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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2005Post-Op and Pathology
Sorry this is so long, but it's a one-time (hopefully post) and some of this might be helpful for someone about to have Robotic Laparoscopy who wonders what one person - me - experienced the week after surgery. I had Robotic Laparoscopy last Thursday, 4/28/2005. Post-op today to remove catheter and get pathology report. Except for the cancer cell found in an area around the apex there was no capsular penetration, no seminal vesicle involvement, and no lymph node involvement. The cancer cell that was found could have been pulled out of the prostate as it was cut away. It was in an area where prostate tissue and striated muscle mix together and there are no clear capsular defining lines. The surgeon examined the path slides himself and is confident it was within the prostate. Everywhere else the cancer cells were 2 or 3 layers of healthy cells beneath the capsule surface. I had much more cancer in the lobes of the prostate than the biopsy showed. I had extensive cancer in both. That is why I had such a high PSA count even though my prostate was small. It was small, but with a lot of cancer in it including some developed Stage 4 tumors. My last PSA prior to surgery was three weeks after my biopsy and had actually fallen from 15.3 to 12.1. So it was down 3.2 from the first one. Surgeon thought that was really interesting and quite surprising. He had expected it to be much higher so soon after the biopsy. But, when I got my biopsy report on 3/30/2005 I went on a no animal products, no cholesterol diet and began taking a carefully selected, well-researched set of supplements. My cholesterol fell from 221 to 168 in the three weeks after that change. Surgical pathology report says that I have a Gleason Grade of 4+3 upgraded from 3+3. I had a 2.2 cm tumor. I am at pathological stage T2-c (confined in both lobes). On the Sloan-Kettering Nomogram I end up: 2 Yr Progression-Free Probability 98 percent 5 Yr Progression-Free Probability 95 percent 7 Yr Progression-Free Probability 94 percent If that one cell whose homebase is questionable was in the Margin after all then there is a slight shift: 2 Yr Progression-Free Probability 93 percent 5 Yr Progression-Free Probability 84 percent 7 Yr Progression-Free Probability 81 percent My surgeon wants to take a PSA in 3 months. See what it is. It may not be down to 0 yet, but it should be way down. Probably that PSA isn't sufficient to make a decision about radiation, but if the PSA rises above 1.0 for sure then he recommends radiating the prostate bed immediately. As to incontinence. So far, so good. He put four ounces of water in my bladder through the catheter to "leak-test" me. Removed the catheter (no big deal at all). Had me stand up holding a towel on my front covering my penis. Then handed me a cup and asked me to pee in it. I peed a little bit, but stopped. He said most people lose it all right away and as it's coming out he asks them to try and stop it. I told him that I couldn't pee more because I just didn't feel like I had an urge to pee. He thought that was all good. So we drove home and I went to the bathroom and my liner was dry. Sat down in the bathroom and peed. I could easily stop it at will. I peed a little more and that was that. Got up a bit ago and peed again on my own and was able to start and stop the stream. I asked about exercise and he said no weight training that would strain any of the surgical area for a month, but easy swimming, recumbent biking slowly and hot tub is ok in four days if I am still peeing okay. Activities: No real limits other than to not strain or overdo anything and to listen for pain. Diet - nothing special. Fred ---------------- PSA 15.3 2/21/2005 @ 52 years of age Biopsy 3/23/2005 G6 (3+3), T1c PSA 12.1 4/22/2005 RLRP 4/28/2005 G7 (4+3), T2cN0M0 Neg margins An interesting report Fred. It sounds like your surgeon must have been a real artist to leave you dry and functional so quickly after surgery. I was particularly interested in your falling PSA and cholesterol. Can you tell us what supplements you are taking and why? I used to think the case for over the counter supplements was very weak but your the second person who has reported a drop in PSA in the last couple of months after taking supplements. I myself had a significant drop (1.8 to .5) after adding lycopene and gamma Vitamin E to my diet, but it's impossible to say whether the supplements were involved, or whether the 1.8 was a post radiation bounce that would have come down just as fast and far without them. These anecdotal stories about PSA drop after taking supplements do not constitute scientific data. A number of different factors can cause a PSA drop and my doctor told me that PSA can vary up to 30% in 24 hours due entirely to the presence or absence of local factors like ejaculation or other prostate stress. Nevertheless, when you find supplements that are cheap, not harmful and may help, even weak evidence for them may be worth pursuing. Alan > An interesting report Fred. It sounds like your surgeon must > have been a real artist to leave you dry and functional so quickly > after surgery. Alan: He also completed a residency in urological reconstuctive surgery so I suspect he's got a little edge maybe over the regular urologist in that area. Although from his description it sounds like it has a lot to do with the patient as well - the unique anatomy of the urethra and bladder and prostate connections, etc. But, I am amazed. I was all prepared for incontinence - at least some. But I have had the catheter out for 11 hours now and have gone to the bathroom and peed four times. Twice standing! :-) It takes some effort to stop the stream, but I can do it and hold it. So looks like that will be okay. > I was particularly interested in your falling PSA and cholesterol. > Can you tell us what supplements you are taking and why? I started my research at: http://www.grouppekurosawa.com/ I recommend reading through: http://www.drmyattswellnessclub.com/prostatecancer.htm Here is what I have been taking and am continuing to take and one or two websites for each that I think summarizes fairly well the reasons I am taking it. I chose only one or two sites to avoid overload. But, after making my list I went to the National Cancer Institute: http://researchportfolio.cancer.gov/ Here I searched for research studies being done with these supplements and I found that almost all of them are involved in some studies related to prostate cancer or cancer in general. So, for example, using their search engine I found four currently funded research studied using Green Tea for cancer treatment. Here is one example: http://researchportfolio.cancer.gov/cgi-bin/abstract.pl?SID=373021&ProjectID=46065 I performed this kind of study and analysis of each of the supplements I considered. I rejected any that had any indication of some kind of interactions or that had any evidence of toxic or hurtful side effects. So I took all of this stuff and still am and I don't notice a thing when I take it all. Green Tea Extract - 300 mg twice times a day (standardized to a minimum of 80 percent polyphenols) http://www.prostate-cancer.org/education/nutrprod/greentea.html Paw-Paw Extract - 25 mg twice a day http://www.trueoptionhealth.com/pawpaw.html Quercetin - 500 mg four times a day http://www.sciencedaily.com/releases/2001/03/010327081312.htm Milk thistle - 350 mg twice a day (standardized to 80 percent Sylimarin) http://www.herbalfields.com/c23.html Turmeric - 450 mg twice a day (standardized to 95 percent circuminoids) http://www.umm.edu/altmed/ConsHerbs/Turmericch.html http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9 489587&dopt=Abstract Vitamin D3 - 700 mg twice a day http://www.lef.org/prod_hp/abstracts/php-ab424.html http://www.psa-rising.com/med/zemplarvitdwakef082003.shtm Lycopene - 10 mg twice a day Selenium- 200 mg in the morning Zinc - 50 mg once a day Saw Palmetto - 320 mg twice a day Magnesium - 250 mg twice a day Calcium Citrate - 315 mg twice a day Melatonin - 30 mg every night http://www.drmirkin.com/archive/7210.html http://www.prostatecancerdeception.com/prostate-cancer-sleep.html http://www.icon.co.za/~edibo/melatonin.htm Lovastatin -10 mg every night http://www.ohsu.edu/news/2004/060704cholLowering.html > I used to think the case for over the counter supplements was > very weak but your the second person who has reported a [quoted text clipped - 4 lines] > 1.8 was a post radiation bounce that would have come > down just as fast and far without them. Right. I hear you. My original PSA was 15.3. Well, I had sex the night before, had gone to the gym and put some miles on the recumbent bike, and an hour before my blood draw had a DRE in my annual physical. I should have waited. Did that combination of stuff nudge my PSA up? Maybe? Did the stuff I started taking lower my PSA? Maybe? It didn't cost me a lot. I was a wise shopper. All of this stuff doesn't cost all that much. I mail ordered the Paw Paw from the manufacturer and got enough for two months for something like $49 or so. I gulped to spend it, but then thought - "Hey, what's my life worth?" > These anecdotal stories about PSA drop after taking > supplements do not constitute scientific data. A number [quoted text clipped - 5 lines] > may help, even weak evidence for them may be worth > pursuing. Alan, of the things that I am taking the most cost effective in my opinion based on all the research I have done is Green Tea Extract, Paw Paw Extract, Milk Thistle and Melatonin. If I had to take just two it would be the Green Tea and the Melatonin. Best wishes, Fred I should have added that I was looking for supplements that "kill" cancer or slow its growth and not just stuff to prevent it. But my focus was on stuff that kills the cancer cells in some way. I should add that before this I have not been the kind of person who is into natural or organic foods or taking stuff like this. Not at all. And I have no financial interest in any of it either!!!! Fred >I should have added that I was looking for supplements that "kill" cancer or slow its >growth and not just stuff to prevent it. But my focus was on stuff that kills the cancer [quoted text clipped - 6 lines] > > Fred Fred, Thanks for the info. I will read all of it. Alan OCL wrote...snip... > Zinc - 50 mg once a day Hi Fred...This one caught my eye. Have you found a reference to zinc helping fight PCa? I've only seen negative things about zinc and PCa...Best wishes and good health, Ron Natl Cancer Inst 2003 Jul 2;95(13):1004-7 Zinc supplement use and risk of prostate cancer. Leitzmann MF, Stampfer MJ, Wu K, Colditz GA, Willett WC, Giovannucci EL M. F. Leitzmann, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD. The high concentration of zinc in the prostate suggests that zinc may play a role in prostate health. We examined the association between supplemental zinc intake and prostate cancer risk among 46 974 U.S. men participating in the Health Professionals Follow-Up Study. During 14 years of follow-up from 1986 through 2000, 2901 new cases of prostate cancer were ascertained, of which 434 cases were diagnosed as advanced cancer. Supplemental zinc intake at doses of up to 100 mg/day was not associated with prostate cancer risk. However, compared with nonusers, men who consumed more than 100 mg/day of supplemental zinc had a relative risk of advanced prostate cancer of 2.29 (95% confidence interval = 1.06 to 4.95; P(trend) =.003), and men who took supplemental zinc for 10 or more years had a relative risk of 2.37 (95% confidence interval = 1.42 to 3.95; P(trend)<.001). Although we cannot rule out residual confounding by supplemental calcium intake or some unmeasured correlate of zinc supplement use, our findings, that chronic zinc oversupply may play a role in prostate carcinogenesis, warrant further investigation Hii Ron, I started taking the 200 mg of zinc when I increased my calcium citrate intake. Even calcium intake is somewhat controversial. But, my urologist felt that with my added calcium that the zinc would not be harmful. It is certainly one of the supplements that I was least committed to taking. Fred > OCL wrote...snip... >> Zinc - 50 mg once a day [quoted text clipped - 29 lines] > oversupply may play a role in prostate carcinogenesis, warrant further > investigation Fred. Glad to hear about your great results.May your recovery continue to be quick. Steve U Very informative and interesting post! I too had robotic surgery on 12/14/04 and was dry from day 1. I am very interested in you post on the supplements. I will read them carefully. I too am now taking oxidants/vitamins as well as green tea extract. I worked out most of my life, kept my weight down, and was generally athletic and overall very healthy. I took supplements, but I too was not much of a big pill popper, just multiple vitamins and minerals and tried to eat right most of the time. I also was diagnosed with PC at 52! Go figure. Good luck and all the best with your recovery. Stats: PSA 7.6 @ 52 years of age Biopsy 8/04 G6 (3+3), T1c RLRP 12/14/04 G7 (4+3), T2cN0M0 Neg margins Organ contained > Very informative and interesting post! I too had robotic surgery on > 12/14/04 and was dry from day 1. I am very interested in you post on the [quoted text clipped - 5 lines] > time. I also was diagnosed with PC at 52! Go figure. Good luck and all > the best with your recovery. Bob: Yes, we sound like we have some similar history. A couple of thoughts about supplements - one is that I learned that there are some antioxidants that are great to take to prevent cancer, but some of them actually help protect cancer cells from radiation for example or some that will counteract the killing effect of other supplements. Vitamin E, for example, is a powerful antioxidant and is widely touted for use in preventing cancer. But, if you are receiving radiation that same Vitamin E could help protect the cancer cells from the effects of the radiation. It could also help protect the cancer cells from the possible killing effects of something like Melatonin. So, it's important to review each supplement you are taking and ascertain if there is any indication that what was helpful before you had cancer might not now be as useful. I didn't mention diet in my previous post, but I said before that I changed my diet to no animal products and no cholesterol. The elimination of animal products is simply to try and eliminate foreign hormone sources. I read one study suggesting that the average American man over 60 now has more estrogen in his body than the average woman. While it is widely accepted that testosterone feeds prostate cancer and one of the effective therapies is to remove testosterone from the body, at the same time there is another competing theory that it isn't the testosterone that does it but the ratio of testosterone to estrogen and that men may have too much estrogen. There are other explanations as well. So, I decided to eliminate hormones and the best way to do that for now was to not eat animal products. Cholesterol effects are being studied and you can read one news report of a study done in Boston at: http://news.yahoo.com/news?tmpl=story&u=/acs/20050426/hl_acs/cholesterol_drugs_m ay_slow_prostate_cancer and http://www.rednova.com/news/display/?id=146674&source=r_science High cholesterol seems to inhibit cancer cell apoptosis or cell death. It really has not been hard to make this dietary change. The positive side is my cholesterol dropped from 221 to 168 in three weeks. Fred ----------------------------------------- PSA 15.3 2/21/2005 @ 52 years of age Biopsy 3/23/2005 G6 (3+3), T1c PSA 12.1 4/22/2005 RLRP 4/28/2005 G7 (4+3), T2cN0M0 Neg margins Hi Fred: Thanks for the reply. I am interested to mainly prevent a chance for a biochemical failure, as well as maintain general health. My last PSA was 0.01. So far, so good on that area. I am very interested on the killing effects of Green Tea Extract, which I now take, as well as Melatonin, which I would like to start on too. I take a supplement now which can be found at this link: http://www.vitaminproshop.com/033984012066.html I do not want to negate the effects of certain vitamins/anti-oxidants with something like the positive effect of Melatonin on killing cancer cells or visa versa. An example would be the high Vitamin E on my present supplement dosage vs the Melatonin. I've also read the book, as well as others on PC, by Dr. Glenn J. Bubley, "What Your Doctor May Not Tell You About Prostate Cancer" on the supplement issue on Chapter 9. Again, thanks for your reply! > I am interested to mainly prevent a chance for a biochemical failure, as > well as maintain general health. My last PSA was 0.01. So far, so good on > that area. I am very interested on the killing effects of Green Tea > Extract, which I now take, as well as Melatonin, which I would like to > start on too. Bob: What I found that I was doing as the weeks passed and I did more and more research was that I was mentally, at least, focusing in on just a very few supplements that I had more confidence in and that would not interact in neagtive ways. So what I am now doing even after my surgery is to take the Green Tea Extract and Melatonin and I will finish up the Paw Paw extract and the Milk Thistle that I have purchased, but not replace either of them. The Green Tea and Melatonin are what I would consider my core anti-cancer supplements. I'll continue taking my prescription low-dose Lovastatin every night to help keep my cholesterol low and stay on a low cholesterol diet (very low) with only organic hormone free lean meat or non-farm raised fish occasionally. I'll increase my exercise as much as I am able. Fred This reminds me . . . weeks ago someone mentioned a supplement cocktail he blended up and drank each day. It sounded like something only a pregnant Klingon could enjoy! There IS a better way to take some of these hypothetical boosters, as long as they're safe, whether beneficial or not; it's called EATING. Sure, tumeric fits in a blender, but why not actually ENJOY it? It's a prime seasoning in Indian (not native American . . . those OTHER Indians) food, and is DELICIOUS on many dishes. Try it on just about any chicken dish, for starters. Cinnamon is another theoretically PC-helpful spice that goes well in many foods, such as Mexican dishes. Some tumeric- and cinnamon- spiced dishes taste even better the next day, after flavors blend better. And why blend cooked tomato products into a Fear Factor slurry when marinara sauce is a Trifecta on so many foods: it tastes marvelous, it's a good salt "substitute" (duh! . . . because it's full of salt), and it's lycopene city. Slather it (and/or salsa) on everything from scrambled eggs to chicken. None of these things is proven to help PC, but a little extra flavor never hurts anything, either, and if proof ever emerges that some of these rumors are true, we'll be ahead of the game. I.P. >> I am interested to mainly prevent a chance for a biochemical failure, as >> well as maintain general health. My last PSA was 0.01. So far, so good on [quoted text clipped - 18 lines] > > Fred > This reminds me . . . weeks ago someone mentioned a supplement cocktail he > blended up and drank each day. It sounded like something only a pregnant > Klingon could enjoy! I.P.: Yes, thay might have been me. Perhaps it would be more enjoyable if I was a pregnant Klingon - I don't know how the tastes of pregnant Klingon's run. I prepare some of my supplements by heating it in boiling coconut milk and then when it cools I add others to it. They are the more fat soluble supplements that I take and they solubilize more effectively in coconut milk and are then ingested more easily and more of the helpful ingredients enter into my blood and lymph systems. If once has Prostate Cancer then one would want to have more of those possibly cancer-killing chemicals in the lymphatic system, I would think. Would you? > There IS a better way to take some of these hypothetical boosters, as long > as they're safe, whether beneficial or not; it's called EATING. You and I are certainly entitled to our own opinions about whether taking these supplements through eating is as effective as taking them in more concentrated doses and in ways that more of the biochemical agents bypass the body's natural gateway called the liver. You are probably familiar with the First Pass Phenomenon and the problems it presents to the pharmaceutical industry. No matter what you eat, the chemicals have to make it past the liver to be clinically effective. Most drugs, as you know, do not make it past the stomach, intestines, liver and kidneys intact. That is why we take something like oral morphine in doses of 15 or 20 mg to achieve some pain relief, but can achieve similar benefit from a few milligrams when injected into the blood or taken via some transdermal method. > Sure, tumeric fits in a blender, but why not actually ENJOY it? The amount of turmeric needed to produce the effects of the kinds of doses used in clinical research studies funded by the National Cancer Institute would require you to eat enough curry to choke a horse. The same is true for most other supplements being studied in medical school and university settings. I enjoy Green Tea, but I don't want to drink a few dozen strong cups a day. I would prefer to take four tablets a day. If you are aware of a food source of Melatonin so that I can get my 30 mg a night, I would appreciate any tips you can give me! :-) > None of these things is proven to help PC, but a little extra flavor never > hurts anything, either, and if proof ever emerges that some of these > rumors are true, we'll be ahead of the game. Right. Few of these things have passed human double-blind trials. That is not to say that they have not been proven to be effective in vitro or ineffective in principle. That the National Cancer Insititute is putting as much research money into these "Complementary" therapeutic modes suggests that they quite promising. In the meantime we have anecdotal evidence or limited studies. They certainly do not meet any recognized standard of proof or of proven truth. But, I would prefer to take supplements that could give me even the slightest edge in dealing with PCa. Other than government funded research it would, of course, be unreasonable to expect drug companies to study something like Green Tea or Melatonin as anti-cancer drugs. Who would make any money ? You have made other choices, apparently. I respect your choice. Fred I wasn't denigrating your path; I was merely trying to alert people to other choices since so few people are willing to stick with such challenging methods. Heck, the vast majority won't even give up their junk food and spare ribs, let alone make special concoctions each day. Additionally, I wasn't aware of most of the issues you point out, such as using cocoanut milk as a Trojan horse to sneak fat-absorbed nutrients past the body's absorption barriers. It makes sense, at least at a superficial level and presuming your research has gotten past pseudoscience into real science. Assuming the latter, what can you tell us about the widespread rumor that adjusting our lymphatic system ph by consuming lots of calcium will kill cancer cells? I've heard it from many lay sources, but have found nothing on it so far in medical literature. I.P. >> This reminds me . . . weeks ago someone mentioned a supplement cocktail >> he blended up and drank each day. It sounded like something only a [quoted text clipped - 68 lines] > > Fred I. P. Freely wrote...snip... > Heck, the vast majority won't even give up their junk food and > spare ribs. What! Spare ribs are junk food?..Ron > Assuming the latter, what can you tell us about the widespread rumor that > adjusting our lymphatic system ph by consuming lots of calcium will kill > cancer cells? I've heard it from many lay sources, but have found nothing > on it so far in medical literature. I.P. That's an easy one for me. I believe that the raising of body alkalinity either in the blod or the lymph is quackery. It denies the simple reality that no matter what you eat or drink or how much calcium you consume it is not going to alter your blood alkalinity. Everything goes through the stomach and the acidic stomach acids acidify everything that goes in to approximately the same level. The idea that you can eat or drink or swallow anything that is going to turn you more alkaline has no medical support that I am aware of. Whenever people ask me about this I refer them to one of my favorite websites and an article they have on this topic: http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/coral2.html and for anyone considering paying to have their saliva analyzed: http://www.quackwatch.org/01QuackeryRelatedTopics/Tests/reams.html Fred The people who praise ph changes for PC control emphasize that it's the lymphatic system which must be altered. Quackwatch shoots down the whole concept in one fell swoop. I had tried QW, but had failed to ask the right question. Thanks. I.P. > I believe that the raising of body alkalinity > either in the blod or the lymph is quackery. It denies the simple reality [quoted text clipped - 9 lines] > > http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/coral2.html > I do not want to negate the effects of certain vitamins/anti-oxidants with > something like the positive effect of Melatonin on killing cancer cells or > visa versa. An example would be the high Vitamin E on my present > supplement dosage vs the Melatonin. Gotta watch that Vit E and balance its threats and benefits (if any). Each new study condemns it further at ever-lower levels. Even the old "safe" 400 i.u. level is now contraidicated for the general public due to its cardiovascular threat. Similarly, this entire antioxidant hypothesis takes a new hit with most emerging studies. I.P. Hi I.P. I was wondering when you'd get into the fray! I always welcome your thoughts and find them very interesting. I'm aware of the Vitamin E controversy. Am I correct that some studies have used synthetic vitamin E instead of the d-alpha-tocopherol kind? I know vitamin E rich foods contain alpha, beta, gamma, and delta tocopherol as well as tocotrienols. I think that vitamin E in food is 70% d-gamma-tocopherol and studies suggest that gamma E has many beneficial effects. D-alpha tocopherol wrongly became the most potent form based on some rat studies performed decades ago. Supposedly, people metabolize vitamin E differently, and benefit from all of these different forms of the vitamin. But what do I know. I just try to read and take in as much as I can understand and use to help myself in some way. B.A. You've already read, or at least digested and remember, more than I have on Vit E. I rapidly forget the differences between the various forms of E. There is as much confusion in the media about most supplements as there was about Terri Schiavo, so I pay little attention beyond reading bottom lines from sources I have some faith in, in the hopes of filtering out the ripples and getting on with the rest of my life. I eat a LOT of food, so hope to get most of my nutrients the way nature packs it, which seems to be quite important to assimilation. Glad you enjoy my ramblings. Maybe when I'm finally able to do little else than sit here I'll have the time to condense them and refine their logic so folks won't get so overwhelmed, bored, and/or confused by them. I.P. > Hi I.P. > [quoted text clipped - 12 lines] > > B.A. Fred: Thanks for the reply. I'll try the Melotonin. I've read some of the links that you've posted on it. What the heck, at the very least, it may help me sleep better! B.A. > Fred: > [quoted text clipped - 3 lines] > > B.A. Bob: I was taking a small 3 mg dose of Melatonin every night to help me sleep and to help curb what seemed to be some seasonal affective disorder (SAD) which strikes us folks sometimes who live in the grey, dreary northwest of the US. A small dose has been shown in clinical studies at Oregon Health Science University to help with some of the symptoms of seasonal affective disorder. I am convinced that it simply helps produce more Vitamin D and its successor hormones and that it enhances one's feeling of physical well-being. But, it also helped me sleep. It's used in sleep clinics as well. I thought the 30 mg dose might knock me out, but it really didn't. I didn't notice a thing. But, then I was kind of tired from having to deal with my cancer diagnosis and all. Best wishes to you! Fred |
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