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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2004DNA ploidy & PET scan
My onc was not receptive to the idea of having the following two diagnostic tests performed: 1. DNA ploidy, which determines to what extent PCa cells have diploid DNA and aneuploid DNA. The first is normal DNA and is affected by ADT, the second is abnormal and hormone-refractory. The onc, whose subspecialty is radiation, told me that at one time the DNA ploidy test was thought to be a possibly certain means of forecasting the future course of the disease, but it proved not to be. Comment? 2. He was also not receptive to having a (11C)choline PET scan performed. I'm less clear on his reason; have the impression that he's unfamiliar with it but hope I'm mistaken. This scan is supposed to have 82% sensitivity and 94% specificity in staging of lymph nodes in PCa cases. Comment? Regards, Steve J __ "Never give in--never, never, never, never, in nothing great or small, large or petty, never give in except to convictions of honour and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.'' --Sir Winston L. S. Churchill Stephen, I suggest you insist on the DNA Ploidy. DNA Ploidy is very helpful in determining how likely prostte cancer is to metastasize. By observing chormosome structure a determination can be made on the aggressiveness of the cancer. Dr. Hennenfent mentions in his book "Surviving Prostate Cancer Without Surgery" one study from the Mayo Clinic of 261 men where upon examination of the prostate once removed by surgery 10 men had aneuploid tumors and all 10 of these men developed progression of their cancer despite surgery. In my own experience a friend of mine with prostate cancer was going to a uro who insisted on surgery. I informed him of the DNA ploidy having read about it in the book. This was the first time he even heard about it as his uro never mentioned it to him. His uro refused DNA ploidy saying it was not accurate and a waste of time. My friend went elsewhere and had the DNA ploidy where the results advised against surgery. Regards, Everett > My onc was not receptive to the idea of having the following two > diagnostic tests performed: [quoted text clipped - 8 lines] > > Comment? On December 4, Everett R. Wadsworth responded to me: > I suggest you insist on the DNA Ploidy. DNA Ploidy is very helpful in > determining how likely prostte cancer is to metastasize. By observing > chormosome structure a determination can be made on the aggressiveness > of the cancer. Quite so. That's why it will be done (by Bostwick Labs) unless my rad onc can convince me via scientific evidence that it's unnecessary/unreliable/useless. And puts his professional reputation (which is high) on the table. (snip) > In my own experience a friend of mine with prostate cancer was going > to a uro who insisted on surgery. I informed him of the DNA ploidy [quoted text clipped - 3 lines] > went elsewhere and had the DNA ploidy where the results advised > against surgery. What!? Exactly how did the "results *advise(d)* against surgery?" Don't keep us in suspense; what did he do, and with what result?? When and where did this occur? Regards, Steve J __ "Never give in--never, never, never, never, in nothing great or small, large or petty, never give in except to convictions of honour and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.'' --Sir Winston L. S. Churchill Stephen, This occurred last year in Pennsylvania but the location is not important because this occurs everyday everywhere. You just never hear about it since most men choose to remain ignorant and just blindly follow the advice of their uro whose interests are not the best interests of the patient rather than taking charge of their situation and educating themselves and learning all they can by reading books like I have by Dr. Hennenfent. As to what happened with my friend he is doing fine. The DNA ploidy showed his cancer was aneuploid. As was previously mentioned the mayo clinic study showed of the 10 men whose cancer was found to be aneuploid all 10 developed progression of their cancer despite surgery. My friend went against his uro's recommendation and avoided surgery and all the complications associated with it and had hormone blockade along with radiation and as a result his PSA was drastically reduced and is now doing fine and he thanked me for the good advice I gave him. Regards, Everett > On December 4, Everett R. Wadsworth responded to me: > > In my own experience a friend of mine with prostate cancer was going [quoted text clipped - 19 lines] > might of the enemy.'' > --Sir Winston L. S. Churchill > Stephen, > This occurred last year in Pennsylvania but the location is not [quoted text clipped - 12 lines] > as a result his PSA was drastically reduced and is now doing fine and > he thanked me for the good advice I gave him. You were really foolish to dispense medical advice of this kind, and your friend was foolish to take it. He should have found some doctors he trusted on the basis of their qualifications and followed their advice. I would never suggest to anyone that they take my advice in preference to a qualified medical expert. As to the study you refer to, there are lots of studies being done all the time. Neither you nor I, nor Dr. Hennenfelt as best I can tell, is qualified to understand which studies are significant and which are not. The patient who decides to be his own physician is a fool, and anyone who gives medical advice to his friends as if he understood it all is worse. Radiation is a standard method to treat early prostate cancer, and it is often supplemented by hormone therapy which tends to make the cancer more susceptible to radiation damage. If, as you suggest, the DNA ploidy tests showed his cancer had almost certainly spread, there was no point in his having rdiation. Surgery and radiation appear to be about equally successful at curing prostate cancer. You also seem to think that urologists suggest surgery because they are mercenary. Perhaps you are unaware that radiation oncologists also get paid for their services and that a full schedule of radiation treatments is also expensive. Morevoer, hormone therapy is also very expensive. > Regards, > Everett [quoted text clipped - 24 lines] >>might of the enemy.'' >>--Sir Winston L. S. Churchill > > Stephen, > > This occurred last year in Pennsylvania but the location is not [quoted text clipped - 24 lines] > The patient who decides to be his own physician is a fool, and anyone > who gives medical advice to his friends as if he understood it all is worse. You really pile it on. The sad fact is that all the treatments turn out about the same in the end, so it hardly matters which one you start with, now does it. You contradict yourself and make other people feel bad at the same time. Proud of yourself? Are you just mad because your favorite choice, surgery, was not chosen? >>>Stephen, >>>This occurred last year in Pennsylvania but the location is not [quoted text clipped - 32 lines] > same time. Proud of yourself? Are you just mad because your favorite > choice, surgery, was not chosen? I made the same point you just did. Of course, we don't know the details of the individual case, but whether or not his friend had surgery or radiation probably didn't make much difference. You think it didn't make any difference at all either way. I think that, assuming certain conditions were met, there would have been a good chance he would have benefited from either. But the point is that neither of us should be telling men to ignore their doctors on the basis of what we tell them. And neither should he. And if he feels bad that he may have misled his friend, that's fine with me. He should feel bad, and he shouldn't be trying to influence his friend's choice of medical treatment. If he felt his friend was getting bad medical advice, he should have suggested getting additional opinions from qualified medical experts, not from some book. You always jump to conclusions. Surgery was the choice I made when I was diagnosed with prostate cancer. But I made that choice after considering all the factors as I felt they applied to me. In fact, radiation was also a choice I could have made at the time, and had I been five years older, I would have gone that way. Had I been ten years older, I would probably have chosen watchful waiting followed by hormone therapy when and if needed. I don't recommend either surgery or radiation or indeed any treatment. I always tell men to get doctors they trust and follow their recommendations. If they have a choice of several possibilities, I try to help them understand what their doctor's have told them. If you paid attention to what I actually say instead of what you imagine I must be saying, you would know all that. > >>>Stephen, > >>>This occurred last year in Pennsylvania but the location is not [quoted text clipped - 42 lines] > But the point is that neither of us should be telling men to ignore > their doctors on the basis of what we tell them. And neither should he. Why not, since doctors recommend what their training was, not what science tells them. If you go to different doctors with idential conditions, you get different recommendations. > And if he feels bad that he may have misled his friend, that's fine > with me. He should feel bad, and he shouldn't be trying to influence > his friend's choice of medical treatment. If he felt his friend was > getting bad medical advice, he should have suggested getting additional > opinions from qualified medical experts, not from some book. See above. > You always jump to conclusions. Surgery was the choice I made when I > was diagnosed with prostate cancer. But I made that choice after [quoted text clipped - 10 lines] > If you paid attention to what I actually say instead of what you imagine > I must be saying, you would know all that. See above. Trust is not the issue. Science is, and that is what has not been done for political reasons and the emotional ones too. >>>>>Stephen, >>>>>This occurred last year in Pennsylvania but the location is not [quoted text clipped - 81 lines] > See above. Trust is not the issue. Science is, and that is what has not > been done for political reasons and the emotional ones too. You ignore the fact that, while some doctors may not understand the relevant science, many fewer laymen do. You in particular show abysmal ignorance of many of the basic facts about prostate cancer. So you are the last person anyone should go to for advice about prostate cancer. I've spent quite a lot of time trying to understand various aspects of prostate cancer. I've learned just enought to understand just how small my knowledge and understanding are. You don't seem to feel it is necessary to do anything like that before expressing your opinions. > >>>>>Stephen, > >>>>>This occurred last year in Pennsylvania but the location is not [quoted text clipped - 85 lines] > relevant science, many fewer laymen do. You in particular show abysmal > ignorance of many of the basic facts about prostate cancer. You just emotionally trash the studies and pretend that in the future everything you say will be proven right. You are a good example of the emotional aspect of science research. Further, if all treatments are about the same, it hardly matters what criteria are used to select one. It can be a friend; it could be a doctor; it could be a table of random numbers. So you are > the last person anyone should go to for advice about prostate cancer. Since all treaments are about the same, you could ask me to pick 1, 2 or 3 and it would make no difference. It has been another year now with no announcements on surgery and its advantages. That comes to about 10 years now. I know, you are waiting for 15. Then it will be 20, 25 and so forth. I see nothing wrong with giving medical advice to my friend. I do not feel I was foolish at all. I would never take the advice of a qualified medical expert without doing my own research after what I've been thru in the past. You seem to be very happy with your surgery but if you took the time to do your own research and learned the facts I doubt you would have choosen surgery for yourself. From my own experience with the many urologists I consulted with I went against everyone of them with their advice and took matters into my own hands and now looking back at it I was correct and they were wrong and I'd sure hate to think where I'd be today otherwise. I am grateful that there are good books like the one I read by Dr. Hennenfent which helped me to make the right decision for myself. Regards, Everett > You were really foolish to dispense medical advice of this kind, and > your friend was foolish to take it. He should have found some doctors > he trusted on the basis of their qualifications and followed their > advice. I would never suggest to anyone that they take my advice in > preference to a qualified medical expert. > I see nothing wrong with giving medical advice to my friend. I do not > feel I was foolish at all. I would never take the advice of a > qualified medical expert without doing my own research after what I've > been thru in the past. You seem to be very happy with your surgery but > if you took the time to do your own research and learned the facts I > doubt you would have choosen surgery for yourself. I did do my own research. I'm sure it was at least as thorough as yours, but I think I approached it with a different attitude in mind. I've done research in mathematics for many years. I found that whenever I explored a new area I had to go through all the standard misconceptions before I began to get some appreciation of what was relevant and what wasn't. This was even more the case when I went outside mathematics to other areas such as medicine. Since I haven't gone to medical school, haven't done a residency, and I don't have any clinical experience dealing with hundreds of patients, I don't have the depth that a physician would have. It is easy to look on the internet or read books trying to make some point, but one then tends to concentrate on a few facts that seem to make an impression. There is a lot of information out there and much of it seems inconsistent if you don't know how to put it in perspective. Without enough training and experience, it is very difficult to tell what is relevant and to glean the wheat from the chaff. > From my own > experience with the many urologists I consulted with I went against [quoted text clipped - 14 lines] >>advice. I would never suggest to anyone that they take my advice in >>preference to a qualified medical expert. Everett wrote...snip... if you took the time to do your own research and learned the facts I doubt you would have choosen surgery Everett...Most men diagnosed with PCa today are in low-risk category (T1c, PSA<10, GS<7). Published data suggests that for low-risk men, both surgery (M. Han, A. W. Partin, M. Zahurak, S. Piantadosi, J. Epstein and P. C. Walsh; J. Urol., 169, 517-523, 2003) and SI+EBRT (F. Critz, W. Williams, A. Levinson, J. Benton, F. Schnell, C. Holladay, and P. Shrake; Poster Abstract 692 at the 2003 AUA meeting) have the best bNED outcomes at 10-years post-treatment. Both of these studies use PSA>0.2 ng/ml as the definition of failure. Other studies have convincingly demonstrated that the ASTRO definition of failure grossly overestimates freedom from disease. What published data are you refering to that makes the case for a more effective treatment than surgery or SI+EBRT for low-risk men?..Ron > Everett wrote...snip... > if you took the time to do your own research and learned the facts I [quoted text clipped - 13 lines] > What published data are you refering to that makes the case for a more > effective treatment than surgery or SI+EBRT for low-risk men?..Ron Ron, I suspect that Everett is not knowledgeable enough to understand any of this, but if he were he might respond that "low" risk category prostate cancers of the kind you describe rarely need to be treated except by watchful waiting followed by hormone therapy when and if needed. (I would actually describe such cancers as moderate risk myself, and the Gleason 7 cancers as high end moderate risk.) Indeed that is the recommended treatment for men with a life expectancy of less than 10 years. I don't buy the argument that men with longer life expectancy will do just as well that way, but we have to admit it hasn't yet been proved definitively by that gold standard, a randomized prospective study. On the other hand, other evidence suggests that treatment benefits such men, and there is no convincing evidence of any kind that such treatment is generally ineffective. Everett seems to be hung up on avoiding surgery, and he doesn't seem to understand that the arguments for radiation over surgery, in most cases, are not persuasive. > > Everett wrote...snip... > > if you took the time to do your own research and learned the facts I [quoted text clipped - 18 lines] > I suspect that Everett is not knowledgeable enough to understand any of > this, Only you have understanding. Sorry. >>>Everett wrote...snip... >>>if you took the time to do your own research and learned the facts I [quoted text clipped - 20 lines] > > Only you have understanding. Sorry. No. Ron and lots of other people understand it. > >>>Everett wrote...snip... > >>>if you took the time to do your own research and learned the facts I [quoted text clipped - 22 lines] > > No. Ron and lots of other people understand it. Science does not document what you claim here. >>>>>Everett wrote...snip... >>>>>if you took the time to do your own research and learned the facts I [quoted text clipped - 24 lines] > > Science does not document what you claim here. Which statement does "science" not document? Is it the quote from Ron, to which he gives explicit references in the medical research literature? Is it my opinion about Everett or my opinion about Ron and others understanding something? I agree that "science" doesn't document those opinions, but they are hardly the sorts of things that one would expect a scientific proof of. Everett wrote...snip... if you took the time to do your own research and learned the facts I doubt you would have choosen surgery Everett...Most men diagnosed with PCa today are in low-risk category (T1c, PSA<10, GS<7). Published data suggests that for low-risk men, both surgery (M. Han, A. W. Partin, M. Zahurak, S. Piantadosi, J. Epstein and P. C. Walsh; J. Urol., 169, 517-523, 2003) and SI+EBRT (F. Critz, W. Williams, A. Levinson, J. Benton, F. Schnell, C. Holladay, and P. Shrake; Poster Abstract 692 at the 2003 AUA meeting) have the best bNED outcomes at 10-years post-treatment. Both of these studies use PSA>0.2 ng/ml as the definition of failure. Other studies have convincingly demonstrated that the ASTRO definition of failure grossly overestimates freedom from disease. What published data are you refering to that makes the case for a more effective treatment than surgery or SI+EBRT for low-risk men?..Ron > I see nothing wrong with giving medical advice to my friend. I do not > feel I was foolish at all. I would never take the advice of a [quoted text clipped - 17 lines] > > advice. I would never suggest to anyone that they take my advice in > > preference to a qualified medical expert. Talking to people is one of the best things you can do before any medical treatment. I see nothing wrong with giving medical advice to my friend. I do not feel I was foolish at all. I would never take the advice of a qualified medical expert without doing my own research after what I've been thru in the past. You seem to be very happy with your surgery but if you took the time to do your own research and learned the facts I doubt you would have choosen surgery for yourself. From my own experience with the many urologists I consulted with I went against everyone of them with their advice and took matters into my own hands and now looking back at it I was correct and they were wrong and I'd sure hate to think where I'd be today otherwise. I am grateful that there are good books like the one I read by Dr. Hennenfent which helped me to make the right decision for myself. Regards, Everett > You were really foolish to dispense medical advice of this kind, and > your friend was foolish to take it. He should have found some doctors > he trusted on the basis of their qualifications and followed their > advice. I would never suggest to anyone that they take my advice in > preference to a qualified medical expert. On December 3, I posted on the DNA ploidy and (11C)choline PET scan staging tests. On December 17, contrary to my rad onc's advice, I consulted a med onc. What an eye opener! She agreed with my assessment that certain things must be done without further delay, and I have embarked upon the course recommended by her. This includes *monthly* "ultrasensitive" PSA tests for six months, further testosterone assay, and a PAP test. In large part this is because I am at high risk. She did tell me that she agreed (just about the only agreement) with the rad onc that the two tests will not produce clinically significant information at this stage. IOW it's too late. So much for that idea. Thank God for Stephen Strum. Regards, Steve J __ "Never give in--never, never, never, never, in nothing great or small, large or petty, never give in except to convictions of honour and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.'' --Sir Winston L. S. Churchill Steve wrote...snip... I have embarked upon the course recommended by her. This includes *monthly* "ultrasensitive" PSA tests for six months, further testosterone assay, and a PAP test. Hi Steve...Sorry, I forget your particulars, like what kind of ADT you are on. In any case, it's usually desirable to measure DHT (at least initially) to make sure that it is in the proper range. Achieving castrate levels of T does not guarantee that DHT will be in the desired range. There are (at least) two pathways for conversion of T to DHT. Proscar blocks one of these pathways and is effective in reducing DHT to the desired range in 80% of men treated. Avodart blocks both pathways and will move DHT down to the desired level in most men. In those few men whose DHT is not reduced to the desired level with either of these two drugs, other steps, such as grapefruit juice or ketoconazole, can be taken. Since DHT is 10 times more active than T, leaving it at 30 or above would be like having T levels above 300! Just a thought...Best wishes and good health, Ron Quoting me: > I have embarked upon the course recommended by her. > This includes *monthly* "ultrasensitive" PSA tests for six months, > further testosterone assay, and a PAP test. He replied: > Hi Steve...Sorry, I forget your particulars, like what kind of ADT you > are on. Lupron 4-month depot. Hot flashes are fewer and less intense than those with Zoladex. While I'm on the subject, I'll point out that Medicare and other insurers will NOT pay for implants that are done at intervals less than *calendar months*. Both my oncs, and the manufacturers, agree that the intervals should be based upon 28-day months. Thus my next Lupron implant is scheduled for March 31, which is ten days more than 4x28=112 days from the date of the prior implant (11/29). The med onc says the time interval is critical. In fact, the last T and PSA tests were done 11/22, three days after the renewal implant was due. It is possible that the results, which were too high (T=36 ng/dL, PSA 0.1 ng/dL), may have resulted from that fact. Dunno. If it's otherwise, the ADT may be failing and I'll have to go to chemo, an unpleasant prospect. What's happening is that the insurers are saving money by insisting upon this, which is at best poor medical practice. But the implants cost ~$2000, so they wield a heavy economic club. Having been in the insurance business for most of my life, I can say without fear of contradiction that they are ruthless. > In any case, it's usually desirable to measure DHT (at least > initially) to make sure that it is in the proper range. Another test that was not timely done. It's now too late. > Achieving castrate levels of T does not guarantee that DHT will be in > the desired range. There are (at least) two pathways for conversion [quoted text clipped - 8 lines] > leaving it at 30 or above would be like having T levels above 300! > Just a thought...Best wishes and good health, Ron Thanx. But as a practical matter, if T is at a castrate level (>20 ng/dL is preferred), then DHT will be suppressed in proportion. I'll see what the 12/20 test tells me. Regards, Steve J __ "No man is an Island, entire of itself; every man is a piece of the Continent, a part of the main; if a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friends or of thine own were; any man's death diminishes me, because I am involved in Mankind; And therefore never send to know for whom the bell tolls; It tolls for thee." -- John Donne > In any case, it's usually desirable to measure DHT (at least > initially) to make sure that it is in the proper range. >> Another test that was not timely done. It's now too late. Too late? I assume you mean for this cycle as opposed to the next time your T is measured. >> But as a practical matter, if T is at a castrate level (>20 ng/dL >> is preferred), then DHT will be suppressed in proportion. That's not true for all men. That's why most PC oncs (Strum and Myers, for example) measure T and DHT...Best wishes and good health, Ron Quoting him: >>In any case, it's usually desirable to measure DHT (at least >>initially) to make sure that it is in the proper range. Quoting me: >>>Another test that was not timely done. It's now too late. Ron sez: > Too late? I assume you mean for this cycle as opposed to the next time > your T is measured. To which I reply: It's necessary to bear in mind that, due to my high Gleason, I'm on Lupron 4-month ADT. AIUI, that means that my T assay, therefore my DHT assay, would be affected. Howsomever, I just an hour ago received a lab report on my T assay as of 12/20. It's <20 ng/mL. Yeehaw! Also, my "ultrasensitive" PSA is 0.03. Yeehaw again! Regards, Steve J |
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