implant at the Massey Cancer Center in Richmond, Virginia. (Next Friday, May 7.) I suspect that, with your numbers, either surgery or brachytherapy will give you the cure you want IF performed by somebody who is absolutely tops in the field. That, I think, is the key. Stay with this NG for support and advice but also check out other sites: http://www.prostatepointers.org/seedpods/ and www.yananow.net and http://www.prostate-help.net/ Ron Carter > I was diagnosed with prostate cancer about three weeks ago. Had an > unusually high PSA (10), but also had a colon infection...urologist [quoted text clipped - 8 lines] > However, I'd like very much to hear from people who have had good > experiences with doctors in New York, and get their recommendations. Glen, I agree with Ron that the group seems to lean towards a surgical approach, as does Dr. Walsh, he is a surgeon. I believe you need to explore the potential treatment protocols and evaluate their effects in regard to your particular situation.You're a young man, and without other serious health problems should have a pretty good life expectancy which should be factored heavily into your decision. Someone else mentioned speaking to the folks at Memorial Sloan Kettering, Columbia Presbyterian is also a great cancer hospital in NYC. No matter what your choice of treatment is, you have to be comfortable with it and your doctors. I'm 17 years older than you and had similar stats. 5.6 Gleason (3+3) T1c 10% of one core of twelve. My urologist (a surgeon) suggested that I would be a good candidate for either a RRP or Seeds, I weighed the numbers and chose brachytherapy preceded by Lupron for a few months to shrink the prostate. A week ago I posted a question about the radiation oncologist I had been referred to, I have since learned that he is the Program Director for the brachytherapy program at University Hospital (a part of The College of Medicine and Dentistry of NJ) and is probably the most experienced brachytheripist in NJ. That, plus the fact that two men I know well have been treated by him has given me confidence in the whole team, and that is necessary. Sorry about the long winded post, I just finished cutting the grass and came in for a beer :-) Tom > Glenn, your numbers suggest that you have plenty of time to research > all the treatment options and the best facilities to perform them. [quoted text clipped - 27 lines] > > However, I'd like very much to hear from people who have had good > > experiences with doctors in New York, and get their recommendations. Glenn, I beg to differ with the well intentioned responses but there is no cure to this date for prostate cancer. A lot of well intentioned people use the word (cure) when they really mean (treatment). There is a big difference between the two. Cure is defined as; healing or being healed; a medicine or treatment for restoring health to a sound condition. (Treatment) is defined as medical or surgical care. Unfortunately we use the word "Cure" to loosely describe the process of either removing the cancerous tumor while it is still contained in the prostate and therefore being cured or we attempt to bombard the cancer cells we find in the prostate and other surounding areas in "hopes" of killing all the cells and if we are lucky in this endeaver, we will be "cured". Unfortunately, the standards for cure for brachytherapy are not what one would expect for the term cure. One would expect to be cured for life and not for 5 or 7 years with reacurrence. One would also expect not to have PSA after being cured instead of a tolerable level. There are no facts or studies to support the claims of cure by the oncologist. Bottom line. I believe the reason most on this site lean toward removing the prostate at an early stage while it is contained inside is because we recoqnize that there is no real cure to date and throwing out the baby with the bathwater is all we have until they truly come up with a real cure. Radiation is a very important treatment option for advanced cancer and older patients but not a good option for a young healthy person such as you. Ron Spane As you can see, Glenn, the debate rages on regarding surgery vs. brachytherapy. If you decide to go with surgery, people will try to scare you with stories of incontinence and rising PSAs. If you decide to go with brachytherapy, they'll try to scare you with that 5-7 year figure (which is based on some antiquated technology, in my opinion) and stories of radiation-induced "secondary" cancers. And if you're like me, you'll go through periods of intense frustration, anger, and depression, but eventually, you'll see some light at the end of the tunnel. No, not a certified "cure" (I admit to using the term too loosely) but an option that will let you get on with your life and give you some hope. Surgery does that for some; brachy is doing it for me. Maybe, someday down the road, I'll be posting about having made a bad decision. Or maybe I'll be posting my latest low PSA. Right now, I'm focused on May 7 and a post-implant trip west. Beyond that, who knows? > Glenn, > [quoted text clipped - 26 lines] > > Ron Spane > Glenn, > [quoted text clipped - 10 lines] > killing all the cells and if we are lucky in this endeaver, we will be > "cured". [other text from Ron's message omitted] Glenn, I can't argue semantics with Ron. But the following is the exact phrase, cut and pasted, used by the surgeon who performed my RRP: "Your PSA was undetectable (ie. <0.1) which means cure!" Here's wishing you the same. JH The biggest advantage to having my RP, (besides now being cancer free), is that before surgery I was a frequent dribbler for years. I made several trips a night to the bathroom. Now I can pee like a garden hose, once a night. In all the years reading and posting here, I think I remember one person saying that they had regrets over their treatment choice? No one here will ever tell you your choice is a bad one. You make your own decision. and we'll still be here to support you. SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories >Subject: Re: NY Doctors >From: "ronju99" res0rbp6@nospam.verizon.net [quoted text clipped - 31 lines] > >Ron Spane True. I studied radiation effects with the Oak Ridge Associated Universities and am confident that killing cells with radiation is a STATISTICAL procedure, and fails to kill a significant percentage of the prostate cancer in the prostate itself. Radiation will kill a large percentage of any cells that have escaped the prostate, and is therefore a better choice if there is a significant probability that the cancer has escaped the capsule of the prostate. If the cancer has really remained confined to within the capsule, prostatectomy is better. Sorry to hear you've joined our club. 45 is far too young to get this disease! I know, because that's how old I probably was (not dx'd until 46). Since you have been reading, you probably already know that surgery is about your only option. Forntunately, with a Gleason of 6, depending on a couple of other factors, it's a very good option. You could be cancer-free by your next birthday. If you haven't done so, take a gander at Dr. patrick Walsh's Guide to Surviving Prostate Cancer and/or www.phoenix5.org. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .1, .1 Lupron 7/03, 8/03, 12/03, 4/04 > I was diagnosed with prostate cancer about three weeks ago. Had an > unusually high PSA (10), but also had a colon infection...urologist [quoted text clipped - 8 lines] > However, I'd like very much to hear from people who have had good > experiences with doctors in New York, and get their recommendations. > I was diagnosed with prostate cancer about three weeks ago. Had an > unusually high PSA (10), but also had a colon infection...urologist [quoted text clipped - 8 lines] > However, I'd like very much to hear from people who have had good > experiences with doctors in New York, and get their recommendations. Thanks for all the comments. Here's one thing I've heard about radiation that concerns me: prostate swelling and resulting difficulty in urination. I have had an enlarged prostate for years (I think it was the result of 4 episodes of prostatitis, 3 of them in one year), and my flow rate is already low (8). The radiation oncologist I have seen was also concerned, and indicated he would put me on Flowmax to treat this. Still, I'm not anxious to have more trouble urinating than I have already (but I'm also not crazy about having the opposite problem after surgery). > Thanks for all the comments. Here's one thing I've heard about > radiation that concerns me: prostate swelling and resulting difficulty [quoted text clipped - 5 lines] > than I have already (but I'm also not crazy about having the opposite > problem after surgery). hi Glen; I have the problem you describe. My prostate was already enlarged when I started radiation. After about 5 treatments (I just finished #17 of 42) the flow really slowed up. I am on 2 flowmax a day and 2 Advil every 6 hours. I got my second 4 mo Lupron shot (Hormone Therapy) last week and things have improved since the Lupron helps to shrink the prostate. Right now things are manageable -pretty good flow during the day and dribbles at night. I was originally set up for 25 rad treatments followed by a seed implant, but when I started having problems the ONC changed it to just Radiation. At this point I feel sure that I'll get through all 42 OK. The nice thing is that is I do have a major stoppage I can stop the Radiation for a few days and the URO can get things flowing again. I have had one dilation already which helped. You should probably be able to handle Hormone plus Radiation therapy if you want to avoid surgery. It's an inconvenience for the flow to slow up - but it will improve when the Rad is completed. I would not consider the seed implant though since my URO says that once the prostate is packed with seeds there isn't much he can do to correct flow problems due to swelling except to give steroid shots which may or may not work well enough. Keep us posted. Good luck on whatever treatment choice you make. George Age - 69 8/12/02 - PSA 3.7 10/13/03 - PSA 4.69 11/11/03 - PSA 4.8 11/18/03 - Biopsy - 10 cores one core-25% of core-Gleason 4+4=8 all other cores benign tissue 12/10/03 - Consult - Oncologist 12/16/03 - Consult - Radiation Oncologist Treatment Plan - Northeast Ga Cancer Center HT - started 12/17/03 - Eulixen & Lupron (2nd 4 mo Lupron-4/26) 2/10/04 - Started - Flowmax and Megastrol Radiation - IMRT to begin 3/30/04 - 42 treatments > Thanks for all the comments. Here's one thing I've heard about > radiation that concerns me: prostate swelling and resulting difficulty [quoted text clipped - 5 lines] > than I have already (but I'm also not crazy about having the opposite > problem after surgery). The chances of a 45-year-old coming out of RRP with life-long incontinence are long. Even life-long ED is probably less than average now. Either or both are sure considerations, but not definite. Furthermore, it sounds to me like you have chronic prostate problems other than PCa. RRP is an absolute cure for prostatitis. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 Hi Glenn...Best I can tell you just asked about some doctors, but seem to be getting a lot more input than that! I'm the third "Ron" to respond, that alone is confusing, but let me chime in with my 2 cents worth. Kupelian's recent study (International Journal of Radiation Oncology*Biology*Physics Volume 58, Issue 1 , 1 January 2004, Pages 25-33) suggests that RP and RT (EBRT, SI, SI+EBRT as long as the dose > 72 grays) have equivalent biochemical failure rates at 7 years, in the 20-25% range. For a man with your stats the failure rates would be much lower. Hopkins and RCOG have 10 year data on RRP and SI+EBRT respectively. At 10 years, men with low risk disease have somewhere around a 5% failure rate. Both RP and RT have their own morbidities which you should consider. Someone above mentioned something about scaring you with stories about secondary cancers if you choose RT. It is not a story, about 3% of men who use RT will have significant bladder cancer. Things haven't been sorted out yet, the small rate could just be coincidence. There isn't a lot of data, because there aren't a lot of men 10-plus years post RT treatment (with the higher intensities that are now being used). Still some notable researchers are less prone to recommend RT for younger men. One more thing, men with RP can fail out beyond 20 years. Men treted with SI + EBRT at RCOG "appear" to stop failing at 8 years post-RT The thing that I wanted to mention is WW, it's not advocated very often in this group. Hopkins is studying WW for men over 65 with stats like yours (look at the Brady website for what they term insignificant disease). For younger men it becomes something of a gamble. Of course the up-side is that there are no morbidities. The down-side is that you may seek treatment at a later date, WW can be tough on the head (not everyone is cut out for it), you may need to change your diet, exercise and stress level, and you will need to monitor your disease very closely. A recent study by Judd Moul followed 300-some men who practiced WW. They didn't all have low-risk disease as defined by Hopkins. As you might expect many men dropped out over time for many reasons, mental presuure, advancing disease, etc. The surprising thing was that roughly 25% of the population was still practicing WW at 8 years. Their stats hadn't changed for the worse, apparently some men don't progress (at least out to 8 years)! Before you select a treatment have an expert PCa pathologist reread your biopsy slides to confirm your GS6. It is relatively difficult for a pathologist to grade PCa. There's not one big solid tumor to examine; rather PCa is typically a diffuse, multifocal tumor. It becomes even more difficult when all you have to examine are small biopsy fragments. That's one of the reasons that an expert PCa pathologist (there are roughly a dozen or so around the US, see http://www.prostate-help.org/cagleex.htm for a listing) should examine PCa biopsy slides. Because many people don't have their Gleason Score determined by one of these experts, there is a documented "under-grading" of Gleason scores from PCa biopsy specimens (to be accurate, I should say that there is both over- and under-grading, but, on average, there is more under-grading). Said differently, the GS from the pathologic specimen obtained after RP frequently comes in higher than the GS determined from the biopsy specimen. This means that sometimes people pick the wrong treatment method because their tumor GS was under-graded. It would probably be worth having your biopsy slides reread by an expert since so much hinges upon the GS. Insurance often covers this re-reading. BTW, if you are taking any hormonal medications (Propecia, for example), it is important to let the pathologist know this as there is some data to suggest that changes in hormonal levels can affect Gleason grading. BTW, let me disclose that I had RRP last year (02/03) and am very satisfied...Best wishes and good health, Ron Hi Ron, This is the other Ron. I read your article with interest and read the articles you referenced. The study compares treatments for 5 and 7 years. There are no recent independent studies involving seed implants with or without external beem radiation for 10 year survival rates relating to cure or biochemical failure rates. The studies most often related to are from clinics offering optimistic results with a strong self interset in the results. It's there bread and butter. The ROCG is not even rated in the top 50 cancer centers in the US. I understand a persons interest in finding a better treatment with a better outcome and less side effects but so far all I see is wishfull thinking and hipe to promote treatment options for localized cancer that is intended for advanced cancer. That's why I would pay close attention to what the top cancer resarch facilities in the country say about treatment options. As for whatfull waiting with a Gleason of 6 (mildly aggressive) and at his age, I think not. To have that aggressive cancer at his age is a good indicator that he needs to take action soon before it's too late for RP because if he waits, the decision will be made for him. I think sometimes in our post we can add to the confusion by all the information we throw at people that are already confused by the deluge of information and new terminology thrown at them. I try to sort through as much of the maze as possible and put it in plain english. I noticed that you also came to the best conclusion possible for your situation. Likewise, I also had a LRP July 1, 2003 and am happy with the results. The other Ron Hi Ron!...Nice to hear from you. I've inserted my comments within your post...Best wishes and good health, Ron_too > Hi Ron, > [quoted text clipped - 5 lines] > from clinics offering optimistic results with a strong self interset in > the results. It's there bread and butter. Some of the papers from clinics or hospitals, do have university faculty as co-authors. IMO, as long as the paper is peer-reviewed, I'll accept it independent of its source. So, as you allude to in the above paragraph, there are several peer-reviewed papers with 10-year biochemical failure data for EBRT only, seeds only and seeds + EBRT. What makes comparison of their data with the published Hopkins 10-15 year RRP data difficult is that most of the RT papers use the ASTRO (or an ASTRO-like) defintion of failure (3 consecutive PSA rises), while Walsh uses 0.2 ng/ml PSA as the RP failure cut-point. Here's where Critz and RCOG come in. Critz has published a number of papers analyzing the RCOG data in the peer-reviewed literature. Critz believes his SI + EBRT technique is so succesful that he has adopted Walsh's 0.2 ng/ml definition of failure for analysis of the RCOG treatment. He has put his 10-year analysis in a poster abstract presented at the 2003 AUA meeting. It is not a peer-reviewed paper, but he has published enough that I read this abstract with interest, I've reproduced the abstract at the end of this post. In essence, Critz's low risk results are very similar to what Walsh obtains. For high and intermediate risk men, his results appear better than Walsh (it's impossible to compare Walsh's and Critz's data head to head because they break there patient subgroups down differently). >The ROCG is not even rated in > the top 50 cancer centers in the US. I spend a fair amount of time at Don Cooley's PHML discussion groups. The General group has a definite RT tilt with a lot of RCOG veterans. All I can say is there are a lot of guys who swear by RCOG, and Critz'z data is impressive. > I understand a persons interest in finding a better treatment with a > better outcome and less side effects but so far all I see is wishfull [quoted text clipped - 4 lines] > facilities in the country say about treatment options. As for whatfull > waiting with a Gleason of 6 (mildly aggressive) Many researchers don't belive that the GS is a measure of PCa aggressiveness, rather PSA doubling time seems to be an indicator of aggressiveness. > and at his age, I think > not. To have that aggressive cancer at his age is a good indicator that he > needs to take action soon before it's too late for RP because if he waits, > the decision will be made for him. Again, I don't know if his cancer is aggressive. Certainly GS6 alone does not suggest this. In fact, one of the criteria to enter the Hopkins' WW program is to have GS6 or less. As to "too late for RP" that is the question! Moul is studying the men who dropped out of his WW experiment and sought treatment. He will publish the results of whether or not these men had any less treatment success than men who started treatment earlier. Epstein's initial analysis of this question suggests that waiting doesn't diminish the curative effect of later treatment. I believe the data is now clear that many low risk (and even some higher risk) men can tolerate WW. It appears that, at a minimum, something around 25% of Moul's low risk had no disease progression over the 8 years Moul observed them. As Dr. Stamey once said, "I believe that when the final chapter of this disease is written, which is unlikely to be in my lifetime, never in the history of oncology will so many men have been so overtreated for one disease." I believe that a significant number of young men can get many more years (maybe even a full lifetime) of morbidity-free life before treatment may (if ever) be required. These men would need color doppler scans, constant monitoring, lifestyle changes and a psyche that can tolerate living with disease. There is much about this disease that remains to be learned. > I think sometimes in our post we can add to the confusion by all the > information we throw at people that are already confused by the deluge of [quoted text clipped - 6 lines] > > The other Ron ________________________________________________________________________ Critz's 2003 AUA Abstarct 692 TEN YEAR DISEASE FREE SURVIVAL RATE CALCULATED WITH PSA CUTPOINT 0.2 NG/ML IN MEN AFTER BRACHYTHERAPY FOR PROSTATE CANCER Frank A Critz*, W Hamilton Williams, Decatur, GA; A Keith Levinson, Decatur, , GA; James B Benton, Frederick J Schnell, Clinton T Holladay, Philip D Shrake, Decatur, GA INTRODUCTION AND OBJECTIVE: Recent reports have documented that it is misleading to compare irradiation disease free survival (DFS) rates calculated by the American Society of Therapeutic Radiation Oncology definition with radical prostatectomy DFS rates calculated by an undetectable prostate specific antigen (PSA). Instead, the same definition of disease freedom should be used to calculate results after surgery or irradiation for localized prostate cancer and PSA cutpoint 0.2 ng/ml has been recommended as the standard. The DFS rates of this brachytherapy program calculated by this standard are documented for men treated five or more years ago. METHODS: From 1992 to 1997, 1,011 consecutive men with clinical stage T1-T2NxMo prostate cancer were treated by simultaneous irradiation: transperineal 1-125 prostate seed implant followed by external beam irradiation. None received neoadjuvant hormones. The median patient age at implant was 66 (range 40-88), median PSA was 7.2 ng/ml (range, 0.3-88 ng/ml), 26% had biopsy Gleason score >= 7, and median followup is 6 years (range, 5-10). DFS rates were calculated by the Kaplan Meier method with disease freedom defined by PSA cutpoint 0.2 ng/ml. RESULTS: Of the 1,011 men, 149 (15%) recurred. The overall five and ten-year DFS rate is 86% and 83%, respectively. Men were subdivided according to risk factors: PSA > 10.0 ng/ml, Gleason score >=7, and stage T2b, T2c. Low (no factor), intermediate (one factor) and high (?two factors) risk men had a 94%, 82%and 61% ten-year DFS rate, respectively (p=0.0001). According to pretreatment 5S PSA <4.0 ng/ml, 4.1-10.0 ng/ml, 10.1-20.0 ng/ml and >20.0 ng/ml, the ten-year m disease free survival rate is 93%, 89%, 68% and 62%, respectively (p=0.0001). CONCLUSIONS: To be fair when comparing irradiation results with radical prostatectomy, a standard definition of disease freedom must be used and, since PSA falls slowly after irradiation, men should have minimum five-year followup to an allow time for recurrence and also time to achieve PSA 0.2 ng/ml (99% of men who achieve PSA 0.2 ng/ml after irradiation do so by five-year followup). These 10-year DFS rates can be reasonably compared with radical prostatectomy results from the PSA era. Source of Funding: None. |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.