Steve,

Doubling rate is a consideration AFTER treatment or in the case of
metastatic cancer.   Normally, I believe, for a diagnosis like that
described here, the PSA will not increase nearly that fast.   The
so-called PSA velocity is the rate at which the PSA increases.   If this
is over 0.75 ng/ml per year overa two year period, that is considered a
reason to have a biopsy.   Given that he has already been diagnosed with
prostate cancer, I'm not sure if the same criterior applies for watchful
waiting, but if he shows any evidence of rapid increase, considerably
less that doubling in two years, I'm sure his doctors will recommend
aggressive treatment.   The reason watchful waiting has been presented
to him as an alternative is that experience has shown that many cancers
similar to his remain quiescent for quite long periods of time and never
 bother the patient during his life time.

hi steve - i wish the doubling rate is what you described, but it is
not.  

what happens is that at the beginning, it starts out slowly doubling.
that is why it is so misleading.  because as the cancer makes more new
cells, it starts growing faster and faster, unchecked.  then it hits a
point to where it really sky rockets and at the end of the man's life,
the pca may double in just a few hours.  that is how it works.  

in my dad's case, when it shot up from 90 to 288, his doubling rate had
dropped from 6 months to less than 3 months.  if they had not gave him
the lupron shots, at the next six month psa test, it would have been in
the neighborhood of 800+  and that is a low estimate.  that is why when
they are treating pca, they look at the doubling rate because it tells
just how active the cancer is.  if it was doubling every 6 months and
they were able to slow it to every 12 months, then they know they have
helped the patient.  

in my dad's case, they shot his psa from 288 to <.1 and as far as the
cancer growing, it isn't.  that is why it is said to have been "put to
sleep"  it's still there, just not active.  as long as they can keep the
psa down to the lowest levels, then the quality of life is good.

at one web site, they use to have an extensive discussion on doubling
rates, but i haven't seen any of them discuss like what i just did.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional

Curtis,

He hasn't given us all the details of his diagnosis, but I presume that
he has a T1c cancer.  That and other criteria can be a justification for
 choosing watchful waiting in some cases.   A T2c cancer would
generally be more aggressive.

Also, it seems that your father's doctors didn't really pay much
attention to what was happening.   Watchful waiting, as it is supposed
to be practiced, requires careful monitoring and intervention when there
is some suspicion that the cancer is growing rapidly.

It sounds to me as if they should have done something as soon as it was
clear the PSA was rising.   But if this all happened over 10-15 years,
ago, it is not clear they could have done much better.   At his age, he
probably wasn't a good candidate for surgery, and radiation was not all
that successful because they couldn't focus well enough to apply a high
enough dose.   You have to remember that great progress has been made in
treatment by radiation in the past 10-15 years.  But it still may have
been worth a try early on.

The rest of your advice is right to the point, but he really needs to
get his final advice from medical authorities, rather than from us.  We
have experienced it and had relatives who experienced it, but we still
only have a limited knowledge of the relative likelihoods of different
outcomes as they apply to specific patients.

My uncle had his cancerous prostate removed when he was 76.  He is 83 now and
doing fine.  Much luckier than me.  NO pain, yet, folks, and the chemotherapy
seems to be doing some good! ;-}

My staging is T2a and one of the doctors recommending WW was at Sloan
Kettering. Next week I am going to have my PSA checked and depending on
the results will make up my mind. But once I come to the doubling stage
I will go straight to radiation.

I was told that lycopene is a good cancer inhibitor. Is anyone using it?

Al

" In the United States, only one of every eight men diagnosed is
forecast to die from the disease.  The indication is that seven of the
eight men would not benefit from treatment.  Unfortunately, it is not
possible today to determine which one of the eight men requires
treatment and there is no assurance that currently available treatments
would be helpful to him even if he could be identified."

I'm still trying to figure out where the motivation is to promote
watchful waiting so heavy and to so many guys who clearly should be
treated.  

Be careful when deciding about WW,  get a second and even a third
opinion before you decide anything.

Dale J.

I think this site underplays the effectiveness of treatment for prostate
cancer.   It makes the following unjustified statements.

 "There is currently no treatment available that has been proven
capable of providing a cure, capable of extending life, or of doing more
good than harm. In addition, all treatments have undesirable side
effects that can seriously detract from the patient's quality of life
for the rest of his days."

What this means is that no double blind randomized study has been done
comparing treating prostate cancer to not treating it.   That is not
quite true.   A recent Swedish study showed that men who were treated by
radical prostatectomy were at significantly lower risk of dying of
prostate cancer during the six or so years they were followed after
treatment than a similar group of men followed by watchful waiting and
treatment with hormones where necessary.   Critics of this study have
made much of the fact that there was no significant difference in the
number of overall deaths in that period between the two groups.   There
are lots of reasons why that is not surprising.   But some have jumped
to the conclusion that those treated by RP were more likely to die of
other causes than those in the ww group.  However, no such conclusion
can be drawn from the actual statistics;  it is a simple minded
misunderstanding of how statistics works in such cases.   However, the
cases studied were quite different than men in the US with prostate
cancer for a variety of reasons.   One is that their cancers were not
discovered early by PSA testing, which is not done routinely in Sweden.
 They were men with actual symptoms which sent them to doctors, who
after examination referred them for biopsy.   All the men in both groups
were considered candidates for RP, but generally speaking their cancers
were 5 years or so further along at diagnosis.

More important, the statement ignores all the other evidence.   From
retrospecitive studies of the natural course of the disease, doctors
know what is likely to happen to prostate cancer patients and over what
period of time.   They also know what happens to men who have been
treated.   See the nomograms at the Sloan Kettering website for example.
  It would seem from that data that treatment is effective.   The
problem is that there could be confounders: factors other than the
treatment which might explain the difference.   So this sort of evidence
is not considered as strong as the result of a double blind randomized
study in which men who are matched in all known relevant ways are
randomly assigned to different treatment modes.  (Actually, no PC study
would be double blind because it would be clear which patients were
treated and which weren't, but the selection process would be double
blind since no one would know beforehand to which category a patient
would be assigned.)   Note however that many things in medicine are
accepted without the support of a double blind randomized study.   One
such is the link between smoking and various diseases such as lung cancer.

"In the United States, only one of every eight men diagnosed is forecast
to die from the disease. The indication is that seven of the eight men
would not benefit from treatment. Unfortunately, it is not possible
today to determine which one of the eight men requires treatment and
there is no assurance that currently available treatments would be
helpful to him even if he could be identified."

This is really bad reasoning.  On what basis do they conclude that only
one in eight cases of prostate cancer will result in death from the
disease?   I suspect this comes from comparing the number cases of PC
diagnosed each year with the number of deaths from PC.   However, the
overwhelming bulk of the men diagnosed with prostate cancer are treated
for it, either early by surgery or radiation, or, late, by hormones.
Since they claim no treatment whatsoever has been shown to be effective,
that includes hormones.   Even if they exclude treatment by hormones
under the term "treatment", then there are large numbers of men treated
by surgery or radiation.   Only by assuming none of these men have
benefited from treatment can one come to the conclusion stated.   But
they are using this statement to justify the conclusion that treatment
is effective.  That is called circular reasoning.

Furthermore, there are other compelling reasons for treating prostate
cancer than avoiding death from the disease.   For example, advanced
prostate cancer is likely to produce urinary symptoms, including
incontinence, and impotence.  It can also lead to great pain and
suffering such as might happen if the spine collapses.  Treatment by
hormones will effectively produce impotence and also has other side
effects.   So even if hormone therapy could control the cancer
indefinitely, there would be reasons to avoid it if one could.

I use an address that is a phony so it doesn't get picked up for spam. I
would appreciate anything you have. My address is alfrae@eathlink.net
Thanks.
Al