RE: Re: My Prostrate Cancer & MRI

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Thanks Bill!billlove42 wrote: I made a related post in Message 14061.Bill, NYC>> Hi KD,> > > > The issue of what is termed Active Surveillance was dealt with in a recent> post of mine and rather than repeat it all here, could I suggest you go to> the

Messages link at the bottom of this mail and navigate to message 14057> headed A Decision Made, posted at 10.00 am July 29.> > > > If you have any queries after reading that one, please don't hesitate to> come back.> > > > > > All the best> > > > Terry Herbert > > in Melbourne Australia > > Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No treatment. Jun> '07 PSA 42.0 - Bony Metastasis: starting ADT> > My site is at www.prostatecancerwatchfulwaiting.co.za > > It is a tragedy of the world that no one knows what he doesn't know, and the> less a man knows, the more sure he is that he knows everything. Joyce> Carey> > > > _____ > > From: ProstateCancerSupport > [mailto:ProstateCancerSupport ] On Behalf Of Kojo Dankwa> Sent: Tuesday, 31 July 2007 2:48 PM> To: ProstateCancerSupport > Subject: My Prostrate Cancer & MRI> > > > Hello All:> > > > I was diagnosed with low grade PCa in 10/05.PSA =3.8,Gleason =3+3=6.My> doctors indicated that it's low grade and but still needed to make a> treatment decision. I am 43. I opted to watch it for a while and make> consistent follow-ups/DREs and PSA. My PSA is now 4.0 almost 2 yrs after> initial diagnosis through biospy.> > After my last PSA I

decided it was time to see a picture of what was going> on 'inside'. I requested an MRI. My Urol did not think it necessary as it> may not show much. I did the MRI 2 weeks ago. The MRI came back with no> threat of spread and no significant evidence of PCa. Doesn't appear as> though much has happened in terms of growth since diagnosis. I have no> symptons and I am perfectly fine.> > > > My question is that given what we all know about the various treatment> options and what I now know through DRE's , PSA and MRI results, is there> really the need to rush to treat? I know I have to treat at some point> (unless my PCa vanishes!).> > > > > > Kind Regards,> > KD> > > > > > _____ > > Sick sense of humor? Visit Yahoo! TV's Comedy> <http://us.rd.yahoo.com/evt=47093/*http:/tv.yahoo.com/collections/222> with> an Edge to see what's on, when.>

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Thanks Fred. My understanding is that MRI is good for detecting cancers too. In fact if cancer spreads,MRI is one of the ways to know. It will however not show minute tumors like mine,in which case spreading is ruled out. Yes,I am being actively monitored by an Urologist. I have psa/DRE every 6 months. I live in MD and have access to s Hopkins as well. In fact I saw a top doc there for a 2nd opinion when I was first diagnosed. The MRI was my idea. My doctors had indicated that they do not believe the cancer had grown any given my low psa and good DRE results and from their experience. However, having waited almost 2 years, I just wondered what was happening inside me and asked my Urol. He predicted that it may not show much given the stage but since. I asked and I have good insurance (yes i pay a lot for it) he sent me off for one anyway. The report cleary spells out the fact that there is no spread and infact the area under suspicion itself shows

decreased enhancement meaning not showing much as predicted by my Urol. Yes, MRI detects cancers and their spread....I have some renewed hope that at least I can be free of the treatments options, at least for now...Also I read that immediate action and delayed action have same outcomes so long as it's confined...i am monitoring closely.ncsailors wrote: KD -Your "youth" is both a plus and a minus for you. You have allthese years ahead of you, giving time

for ProCa to possiblygrow. I wonder how MRI compares to radioactive Bone Scan?I didn't know (nor would I) that MRI was all that useful inidentifying spread of cancer. Its great for things likebad knees, and broken shoulders. Was it an MRI witha pre-dose of radioactive isotopes a few hours aheadof test?Are you being treated by a very active Urologist, andoncologist (cancer treatment specialists)? What made themeven look further, with such a low PSA? Just curious.Sounds like now, you're doing quite well.There is a great prostate cancer treatment center in Georgio,whom have been treating men for many years. Here is theirlink: http://www.rcog.com/questions_and_answers.cfmIt's a long read, but their site sure explains some of thedetails and even realities, well. I read 1/2 of it lastnight.Fred .... awaiting

MY treatment decision, fall 2007>> Hello All:> > I was diagnosed with low grade PCa in 10/05.PSA =3.8,Gleason =3+3=6.My doctors indicated that it's low grade and but still needed to make a treatment decision. I am 43. I opted to watch it for a while and make consistent follow-ups/DREs and PSA. My PSA is now 4.0 almost 2 yrs after initial diagnosis through biospy.> After my last PSA I decided it was time to see a picture of what was going on 'inside'. I requested an MRI. My Urol did not think it necessary as it may not show much. I did the MRI 2 weeks ago. The MRI came back with no threat of spread and no significant evidence of PCa. Doesn't appear as though much has happened in terms of growth since diagnosis. I have no symptons

and I am perfectly fine.> > My question is that given what we all know about the various treatment options and what I now know through DRE's , PSA and MRI results, is there really the need to rush to treat? I know I have to treat at some point (unless my PCa vanishes!).> > > Kind Regards,> KD> > > > ---------------------------------> Sick sense of humor? Visit Yahoo! TV's Comedy with an Edge to see what's on, when.>

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Thanks! I am taking some suppliments from Theralogix (prostrate 2.2) that has Selenium, Vit E and D,Lycopene, SOY and other ingredients. Thanks for the advice though. I am keeping a close eye and at the first sign of trouble will opt for the knife. From what I have read, the consequences of treatment is not someting I want to endure now if I can delay it or hopefully not have to endure at all. Keeping a close eye and a positive attitude.mccartney_7 wrote: Might be worthwhile to try some

natural type treatments that have shown promise for this since your cancer (and I'd assume you do have cancer) is in it's early stage and slow growing. Do a search on the SELECT cancer study that concerns the mineral selenium and vitamin E, and read up on pomegranate juice and prostate cancer for a start. But from what I've read this cancer in a younger guy can get serious real quick, don't underestimate the consequences of inaction. >> Hello All:> > I was diagnosed with low grade PCa in 10/05.PSA =3.8,Gleason =3+3=6.My doctors indicated that it's low grade and but still needed to make a treatment decision. I am 43. >

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Thanks! I thik the sonogram never shows clear pictures. The MRI defines internal organs very cleary. They will give you something generically called 'contrast' which highlights areas of cancer. It's then up to the Radiologist to interprete. I am sending my pictures to another radiologist for a 2nd opinion. My goal is to delay as long as possible the effects of rushed treatment...dolphin_79605 wrote: My PCa was discovered when my PSA rose to 2.83 from

1.something a year previous. The jump was what alerted my Doc, not the reading in and of itself. He never felt anything during my annual DRE either. On his offer, I allowed him to look into things further with a sonogram(?). He couldn't find anything definate, but recommended me to consider the biopsy prcedure while I was on the table.He took (4) samples. Ultimately returning one sample (3+3=6) GS out of the (4).You have an aware Doctor. This is a good thing.Mick -- Abilene, TX> >> > Hello All:> > > > I was diagnosed with low grade PCa in 10/05.PSA =3.8,Gleason > =3+3=6.My doctors indicated that it's low grade and but still needed > to make a treatment decision. I am 43. I opted to watch it for a > while and make consistent follow-ups/DREs and PSA. My PSA is now 4.0 > almost 2 yrs after initial diagnosis through biospy.> > After my last PSA I decided it was time to see a picture of what > was going on 'inside'. I requested an MRI. My Urol did not think it > necessary as it may not show much. I did the MRI 2 weeks ago. The MRI > came back with no threat of spread and no significant evidence of > PCa. Doesn't appear as

though much has happened in terms of growth > since diagnosis. I have no symptons and I am perfectly fine.> > > > My question is that given what we all know about the various > treatment options and what I now know through DRE's , PSA and MRI > results, is there really the need to rush to treat? I know I have to > treat at some point (unless my PCa vanishes!).> > > > > > Kind Regards,> > KD> > > > > > > > ---------------------------------> > Sick sense of humor? Visit Yahoo! TV's Comedy with an Edge to see > what's on, when.> >>

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Hello: Wanted to share some information on MRI. They injected me with some substance (called contrast -which is meant to highlight the cancer). The lonk below throws some light on the pros of the procedure.... http://www.radiologyinfo.org/en/info.cfm?pg=mr_prostate & bhcp=1#part_onencsailors wrote: KD -Your "youth" is

both a plus and a minus for you. You have allthese years ahead of you, giving time for ProCa to possiblygrow. I wonder how MRI compares to radioactive Bone Scan?I didn't know (nor would I) that MRI was all that useful inidentifying spread of cancer. Its great for things likebad knees, and broken shoulders. Was it an MRI witha pre-dose of radioactive isotopes a few hours aheadof test?Are you being treated by a very active Urologist, andoncologist (cancer treatment specialists)? What made themeven look further, with such a low PSA? Just curious.Sounds like now, you're doing quite well.There is a great prostate cancer treatment center in Georgio,whom have been treating men for many years. Here is theirlink: http://www.rcog.com/questions_and_answers.cfmIt's a long read, but their site sure explains some of

thedetails and even realities, well. I read 1/2 of it lastnight.Fred .... awaiting MY treatment decision, fall 2007>> Hello All:> > I was diagnosed with low grade PCa in 10/05.PSA =3.8,Gleason =3+3=6.My doctors indicated that it's low grade and but still needed to make a treatment decision. I am 43. I opted to watch it for a while and make consistent follow-ups/DREs and PSA. My PSA is now 4.0 almost 2 yrs after initial diagnosis through biospy.> After my last PSA I decided it was time to see a picture of what was going on 'inside'. I requested an MRI. My Urol did not think it necessary as it may not show much. I did the MRI 2 weeks ago. The MRI came back with no threat of spread and no significant evidence of PCa.

Doesn't appear as though much has happened in terms of growth since diagnosis. I have no symptons and I am perfectly fine.> > My question is that given what we all know about the various treatment options and what I now know through DRE's , PSA and MRI results, is there really the need to rush to treat? I know I have to treat at some point (unless my PCa vanishes!).> > > Kind Regards,> KD> > > > ---------------------------------> Sick sense of humor? Visit Yahoo! TV's Comedy with an Edge to see what's on, when.>

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Thanks all....I think that biopsy is still a diagnostic tool but MRI can help track progress of the cancer. It's an established fact that MRI have always pinpointed spread of tumors and other ailments with great accuracy. It's general unavailability is perhaps why guess work is used in many treatment decisions. I am using PSA, DRE and MRI (and changed diet) in my active monitoring fight. I understand the risks of waiting but I also understand the risks of treatment. My father's Prostrate cancer was caught in his early 70s. He probably has had it since my age but did not have the benefit of PSA and hence did not have to worry till he was an old man. He is fully cured now after surgery. Had he known then, he probably would have had to live with the effects of surgery 30 years earlier! My point? Why can't I also buy some time with some active monitoring and then 'ED' myself later when it doesn't matter anymore? In any case, there is more

than one way to kick the bucket! Just the thoughts of a man left with difficult choices..... Fuller wrote: Hi :My guess would be that the equipment used and the expertise necessary to "read" the results correctly is not widely available, and also the procedure is relatively expensive and not covered by some insurance, but that is just a guess. In the abstract of the referenced article they

say:"Prostate zonal anatomy and prostate cancer are best depicted on multiplanar T2-weighted MR images. MR imaging and 1H MR spectroscopy are not used as an initial diagnostic tool. Their use in tumor detection is reserved for patients with elevated prostate-specific antigen levels in whom previous biopsy results were negative."My further research on this subject indicates that there is controversy within the medical community rearding the value of staging evaluation using MRI. This is seemingly like the other things we contend with for PCa; there is contoversy and difference of opinion!All I can say is that I trusted Dr. Rossi as an expert in radiological oncology, and he used it as an aid in my case.Fuller>> Fuller...>

> My question would be, and please do not take it as any kind of an > argument for or against MRI, if MRI is so good for "seeing" > metastasized PCa, why can't it be (or isn't it) used to diagnose it > in the first place; rather than the relatively medieval biopsy. > (Which misses more cancers than it detects.)>

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Thanks : I agree with you assertion. When you remove it, you improve your chances but doesn't rule out recurrence. When you don't there is a chance it will never grow and there is a chance it will, to put it simply. I think at the end of the day, I can only fall on the belief that if this is my 'mode of exit', it will regardless if what I do. What else can I say? Shuey wrote: I would never give advice to anyone. (I am not a doctor, although I did play one

in elementary school.) We all need to do our research and make our own decisions in light of our own needs, personas, etc.But I would raise one red flag...Watchful waiting can be and is a reasonable strategy if, and only if, your PCa is of a very slow growing, non-mestastasizing variety. To the best of my knowledge, no definitive markers have yet been identified for that purpose... meaning that whatever route one chooses is basically a roll of the dice.> >> > Fuller...> > > > My question would be, and please do not take it as any kind of an > > argument for or against MRI, if MRI is so good for "seeing" > > metastasized PCa, why can't it be (or isn't it) used to diagnose it > > in the first place; rather than the relatively medieval biopsy. > > (Which misses more cancers than it detects.)> > > > > > > > > ---------------------------------> Need a vacation? Get great deals to amazing places on Yahoo! Travel.>

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Thanks Mick...I think that if we looked at it that way, we'd be free of the intense worries that may kill us first! dolphin_79605 wrote: Thank you kojo. I always wondered what I could do in a positive light with my fears and or negativity about such. Having a fall back plan of: this is "my mode of exit" gives me comfort. I hope if it comes that it will be fast and peaceful. I want to be one of the "lucky bastards". Selfishly, Mick --

Abilene, TX> > >> > > Fuller...> > > > > > My question would be, and please do not take it as any kind of an > > > argument for or against MRI, if MRI is so good for "seeing" > > > metastasized PCa, why can't it be (or isn't it) used to diagnose > it > > > in the first place; rather than the relatively medieval biopsy. > > > (Which misses more cancers than it detects.)> > > > > > > > > > > > > > > > > ---------------------------------> > Need a vacation? Get great deals to amazing places on Yahoo! Travel.> >> > > > > > > >

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[Guest guest]

Kojo,

Soon after I was diagnosed, back in 1996, I

came across a fascinating piece, written by Jay Gould which helped me a lot, especially because I was not particularly

numerate. It was called The Median

Isn't The Message and it can be found here http://tinyurl.com/6nwg7

One of the telling points for me was this <snip>

…… I asked Sir Medawar, my personal scientific guru and a

Nobelist in immunology, what the best prescription for success against cancer

might be. " A sanguine personality, " he replied…. <snip> It

seems to me that you have that kind of personality and that Active Surveillance

may well be a good path for you to take. It certainly is not for everyone.

As a matter of interest, did you read

those articles I referred you to the other day? I think they put what

refers to as ‘a roll of the dice’ into some kind of perspective.

All the best

Terry Herbert

in Melbourne

Australia

Diagnosed ‘96: Age

54: Stage T2b: PSA 7.2: Gleason 3+3=6: No treatment. Jun '07 PSA 42.0 - Bony

Metastasis: starting ADT

My site is at

www.prostatecancerwatchfulwaiting.co.za

It is a

tragedy of the world that no one knows what he doesn’t know, and the less

a man knows, the more sure he is that he knows everything. Joyce Carey

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kojo Dankwa

Sent: Thursday, 2 August 2007 9:13

AM

To: ProstateCancerSupport

Subject: Re:

Re: My Prostrate Cancer & MRI

Thanks Mick...I think that if we looked at it that way, we'd be free of

the intense worries that may kill us first!

dolphin_79605

<dolphin_79605> wrote:

Thank you kojo. I always wondered what I could

do in a positive

light with my fears and or negativity about such. Having a fall

back plan of: this is " my mode of exit " gives me comfort. I hope if

it comes that it will be fast and peaceful. I want to be one of

the " lucky bastards " .

Selfishly, Mick -- Abilene,

TX

> I would never give advice to anyone. (I am not a doctor,

although I

> did play one in elementary school.) We all need to do our research

> and make our own decisions in light of our own needs, personas,

etc.

>

> But I would raise one red flag...Watchful waiting can be and is a

> reasonable strategy if, and only if, your PCa is of a very slow

> growing, non-mestastasizing variety. To the best of my knowledge,

no

> definitive markers have yet been identified for that purpose...

> meaning that whatever route one chooses is basically a roll of the

> dice.

>

[Guest guest]

Thanks a bunch Terry. Yes, I did see the article , thanks! When I asked for an MRI, my doctor responded by saying it may be too small for MRI to see. A radio onc. told me the same thing at Hopkins. And yet, these same doctors want to 'knife' me the next second i walk in. If it's so small why can't I wait a bit? Especially when good research reveals that early treatment vrs delayed have same outcomes? Also who knows, some better therapy may come along. In 2 years, my psa has increased by .2. I won't rush give myself issues I don't need to have! I will beat this! Terry Herbert wrote: Kojo, Soon after I was diagnosed, back in 1996, I came across a fascinating piece, written by Jay Gould which helped me a lot, especially because I was not particularly numerate. It was called The MedianIsn't The Message and it can be found here http://tinyurl.com/6nwg7 One of the telling points for me was this

<snip> …… I asked Sir Medawar, my personal scientific guru and a Nobelist in immunology, what the best prescription for success against cancer might be. "A sanguine personality," he replied…. <snip> It seems to me that you have that kind of personality and that Active Surveillance may well be a good path for you to take. It certainly is not for everyone. As a matter of interest, did you read those articles I referred you to the other day? I think they put what refers to as ‘a roll of the dice’ into some kind of perspective. All the best Terry Herbert in Melbourne

Australia Diagnosed ‘96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No treatment. Jun '07 PSA 42.0 - Bony Metastasis: starting ADT My site is at www.prostatecancerwatchfulwaiting.co.za It is a tragedy of the world that no one knows what he doesn’t know, and the less a man knows, the more sure he is that he knows everything. Joyce Carey From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kojo DankwaSent: Thursday, 2 August 2007 9:13 AMTo: ProstateCancerSupport Subject: Re:

Re: My Prostrate Cancer & MRI Thanks Mick...I think that if we looked at it that way, we'd be free of the intense worries that may kill us first! dolphin_79605 <dolphin_79605> wrote: Thank you kojo. I always wondered what I could do in a positive light with my fears and or negativity about such. Having a fall back plan of: this is "my mode of exit" gives me comfort. I hope if it comes that it will be fast and peaceful. I want to be one of the "lucky bastards". Selfishly, Mick -- Abilene, TX> I would never give advice to anyone. (I am not a doctor, although I > did play one in elementary school.) We all need to do our research > and make our own decisions in light of our own needs, personas, etc.> > But I would raise one red flag...Watchful waiting can be and is a > reasonable strategy if, and only if, your PCa is of a very slow > growing, non-mestastasizing variety. To the best of my knowledge, no > definitive markers have yet been identified for that purpose... > meaning that whatever route one chooses is basically a roll of the > dice.>

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[Guest guest]

Thanks Jon. My Urologist had indeed indicated that MRI may not say much about my small tumor. However, I think the main goal was to see if it is spreading although that was equally unlikely per my doctor. I think it's generally known that cancer spread is detected by MRI. My goal wasn't diagnosis. That had been done earlier through biopsy. Regards, KDccnvweb wrote: I've been traveling and in catching up on posts there seems to be a need to provide a

bit more information on "MRIs" and "sonograms" for prostate cancer monitoring. A normal MRI, even with contrast enhancement, is unlikely to provide any information about an early detected prostate cancer. The contrast between normal prostate tissue and prostate cancer tissue is not enough. What is used for prostate cancer scans, with readings by trained radiologists, is MRSI. This is MRI with spectroscopy, which provides additional information about the metabolic chemistry of what is scanned. However, this technology may not provide much information about very small tumors (less than 0.5 cc). Similarly, a normal sonogram is unlikely to provide much meaningful information about an early prostate cancer. A few centers in the U.S. have enhanced transrectal color Doppler (also may be called "power doppler") ultrasound machines that provide more resolution than the normal ultrasounds used for biopsies and, in

addition, the 'doppler' technology provides information about blood flow in microvascular vessels in the prostate. The latter information is important as aggressive cancers tend to increase their local blood supply. However, as is the case for MRSI, a significant amount of skill and experience is needed to interpret the color Doppler images. Just having the bucks to buy the machines does not mean a center will have the skill to interpret the images. For more details on MRSI scans: http://www.prostate-cancer.org/education/staging/kurhanewicz_MRIofPC.html For more info on color Doppler ultrasound (CDU) scans: http://www.prostate-cancer.org/education/localdis/Bahn_ActiveSurveillanceCDU.html For more info on Active Surveillance: http://www.prostate-cancer.org/education/localdis/klotz_activesurveillance.html The Best to You and Yours! Jon >> Thanks! I thik the sonogram never shows clear pictures. The MRI defines internal organs very cleary. They will give you something generically called 'contrast' which highlights areas of cancer. It's then up to the Radiologist to interprete. I am sending my pictures to another radiologist for a 2nd opinion.>

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