Smith,

Welcome.  Belated condolences on the loss of your father.

I'm not a doctor, just a veteran of PCa with a copy of the book Dr. Walsh's
Guide to Surviving Prostate Cancer at hand.

P. 66 says there is a hereditary form of PCa, but as of the publication of
the book the faulty genes had not been identified.  One death does not
actually qualify as hereditary (p. 65).

Hereditary or not, your increased risk can be calculated from the figures on
p. 74.  Pardon me for referring you to them instead of interpreting them for
you.

Your screening should begin by age 40 (p. 65).

Needle biopsy takes about 20 minutes.  If you can search the archives of
this newsgroup you will find several personal descriptions.  Mine was
painless.

You are correct, "increasing PSA velocity" warrants a biopsy, regardless of
the actual reading, in the view of some doctors.

Lycopene obviously did not work for some on this newsgroup, since they post
here.  Don't know if you can overdose on it.

With checkups, you will avoid your father's fate.

jimhoney
standard RRP age 52, cured, no significant aftereffects

I don't know that a whole lot is known about this.  Jim has referred you
to Patrick Walsh's Guide to Surviving Prostate Cancer, which is a good
place to start.  It is very comprehensive.  But keep in mind that a lot
of research is being done in prostate cancer, and some of what you find
there may be a bit out of date.

You don't say how old your father was when diagnosed, but if he was
under 65, that means you are definitely at increased risk.

Talk to your doctor about it, and don't panic.  Probably once a year is
right.  Prostate cancer is almost always slow growing and usually you
have plenty of time to make a definite diagnosis.  Recent research shows
that the PSA level by itself may not be as important as the rate at
which it is growing.

Again, you really need to get an opinion from a qualified medical
expert.  If you don't feel your regular doctor is well enough versed in
the subject, ask to get referred to a qualified urologist to get advice
on what kind of testing should be done in your case.

People vary in how they react to it.  Most people seem to think it is
comparable to having a tooth filled or something similar.  In any case,
it is not such a major procedure that you should be frightened of it.

That probably can't hurt.  But it has not yet been definitevely
established that it will help.  There are some reasons for believing it
will.  There is what will probably be a definite study testing whether
it is effective or not underway right now,  but the results won't be in
for several years.

I think just eating three or more servings a week of foods made with
tomato sauce would suffice.  I wouldn't be able to get down raw tomato
paste myself, but if you like it, then by all means do it.  I don't
imagine it will hurt.   Avoid overdoing things like pizza which have
tomaoto sauce but also are very high in fat, which may predispose toward
prostate cancer.

There is some evidence that too much calcium in the diet can predispose
toward prostate cancer.  It might make sense to keep the level down to
the equivalent of two glasses of milk a day.  Also, according to Walsh,
eating fruit may counteract the effect of the calcium.

But don't go wild in all of this.  The best diet is a balanced diet.

By all means, don't smoke.

These other things, if indeed they have any effect at all, it will be to
change the odds by a modest amount.  One is six men will at some time in
life be diagnosed with prostate cancer, and the two biggest risk factors
are ones you can't easily avoid: being a man and getting older.

If you are unlucky enough to get prostate cancer, and it is far from
certain that you will,  now that you have been warned, it is likely to
be caught in time.   When prostate cancer spreads, it can be unpleasant,
but these days the vast majority of men diagnosed with prostate cancer
don't ever develop metastatic prostate cancer.

You didn't say how old your father was when he was diagnosed. If he was just
20 years older than you then he would have been 55. That is young and young
men tend to have more aggressive cancers.

Personally. I would start testing PSA right away! There is another young man
(age 40) battling aggressive PC on this group. There is no magic age to
start testing. Some doctors seem to think 40 is good and others hardly think
PSA testing is even worth bothering with at any age. But if your dad had PC
at a young age then you are sitting on a much higher chance of having PC at
a young age, too. So be your own judge. Ask for the test, what have you got
to lose?

I've never seen anyplace where it shows a direct link between parent or
child. No found gene, etc. But there does seem to be a "family"
relationship. If either parent has a hormone driven cancer such as PC or
breast then the offspring of those folks seem to have a higher incidence of
these cancers. Most are aware that if a mother has breast cancer then her
daughters have a greater chance of having breast cancer but the odd link
here is if the father has PC then the daughter's risk increases for breast
cancer and vice versa. What seems to be unknown is why - the only
correlation is they are both hormone driven cancers.

Now on the flip side there are many many families where PC has ripped
through the male members: fathers, uncles, brothers, sons, etc. and right in
the middle of everything one son seems to never ever have a problem.
Diabetes will often produce the same patterns within a family and for
whatever reason it just skips someone. So just because you father had PC
does not mean you will get it, that yours will be aggressive, etc. But
hopefully you will have educated yourself enough to realize the importance
of checking for this cancer. It is important to find the cancer in the early
stages and then treat it aggressively!

Your father treated his PC aggressively but obviously it had already escaped
the prostate bed.A PSA test is just a tiny blood sample. Any change should
immediately signal the need for a DRE and then a possible biopsy.
Unfortunately biopsies are not perfect either but they are getting better
with super Doppler ultra sound images to allow the doctor to see and sample
suspicious areas.

Yes, if you were my son I would encourage you to keep a very close eye on
your prostate's health. This is one time you do not want to follow in your
father's footsteps! But biopsy only when there appears to be a need.
Bev (not a doctor just a wife)

Biopsies are invasive.  They can be a bit painful, though I
would characterize mine as more uncomfortable than
seriously painful.  They do penetrate the skin and therefore
introduce a slight risk of infection.

They also cost some money.  In my case, a urologist
plus a nurse/assistant spent at least 20 minutes doing
the procedure, plus they must have spent time with
sterilizations and cleanups, plus they had to package
all the stuff up and send it to a pathologist, who in turn
had to spend time making and studying the slides, etc.

I'm guessing that your HMO or insurer wouldn't cover
any of that unless a rising PSA or digital rectal exam
indicated a need for it, and your GP would probably
not recommend it because doctors, wisely, don't like
to recommend invasive procedures if there if relatively
non-invasive tests (the PSA and DRE) don't show any
need for it.

So the question may be, how much of a rise in PSA
justifies a biopsy.

Unfortunately, your general practitioner may not know
the answer to that.  Mine told me that my PSA of 3.7
was within the normal range of 0-4 and didn't recommend
a biopsy or another PSA test at some near time.  I went
two more years before I had another PSA test, by which
time I had an "intermediate" risk cancer - i.e., one that
may or may not have been cured by the treatment I got.

I would suggest to your GP that you get a PSA baseline
now and another every year.  I'm thinking that if the PSA
is low, it won't suddenly shoot up in one year.  If it does
go up, then you'll have definite numbers to pose to the
doctor and to this group that might help people give a more
definite answer about whether a biopsy is a good idea.

Starting now is probably overkill.  No one really recommends
it before age 40.  But if it gives you more peace of mind,
I don't think it's an expensive test and maybe your doctors
will consider it reasonable.

   Alan

Everyone, thank you so much for your replies!!

I'm sorry, I didn't state my fathers age. He was 74 when he died last
year. I don't know what year exactly he was Dx but he  had treatment
in 1997 (I think he was Dx in 1994 or so). Basically he was around 65
I guess.

His treatment was radiation and seed implants. Seem to work for a
while, but than the cancer came back so he was put on hormone therapy.

I don't believe my grandfather had PC, or had no signs of it. I don't
know if that makes  a difference or not.

I'm trying to be good. I'm 36, exercise a lot and eat lots of fruits
and veggies, and I'm not overweight.

Sorry to hear about your dad, I suspect that he would be pleased that
you are taking early action to protect yourself against this disease.
I've inserted some information within your post below...Best wishes
and good health, Ron

Recent studies by Moul and, in particular, Bratt find similar tumor
grade distributions between men with hereditary and men with sporadic
PCa.

I've asked my sons to have their first PSA test run by age 35, that
way they'll have a good baseline measurement.  Once my PSA moved above
3.0, I started having it measured every 3-4 months in order to more
accurately assess its rate of change and catch any excursion quickly.
Regarding biopsy, one thing you should be aware of is that it is a
rather crude sampling technique (needle in the haystack analogy).  In
fact, there are regions of the prostate that cannot even be sampled
with the normal rectal biopsy (a perineal biopsy can sample these
regions).  Make sure you have a DRE performed yearly, preferably by a
doc or urologist who knows what they're looking for.

Concerning the lycopene and antioxidant supplements, none of these will
guarantee escaping cancer or any other disease, but there is a great
deal of discussion about the effects of free radicals on our bodies, and
I believe it can't hurt to kill some of 'em. As my radiation- oncologist
said, "We're rusting to death".

Instead of tomato paste, drink a glass of tomato juice or V-8 every day,
eat watermelon and drink green tea. I don't think you can get excess
lycopene or any other antioxidant from foods.

Watch it close --- there are folks here who can tell you with great
authority, from first-hand experience, that the 0 - 4 ng/ml "normal"
range is obsolete.

Larry

Sorry to hear about the death of your father, it's a tough way to go.
My father had implants 5 years ago, he's 74 now and still doing okay,
asides from urinary problems. No one else in my immediate family ever
had it. I wasn't as lucky. I was diagnosed with agressive prostate
cancer at age 49, T2b, Gleason 7(4+3). I had RRP 2 years ago, am lucky
I guess, my PSA is still less than .01.

You would be smart to keep on top of your PSA's, get tested at least
once a year. I had a PSA of 4.3 4 years before my surgery and didn't
think much of it(neither did Kaiser Permanente). It then went to 5.0 6
months before surgery and then to 6.3 4 months later. 5 of my 6 biopsy
samples showed cancer. The trick is finding a doctor who will do a
biopsy when you think you need it. It's realtively painless, don't
worry about that.

I was always physically active(8,000+ miles cycling a year for the
last 15 years or so) and ate very well, lots of tomatoes, etc. I would
do what you are doing and just don't worry much about it(if possible),
just get your PSA checked regularly and keep track of increases.

KInd regards, Tom

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