Re: UroToday - Do Margins Matter The Prognostic Significance of Positive Surgical Margins in Radical Prostatectomy

[Guest guest]

I’m here to say that I found

it difficult to understand the significance of this post or who might

benefit from it. It seemed to say that positive surgical margins were associated

with a greater likelihood of disease progression, but didn’t we know

that? And didn’t we know that the

incidence of these positive margins increased with increasing PSA, pathologic

Gleason score and stage?

I went to the Abstract (first published

three years ago) which gave a little more information. Part of the Conclusions

of the study was:

<snip> While prostate cancer

screening strategies have resulted in a majority of men having organ confined

disease at RP, surgeons should continue to strive to reduce the rate of

positive surgical margins to improve cancer control outcomes. <snip>

Yes, and apple pie is very nice too.

What have I missed?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy Meade

Sent: Friday, 13 June 2008 10:45

PM

To: Kathy Meade

Subject:

UroToday - Do Margins Matter The Prognostic Significance of Positive Surgical

Margins in Radical Prostatectomy

Thursday, 12 June

2008

BERKELEY,

CA

(UroToday.com) - Positive surgical margins (PSM) are an adverse outcomes

variable in patients undergoing radical prostatectomy (RP) and is the one

variable that can be influenced by surgical technique. In the current

literature, studies evaluating the impact of a PSM often exclude the effect of

adjuvant therapy (AT), usually by excluding these patients. In a Journal of

Urology May 2008 supplement, an important paper by Dr. Swindle and associates

at Memorial

Sloan Kettering Cancer

Center

and Baylor College of Medicine is revisited regarding this issue. The study

used multiple methods of statistical analysis to account for the use of AT in a

series of 1,389 patients operated on by 2 surgeons.

The data

was analyzed by proportional hazards models and dealt with patients who

received AT in 5 ways; 1) exclusion. 2) inclusion (AT ignored), 3) censoring at

the time of AT, 4) failing at the time of AT, 5) considering AT as a time

dependent covariate. So this meant that the probability of recurrence was

analyzed by first excluding all patients who received AT from the analysis,

then by including those who received AT and ignoring the AT, then by censoring

those patients at the time of AT, and finally by considering AT as treatment

failure or recurrence.

A total

of 179 of the men had a PSM (12.9%). There was a median follow-up of 50 months

and biochemical recurrence was defined as a PSA >0.4ng/ml and reconfirmed on

a second PSA test. The incidence of PSM increased with increasing PSA,

pathologic Gleason score and stage. The overall progression-free survival

(PFS) for those with a PSM was 58%, compared with 81% for patients with

negative surgical margins. A PSM was a significant predictor of cancer

recurrence when analyzed by methods 1, 3, 4, and 5, but not method 2 in which

AT was ignored. Pretreatment PSA, pathologic stage and grade were all

independent predictors of progression in all 5 methods analyzed. A PSM was a

significant predictor of progression for all methods of analysis, except for

method 2. For patients with extra-capsular extension, a PSM was significant

using all methods of examining patients who received AT. However, this

decreased from 31.7% before 1990 to 11.1% after 2000. The year of surgery and

presence of organ confined cancer contributed to the decrease in PSM incidence.

These data are important as surgical techniques are again changing with the

advent of robotic assisted laparoscopic radical prostatectomy.

Swindle

P, Eastham JA, Ohori M, Kattan MW, Wheeler T, Maru N, Slawin K, Scardino PT

J Urol.

2008 May;179(5 Suppl):S47-51.

doi: 10.1016/j.juro.2008.03.137

PubMed

Abstract

PMID: 18405751

[Guest guest]

I’m here to say that I found

it difficult to understand the significance of this post or who might

benefit from it. It seemed to say that positive surgical margins were associated

with a greater likelihood of disease progression, but didn’t we know

that? And didn’t we know that the

incidence of these positive margins increased with increasing PSA, pathologic

Gleason score and stage?

I went to the Abstract (first published

three years ago) which gave a little more information. Part of the Conclusions

of the study was:

<snip> While prostate cancer

screening strategies have resulted in a majority of men having organ confined

disease at RP, surgeons should continue to strive to reduce the rate of

positive surgical margins to improve cancer control outcomes. <snip>

Yes, and apple pie is very nice too.

What have I missed?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy Meade

Sent: Friday, 13 June 2008 10:45

PM

To: Kathy Meade

Subject:

UroToday - Do Margins Matter The Prognostic Significance of Positive Surgical

Margins in Radical Prostatectomy

Thursday, 12 June

2008

BERKELEY,

CA

(UroToday.com) - Positive surgical margins (PSM) are an adverse outcomes

variable in patients undergoing radical prostatectomy (RP) and is the one

variable that can be influenced by surgical technique. In the current

literature, studies evaluating the impact of a PSM often exclude the effect of

adjuvant therapy (AT), usually by excluding these patients. In a Journal of

Urology May 2008 supplement, an important paper by Dr. Swindle and associates

at Memorial

Sloan Kettering Cancer

Center

and Baylor College of Medicine is revisited regarding this issue. The study

used multiple methods of statistical analysis to account for the use of AT in a

series of 1,389 patients operated on by 2 surgeons.

The data

was analyzed by proportional hazards models and dealt with patients who

received AT in 5 ways; 1) exclusion. 2) inclusion (AT ignored), 3) censoring at

the time of AT, 4) failing at the time of AT, 5) considering AT as a time

dependent covariate. So this meant that the probability of recurrence was

analyzed by first excluding all patients who received AT from the analysis,

then by including those who received AT and ignoring the AT, then by censoring

those patients at the time of AT, and finally by considering AT as treatment

failure or recurrence.

A total

of 179 of the men had a PSM (12.9%). There was a median follow-up of 50 months

and biochemical recurrence was defined as a PSA >0.4ng/ml and reconfirmed on

a second PSA test. The incidence of PSM increased with increasing PSA,

pathologic Gleason score and stage. The overall progression-free survival

(PFS) for those with a PSM was 58%, compared with 81% for patients with

negative surgical margins. A PSM was a significant predictor of cancer

recurrence when analyzed by methods 1, 3, 4, and 5, but not method 2 in which

AT was ignored. Pretreatment PSA, pathologic stage and grade were all

independent predictors of progression in all 5 methods analyzed. A PSM was a

significant predictor of progression for all methods of analysis, except for

method 2. For patients with extra-capsular extension, a PSM was significant

using all methods of examining patients who received AT. However, this

decreased from 31.7% before 1990 to 11.1% after 2000. The year of surgery and

presence of organ confined cancer contributed to the decrease in PSM incidence.

These data are important as surgical techniques are again changing with the

advent of robotic assisted laparoscopic radical prostatectomy.

Swindle

P, Eastham JA, Ohori M, Kattan MW, Wheeler T, Maru N, Slawin K, Scardino PT

J Urol.

2008 May;179(5 Suppl):S47-51.

doi: 10.1016/j.juro.2008.03.137

PubMed

Abstract

PMID: 18405751

[Guest guest]

I find this conflicting. I asked why my husbands PSA

level was only 1.7 with cancer found and was told by

both the surgeon and the radiologist that because the

cancer is so close to the margin it can give off a

lower PSA.

Gail

--- Terry Herbert wrote:

> I'm here to say that I found it difficult to

> understand the significance of

> this post or who might benefit from it. It seemed to

> say that positive

> surgical margins were associated with a greater

> likelihood of disease

> progression, but didn't we know that? And didn't we

> know that the incidence

> of these positive margins increased with increasing

> PSA, pathologic Gleason

> score and stage?

[Guest guest]

I find this conflicting. I asked why my husbands PSA

level was only 1.7 with cancer found and was told by

both the surgeon and the radiologist that because the

cancer is so close to the margin it can give off a

lower PSA.

Gail

--- Terry Herbert wrote:

> I'm here to say that I found it difficult to

> understand the significance of

> this post or who might benefit from it. It seemed to

> say that positive

> surgical margins were associated with a greater

> likelihood of disease

> progression, but didn't we know that? And didn't we

> know that the incidence

> of these positive margins increased with increasing

> PSA, pathologic Gleason

> score and stage?

[Guest guest]

On June 14, Gail replied to Terry:

> I find this conflicting. I asked why my husbands PSA

> level was only 1.7 with cancer found and was told by

> both the surgeon and the radiologist that because the

> cancer is so close to the margin it can give off a

> lower PSA.

That sounds unrealistic to this amateur.

What is/was Husband's Gleason score?

A substantial Gleason coupled with a low PSA may be a sign of small-cell

or neuroendocrine PCa, which requires aggressive treatment.

Blood tests which can help to assess this are:

CGA (chromogranin alpha), a neuroendocrine PCa marker

NSE (neuron-specific enolase), another neuroendocrine PCa marker

CEA (carcino-empbryonic antigen) which can be expressed by PCa that is

aggressive and often androgen-independent

Another useful test for such PCa is DNA ploidy examination of the biopsy

specimens. Bostwick Laboratories does this, perhaps others as well. The

pathologist searches for signs of " aneuploid " cells.

For more, see this section of the Prostate Cancer Research Institute

site:

http://prostate-cancer.org/education/riskases/Strum_StrategyOfSuccess1.html

or

http://tinyurl.com/m68qo

It would likely be prudent to consult a genuine cancer specialist, a

medical oncologist; preferably one who is well-educated in treatment of

PCa. There is a list of some experts in the field on the PCRI website.

Regards,

Steve J

[Guest guest]

On June 14, Gail replied to Terry:

> I find this conflicting. I asked why my husbands PSA

> level was only 1.7 with cancer found and was told by

> both the surgeon and the radiologist that because the

> cancer is so close to the margin it can give off a

> lower PSA.

That sounds unrealistic to this amateur.

What is/was Husband's Gleason score?

A substantial Gleason coupled with a low PSA may be a sign of small-cell

or neuroendocrine PCa, which requires aggressive treatment.

Blood tests which can help to assess this are:

CGA (chromogranin alpha), a neuroendocrine PCa marker

NSE (neuron-specific enolase), another neuroendocrine PCa marker

CEA (carcino-empbryonic antigen) which can be expressed by PCa that is

aggressive and often androgen-independent

Another useful test for such PCa is DNA ploidy examination of the biopsy

specimens. Bostwick Laboratories does this, perhaps others as well. The

pathologist searches for signs of " aneuploid " cells.

For more, see this section of the Prostate Cancer Research Institute

site:

http://prostate-cancer.org/education/riskases/Strum_StrategyOfSuccess1.html

or

http://tinyurl.com/m68qo

It would likely be prudent to consult a genuine cancer specialist, a

medical oncologist; preferably one who is well-educated in treatment of

PCa. There is a list of some experts in the field on the PCRI website.

Regards,

Steve J

[Guest guest]

He's Gleason is 6. Cancer found with DRE biopsy 3 out

of 8 adenocarcinoma 10% of one core small focus on the

other two, stains for RACEMASE are positive confirmed

by second opinion from Epstein.

Third pathology report being done at the hospital no

results on that yet. MRI to be done on Monday using 3

Tesla MRI machine, Ultrasound on Tuesday.

Gail

--- Steve Jordan wrote:

> On June 14, Gail replied to Terry:

>

> > I find this conflicting. I asked why my husbands

> PSA

> > level was only 1.7 with cancer found and was told

> by

> > both the surgeon and the radiologist that because

> the

> > cancer is so close to the margin it can give off a

> > lower PSA.

>

> That sounds unrealistic to this amateur.

>

> What is/was Husband's Gleason score?

>

> A substantial Gleason coupled with a low PSA may be

> a sign of small-cell

> or neuroendocrine PCa, which requires aggressive

> treatment.

>

> Blood tests which can help to assess this are:

>

> CGA (chromogranin alpha), a neuroendocrine PCa

> marker

> NSE (neuron-specific enolase), another

> neuroendocrine PCa marker

> CEA (carcino-empbryonic antigen) which can be

> expressed by PCa that is

> aggressive and often androgen-independent

>

> Another useful test for such PCa is DNA ploidy

> examination of the biopsy

> specimens. Bostwick Laboratories does this, perhaps

> others as well. The

> pathologist searches for signs of " aneuploid " cells.

>

> For more, see this section of the Prostate Cancer

> Research Institute

> site:

>

http://prostate-cancer.org/education/riskases/Strum_StrategyOfSuccess1.html

> or

> http://tinyurl.com/m68qo

>

> It would likely be prudent to consult a genuine

> cancer specialist, a

> medical oncologist; preferably one who is

> well-educated in treatment of

> PCa. There is a list of some experts in the field on

> the PCRI website.

>

> Regards,

>

> Steve J

>

>

>

>

[Guest guest]

He's Gleason is 6. Cancer found with DRE biopsy 3 out

of 8 adenocarcinoma 10% of one core small focus on the

other two, stains for RACEMASE are positive confirmed

by second opinion from Epstein.

Third pathology report being done at the hospital no

results on that yet. MRI to be done on Monday using 3

Tesla MRI machine, Ultrasound on Tuesday.

Gail

--- Steve Jordan wrote:

> On June 14, Gail replied to Terry:

>

> > I find this conflicting. I asked why my husbands

> PSA

> > level was only 1.7 with cancer found and was told

> by

> > both the surgeon and the radiologist that because

> the

> > cancer is so close to the margin it can give off a

> > lower PSA.

>

> That sounds unrealistic to this amateur.

>

> What is/was Husband's Gleason score?

>

> A substantial Gleason coupled with a low PSA may be

> a sign of small-cell

> or neuroendocrine PCa, which requires aggressive

> treatment.

>

> Blood tests which can help to assess this are:

>

> CGA (chromogranin alpha), a neuroendocrine PCa

> marker

> NSE (neuron-specific enolase), another

> neuroendocrine PCa marker

> CEA (carcino-empbryonic antigen) which can be

> expressed by PCa that is

> aggressive and often androgen-independent

>

> Another useful test for such PCa is DNA ploidy

> examination of the biopsy

> specimens. Bostwick Laboratories does this, perhaps

> others as well. The

> pathologist searches for signs of " aneuploid " cells.

>

> For more, see this section of the Prostate Cancer

> Research Institute

> site:

>

http://prostate-cancer.org/education/riskases/Strum_StrategyOfSuccess1.html

> or

> http://tinyurl.com/m68qo

>

> It would likely be prudent to consult a genuine

> cancer specialist, a

> medical oncologist; preferably one who is

> well-educated in treatment of

> PCa. There is a list of some experts in the field on

> the PCRI website.

>

> Regards,

>

> Steve J

>

>

>

>

[Guest guest]

gail:

Where is he taking the MRI using a 3.0 tesla machine? Is it MRI or MRIS? Who is paying for the MRI?

Very interested as I have been all over the place on these issues.

Dwight Black> On June 14, Gail replied to Terry:> > > I find this conflicting. I asked why my husbands> PSA> > level was only 1.7 with cancer found and was told> by> > both the surgeon and the radiologist that because> the> > cancer is so close to the margin it can give off a> > lower PSA.> > That sounds unrealistic to this amateur.> > What is/was

Husband's Gleason score?> > A substantial Gleason coupled with a low PSA may be> a sign of small-cell > or neuroendocrine PCa, which requires aggressive> treatment.> > Blood tests which can help to assess this are:> > CGA (chromogranin alpha), a neuroendocrine PCa> marker> NSE (neuron-specific enolase), another> neuroendocrine PCa marker> CEA (carcino-empbryonic antigen) which can be> expressed by PCa that is > aggressive and often androgen-independen t> > Another useful test for such PCa is DNA ploidy> examination of the biopsy > specimens. Bostwick Laboratories does this, perhaps> others as well. The > pathologist searches for signs of "aneuploid" cells.> > For more, see this section of the Prostate Cancer> Research Institute > site: >http://prostate- cancer.org/ education/ riskases/ Strum_StrategyOf Success1. html> or> http://tinyurl. com/m68qo> > It would likely be prudent to consult a genuine> cancer specialist, a > medical oncologist; preferably one who is> well-educated in treatment of > PCa. There is a list of some experts in the field on> the PCRI website.> > Regards,> > Steve J> > > >

[Guest guest]

gail:

Where is he taking the MRI using a 3.0 tesla machine? Is it MRI or MRIS? Who is paying for the MRI?

Very interested as I have been all over the place on these issues.

Dwight Black> On June 14, Gail replied to Terry:> > > I find this conflicting. I asked why my husbands> PSA> > level was only 1.7 with cancer found and was told> by> > both the surgeon and the radiologist that because> the> > cancer is so close to the margin it can give off a> > lower PSA.> > That sounds unrealistic to this amateur.> > What is/was

Husband's Gleason score?> > A substantial Gleason coupled with a low PSA may be> a sign of small-cell > or neuroendocrine PCa, which requires aggressive> treatment.> > Blood tests which can help to assess this are:> > CGA (chromogranin alpha), a neuroendocrine PCa> marker> NSE (neuron-specific enolase), another> neuroendocrine PCa marker> CEA (carcino-empbryonic antigen) which can be> expressed by PCa that is > aggressive and often androgen-independen t> > Another useful test for such PCa is DNA ploidy> examination of the biopsy > specimens. Bostwick Laboratories does this, perhaps> others as well. The > pathologist searches for signs of "aneuploid" cells.> > For more, see this section of the Prostate Cancer> Research Institute > site: >http://prostate- cancer.org/ education/ riskases/ Strum_StrategyOf Success1. html> or> http://tinyurl. com/m68qo> > It would likely be prudent to consult a genuine> cancer specialist, a > medical oncologist; preferably one who is> well-educated in treatment of > PCa. There is a list of some experts in the field on> the PCRI website.> > Regards,> > Steve J> > > >

[Guest guest]

We are in CT. Insurance covers it Blue Cross Blue

Shield National. Here's the link of where he is going.

http://www.srhs.org/betterhealth_story.asp?StoryID=433

Gail

--- dwight black wrote:

> & nbsp;

> & nbsp;

> & nbsp;

> gail:

> & nbsp;

> Where is he taking the MRI using a 3.0 tesla

> machine? Is it MRI or MRIS? Who is paying for the

> MRI?

> & nbsp;

> Very interested as I have been all over the place on

> these issues.

> & nbsp;

> Dwight Black

>

>

>

> & gt; On June 14, Gail replied to Terry:

> & gt;

> & gt; & gt; I find this conflicting. I asked why my

> husbands

> & gt; PSA

> & gt; & gt; level was only 1.7 with cancer found and

> was told

> & gt; by

> & gt; & gt; both the surgeon and the radiologist that

> because

> & gt; the

> & gt; & gt; cancer is so close to the margin it can

> give off a

> & gt; & gt; lower PSA.

> & gt;

> & gt; That sounds unrealistic to this amateur.

> & gt;

> & gt; What is/was Husband's Gleason score?

> & gt;

> & gt; A substantial Gleason coupled with a low PSA

> may be

> & gt; a sign of small-cell

> & gt; or neuroendocrine PCa, which requires

> aggressive

> & gt; treatment.

> & gt;

> & gt; Blood tests which can help to assess this are:

> & gt;

> & gt; CGA (chromogranin alpha), a neuroendocrine PCa

> & gt; marker

> & gt; NSE (neuron-specific enolase), another

> & gt; neuroendocrine PCa marker

> & gt; CEA (carcino-empbryonic antigen) which can be

> & gt; expressed by PCa that is

> & gt; aggressive and often androgen-independen t

> & gt;

> & gt; Another useful test for such PCa is DNA ploidy

> & gt; examination of the biopsy

> & gt; specimens. Bostwick Laboratories does this,

> perhaps

> & gt; others as well. The

> & gt; pathologist searches for signs of " aneuploid "

> cells.

> & gt;

> & gt; For more, see this section of the Prostate

> Cancer

> & gt; Research Institute

> & gt; site:

> & gt;

> http://prostate- cancer.org/ education/ riskases/

> Strum_StrategyOf Success1. html

> & gt; or

> & gt; http://tinyurl. com/m68qo

> & gt;

> & gt; It would likely be prudent to consult a genuine

> & gt; cancer specialist, a

> & gt; medical oncologist; preferably one who is

> & gt; well-educated in treatment of

> & gt; PCa. There is a list of some experts in the

> field on

> & gt; the PCRI website.

> & gt;

> & gt; Regards,

> & gt;

> & gt; Steve J

> & gt;

> & gt;

> & gt;

> & gt;

>

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

We are in CT. Insurance covers it Blue Cross Blue

Shield National. Here's the link of where he is going.

http://www.srhs.org/betterhealth_story.asp?StoryID=433

Gail

--- dwight black wrote:

> & nbsp;

> & nbsp;

> & nbsp;

> gail:

> & nbsp;

> Where is he taking the MRI using a 3.0 tesla

> machine? Is it MRI or MRIS? Who is paying for the

> MRI?

> & nbsp;

> Very interested as I have been all over the place on

> these issues.

> & nbsp;

> Dwight Black

>

>

>

> & gt; On June 14, Gail replied to Terry:

> & gt;

> & gt; & gt; I find this conflicting. I asked why my

> husbands

> & gt; PSA

> & gt; & gt; level was only 1.7 with cancer found and

> was told

> & gt; by

> & gt; & gt; both the surgeon and the radiologist that

> because

> & gt; the

> & gt; & gt; cancer is so close to the margin it can

> give off a

> & gt; & gt; lower PSA.

> & gt;

> & gt; That sounds unrealistic to this amateur.

> & gt;

> & gt; What is/was Husband's Gleason score?

> & gt;

> & gt; A substantial Gleason coupled with a low PSA

> may be

> & gt; a sign of small-cell

> & gt; or neuroendocrine PCa, which requires

> aggressive

> & gt; treatment.

> & gt;

> & gt; Blood tests which can help to assess this are:

> & gt;

> & gt; CGA (chromogranin alpha), a neuroendocrine PCa

> & gt; marker

> & gt; NSE (neuron-specific enolase), another

> & gt; neuroendocrine PCa marker

> & gt; CEA (carcino-empbryonic antigen) which can be

> & gt; expressed by PCa that is

> & gt; aggressive and often androgen-independen t

> & gt;

> & gt; Another useful test for such PCa is DNA ploidy

> & gt; examination of the biopsy

> & gt; specimens. Bostwick Laboratories does this,

> perhaps

> & gt; others as well. The

> & gt; pathologist searches for signs of " aneuploid "

> cells.

> & gt;

> & gt; For more, see this section of the Prostate

> Cancer

> & gt; Research Institute

> & gt; site:

> & gt;

> http://prostate- cancer.org/ education/ riskases/

> Strum_StrategyOf Success1. html

> & gt; or

> & gt; http://tinyurl. com/m68qo

> & gt;

> & gt; It would likely be prudent to consult a genuine

> & gt; cancer specialist, a

> & gt; medical oncologist; preferably one who is

> & gt; well-educated in treatment of

> & gt; PCa. There is a list of some experts in the

> field on

> & gt; the PCRI website.

> & gt;

> & gt; Regards,

> & gt;

> & gt; Steve J

> & gt;

> & gt;

> & gt;

> & gt;

>

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Dwight,

What problem are you having? Finding the machine or getting it paid

for?

Gail

>

> & gt; On June 14, Gail replied to Terry:

> & gt;

> & gt; & gt; I find this conflicting. I asked why my husbands

> & gt; PSA

> & gt; & gt; level was only 1.7 with cancer found and was told

> & gt; by

> & gt; & gt; both the surgeon and the radiologist that because

> & gt; the

> & gt; & gt; cancer is so close to the margin it can give off a

> & gt; & gt; lower PSA.

> & gt;

> & gt; That sounds unrealistic to this amateur.

> & gt;

> & gt; What is/was Husband's Gleason score?

> & gt;

> & gt; A substantial Gleason coupled with a low PSA may be

> & gt; a sign of small-cell

> & gt; or neuroendocrine PCa, which requires aggressive

> & gt; treatment.

> & gt;

> & gt; Blood tests which can help to assess this are:

> & gt;

> & gt; CGA (chromogranin alpha), a neuroendocrine PCa

> & gt; marker

> & gt; NSE (neuron-specific enolase), another

> & gt; neuroendocrine PCa marker

> & gt; CEA (carcino-empbryonic antigen) which can be

> & gt; expressed by PCa that is

> & gt; aggressive and often androgen-independen t

> & gt;

> & gt; Another useful test for such PCa is DNA ploidy

> & gt; examination of the biopsy

> & gt; specimens. Bostwick Laboratories does this, perhaps

> & gt; others as well. The

> & gt; pathologist searches for signs of " aneuploid " cells.

> & gt;

> & gt; For more, see this section of the Prostate Cancer

> & gt; Research Institute

> & gt; site:

> & gt;

> http://prostate- cancer.org/ education/ riskases/ Strum_StrategyOf

Success1. html

> & gt; or

> & gt; http://tinyurl. com/m68qo

> & gt;

> & gt; It would likely be prudent to consult a genuine

> & gt; cancer specialist, a

> & gt; medical oncologist; preferably one who is

> & gt; well-educated in treatment of

> & gt; PCa. There is a list of some experts in the field on

> & gt; the PCRI website.

> & gt;

> & gt; Regards,

> & gt;

> & gt; Steve J

> & gt;

> & gt;

> & gt;

> & gt;

>