Re: New Member - Active Surveillance or Immediate Action?

[Guest guest]

> I have had a biopsy that showed cancer in only of 12 samples -

should I opt

It depends on your Gleason & /or staging.

Mine was only in one of 12 (1 of 24 if you count both biopsies I

had). Plus it was estimated at only 2mm. But it was a 3+4 Gleason,

and not far from the capsule, so I have opted to attack it.

The only good cancer is a dead cancer.

[Guest guest]

You say <snip> The only good cancer

is a dead cancer. <snip> and few would disagree, but I believe it is

essential  to define what a cancer is in reality.

Logothetis, a

leading expert in advanced prostate cancer was asked a question at a US-TOO

meeting in Texas.

He had been commenting on the relative inaccuracy of the diagnostic process.

The question was: " Does this mean that a lot of people who are diagnosed

as having cancer really don't? His answer was: " Yes, if one accepts the

diagnosis that the cancer is a disease that is potentially

lethal……. One of the problems with prostate cancer is definition.

They label it as a cancer, and they force us all to behave in a way that

introduces us to a cascade of events that sends us to very morbid therapy. It's

sort of like once that cancer label is put on there we are obligated to behave

in a certain way, and its driven by physician beliefs and patient beliefs and

frequently they don't have anything to do with reality. And they are only

worrisome because the pathologist has decided to call it a cancer.”

I think it is very

important for all newly diagnosed men to understand this and to make sure that

when they make their decision as to which treatment to choose they make this in

the full knowledge of the alternatives.

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 Shuey

Sent: Thursday, 16 August 2007

11:25 AM

To: ProstateCancerSupport

Subject:

Re: New Member - Active Surveillance or Immediate Action?

> I have had a biopsy that showed cancer in only of 12 samples -

should I opt

It depends on your Gleason & /or staging.

Mine was only in one of 12 (1 of 24 if you count both biopsies I

had). Plus it was estimated at only 2mm. But it was a 3+4 Gleason,

and not far from the capsule, so I have opted to attack it.

The only good cancer is a dead cancer.

[Guest guest]

Terry...

You are absolutely right, of course.

The only problem is that, as of today, we have no way to know for sure

which " cancer " is slow-growing and which will metastasize rapidly

until it has started to happen.

It would be great if a pathologist could look at the DNA of a tumor

and say either " Don't worry " or " Get at it now " . But we ain't there

yet and, for me, prudence is the better part of valor.

[Guest guest]

Not to take isue with , (and he is right about not knowing until

it has started to happen) but the Gleason grade and PSA " velocity "

(rate of increase or " doubling " ) are pretty good indicators as to

when a more aggressive cancer is attacking, and that we need to take

action sooner rather than later. For instance GS 7 or greater; PSA

going from 4 to 5 in less than a year (as mine did) - means you have

time to do your research, but you should think seriously about

treatment. A PSA of 10 or higher and/or Gleason of 8 or more means

that there is a fairly aggressive attack. You don't want to chance

having the PCa Beast escape and metastasize if it has not. Of course,

one never really knows about the microscopic PCa cells, and once we

are diagnosed, life as we know it has changed.

Fuller

>

> Terry...

>

> You are absolutely right, of course.

>

> The only problem is that, as of today, we have no way to know for

sure

> which " cancer " is slow-growing and which will metastasize rapidly

> until it has started to happen.

>

> It would be great if a pathologist could look at the DNA of a tumor

> and say either " Don't worry " or " Get at it now " . But we ain't

there

> yet and, for me, prudence is the better part of valor.

>

[Guest guest]

,

I doubt very much that we will EVER be in

the position that we can say with any absolute certainty that this disease will

progress and that one will not. I do believe that there will be an improvement

in the reduction of uncertainty.

Although any forecast made at present will

of necessity be uncertain, there are more tests than the “standard”

ones used again and again to make a hurried decision – a single elevated

PSA and a biopsy with minimal positive material which, although now scored as

a Gleason 7 would not have been so graded ten years ago, followed by useless

but expensive scans.

What should be done is a variety of tests

that are currently available, including something as simple as tracking PSA

results for some time. The preliminary study reports indicate no danger in

doing this in suitable cases. Yet a report I read said that the normal time from

diagnosis to prostatectomy in the US was six weeks. Hardly time to

really assess the risks and rewards of all the treatment choices available.

I also seem to recall Scardino saying that

it was possible to assess potential for aggressiveness in about 90% of cases. I

can’t track the piece, but if I can I’ll post it.

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 Shuey

Sent: Thursday, 16 August 2007

9:39 PM

To: ProstateCancerSupport

Subject:

Re: New Member - Active Surveillance or Immediate Action?

Terry...

You are absolutely right, of course.

The only problem is that, as of today, we have no way to know for sure

which " cancer " is slow-growing and which will metastasize rapidly

until it has started to happen.

It would be great if a pathologist could look at the DNA of a tumor

and say either " Don't worry " or " Get at it now " . But we

ain't there

yet and, for me, prudence is the better part of valor.

[Guest guest]

may inadvertenly be promoting a misconception that is unfortunately all too common among recently diagnosed patients and in advice from many urologists.

In absolute terms, it is true that there is not way "for sure" to guarantee a cancer is indolent. Similarly, and perhaps more probably based on published research to date, there is not way to know "for sure" that any type of cancer treatment will not fail with recurrence of the prostate cancer.

Those clinics and institutions following men on Active Surveillance have demonstrated track records that delaying treatment during appropriate monitoring has a very low risk that the cancer will metastasize before treatment is indicated. Once a man on appropriately monitored Active Surveillance does have treatment, the studies to date show that the odds of recurrence are no greater than if he had treatment immediately. For example, in the Files section of this support group see the pdf files "Insights AS article" and the two "European Reports".

No, Active Surveillance is not treatment. However, for those cases meeting the rather strict criteria for consideration, Active Surveillance does provide an extended window of no occurence of the side effects probable with any type of treatment. See in the Files section of this support group "Active Surveillance Ctiteria.pdf" and "Predicting indolent cancer".

The final decisions each of us make to deal with our prostate cancers are very personal, and must be based on our individual concerns, life styles and goals. There is no treatment or approach, no matter what some might suggest, that 'fit all.' Hopefully, men diagnosed with prostate cancer allow sufficient time before treatment to seek multiple sources of information to become educated on the implications of their own specific individual cases.

The Best to You and Yours!

Jon

>> Terry...> > You are absolutely right, of course.> > The only problem is that, as of today, we have no way to know for sure > which "cancer" is slow-growing and which will metastasize rapidly > until it has started to happen. > > It would be great if a pathologist could look at the DNA of a tumor > and say either "Don't worry" or "Get at it now". But we ain't there > yet and, for me, prudence is the better part of valor.>

[Guest guest]

I am not an expert and most of us are not. BUT I do have an opinion

(Like all of us ) For myself (right or wrong that, opinion thing) I

have opted for action! I had a biopsy July 11th that came back

positive 6 out of 12 all on the right side. The Gleason score for 4

was 6(3+3) and for 2 it was 3+4=7(a good 7) and they where + 80%

cores. I am 1 2 weeks shy of 50 and in good health plus I have Two

small kids one 15 and one 7. I also am not a good waiter (stuff like

this drives me up a wall) I know that it is not a fix all and there

will be issues to deal with post-op. These are all things that each

of us look at. I chose to have a RP using the DeVinci. We will do

it 9/12/2007. I hope that you will find the path can live with.

What I know from the short time that I have dealt with this is that

we all have an opinion. Most of all I wish you well, and from one

Newbe to another good Luck. Jody

>

> Welcome to duckie196 pip7742@... who has joined the

> ProstateCancerSupport group and says:

>

>

>

> I have had a biopsy that showed cancer in only of 12 samples -

should I opt

> for treatment now or wait and see if my PSA goes up from 4.0?

>

>

>

> Sorry to hear of your diagnosis but welcome to the club you never

wanted to

> join. No doubt you're in a bit of a state of shock, and perhaps

feeling

> isolated. You'll find plenty of friendly folk on this List who will

do what

> they can to help you through.

>

>

>

> You might find it useful to visit YANA - You Are Not Alone Now

> www.yananow.net <http://www.yananow.net/> a site set up for newly

diagnosed

> people. The first section gives some basic information in plain

language

> with links to more complex and technical sites. The second section

of the

> site is where men are invited to tell their prostate cancer stories

and how

> they arrived at their decisions regarding treatment. Many people

have mailed

> to say how useful they have found this, especially because most of

the men

> are happy to respond to specific questions. The section of the site

can be

> found by clicking the link labelled Experiences or going to

> http://www.yananow.net/Experiences.html

>

>

>

> But in any event, please post some details of your diagnosis -

your Age,

> your PSAs leading up to the diagnosis, your Gleason Score and

Staging (these

> terms are all explained on the YANA site) and any questions you

might have.

> Just remember - there are no dumb questions. We all started off

where you

> are now, but we've collectively learned a lot over the years.

>

>

>

> From the little information you have given it seems that you might

have what

> is termed an insignificant tumour, often defined as being:

>

>

>

> 1. Nonpalpable

>

> 2. Stage T1c

>

> 3. Percent free PSA 15 or greater

>

> 4. Gleason less than 7

>

> 5. Less than three needle cores with none greater than 50% tumour.

>

>

>

> If this is so, and if you are temperamentally suited to the concept

of

> waiting to see if and when there are significant developments, you

might be

> interested in going to my website at

> http://www.prostatecancerwatchfulwaiting.co.za

> <http://www.prostatecancerwatchfulwaiting.co.za/> where there is

some

> information on the option known now as Active Surveillance. It

might also be

> of interest to click on the Files link at the foot of this mail and

read the

> Insights AS Article and the Criteria for AS.

>

>

>

>

>

>

>

> 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

>

[Guest guest]

provides an excellent example of a diagnosis that IS NOT appropriate for consideration of Active Surveillance: more then 2 positive cores, Gleason greater than 6, more than 50% of any core positive. Not much question that "action" was appropriate :-)

The guidelines for "considering" Active Surveillance-- i.e. seriously including Active Surveillance in your list of potential options to research when diagnosed with prostate cancer-- are outlined in the Files section in "ActiveSurveillanceCriterial.pdf". The list is a summary of the criteria used by major clinics worldwide, a bit more than "opinions".

The Best to You and Yours!

Jon

In a message dated 8/18/2007 2:52:23 A.M. Pacific Daylight Time, ProstateCancerSupport writes:

Re: New Member - Active Surveillance or Immediate Action?

Posted by: " Coker" jodycoker@... jodycoker

Fri Aug 17, 2007 5:34 pm (PST)

I am not an expert and most of us are not. BUT I do have an opinion (Like all of us ) For myself (right or wrong that, opinion thing) I have opted for action! I had a biopsy July 11th that came back positive 6 out of 12 all on the right side. The Gleason score for 4 was 6(3+3) and for 2 it was 3+4=7(a good 7) and they where + 80% cores.

Get a sneak peek of the all-new AOL.com.